Radiotherapy, Female Fertility and Ootoxicity

Fertility is an important component of quality of life and oncological patients should be questioned about their expectations before treatment. Radiotherapy (RT) can adversely affect fertility irreversibly and progressively. Therefore, patients with expectation of fertility should be evaluated before RT and guided for appropriate interventions. Radiotherapy negatively affects fertility in many aspects. Cranial RT disrupts the hypothalamus-pituitary-ovarian (H-P-O) axis, pelvic RT directly affects the ovary and uterus. Because of the long latent period of endocrinopathies caused by cranial RT, these patients should be followed up for a long time. Due to dose-dependent uterine and ovarian toxicities that develop after abdominopelvic RT, patients are at high risk for infertility and pregnancy complications. Uterus and ovaries have different radiosensitivity depending on age. With aging, radiosensitivity of the uterus decreases, while radiosensitivity of the ovaries increase. Although there is no consensus on the threshold doses that can cause RT-related infertility, according to current data, the threshold value for the hypothalamo-pituitary axis is 30 Gy; 25 Gy for young women and 45 Gy for adult women for the uterus; 10 Gy for acute ovarian failure in the ovary and 25 Gy for premature ovarian failure under 35 years of age. There is no significant relationship between parental radiation exposure and inherited genetic disease in their infants.