Therapy Insight: fertility in women after cancer treatment

Cancer is the second-commonest cause of death in women under 40 years of age in Western Europe and the US. The survival of cancer patients has, nevertheless, improved during the past two decades. During this period, and especially during the last decade, there have been ground-breaking advances in the optimization of the quality of life of patients treated for cancer, in particular by the development of fertility-enhancing and fertility-preserving procedures in young patients treated for cancer. Surgery, chemotherapy and radiation therapy affect the fertility potential of women in different ways. Surgery to remove the uterus and ovaries has a direct impact on fertility. Radiation therapy (external or brachytherapy) can affect ovarian and also uterine function. Different drugs used in chemotherapy can directly influence ovarian function. Some markers have now been evaluated that are predictive of the potential toxic injury to the gonads and uterus. Various procedures have been proposed to preserve the fertility potential in women before anticancer treatment begins or after the tumor is treated; however, such optimization of management should only be undertaken if it does not have a deleterious effect on the survival of the patient.