Female Fertility Potential and Cancer Treatment

The effect of either chemotherapy or radiation on female fertility pertains to the accelerated depletion of the primordial germ cell pool resulting from these treatments. Those chemotherapy regimens containing alkylating agents, such as cyclophamide, are not specific to any stage of cell development and are the most deleterious to the ovarian oocyte reserve. The impact of these regimens is inversely related to the age of the patient.

Women over the age of 40 years will have a 90% chance of amenorrhea subsequent to multi-agent chemotherapy, whereas the potential for amenorrhea in younger patients varies between 40-55%.ALL PATIENTS who have undergone chemotherapy will have a diminished ovarian reserve and; therefore, potential infertility with a significant predisposition for developing premature ovarian failure.

Breast cancer is the most common indication for fertility preservation in the U.S. Approximately 25% of breast cancer patients are premenopausal and 10-20% of newly diagnosed breast cancer cases occur in women of childbearing age. The typical time course between surgical treatment for invasive breast cancer and the initiation of chemotherapy is 6 to 8 weeks. This time interval lends itself well to the completion of controlled ovarian hyperstimulation, oocyte retrieval and in vitro fertilization with embryo cryopreservation. The average time for surgery to cryopreservation is two to three weeks, having minimal to NO IMPACT on any potential delay in beginning chemotherapy.

If you or someone you know of childbearing age (including teenagers) is facing cancer treatment, please have them contact MCRM Fertility, immediately, at 844-41-4BABY to request a consultation. Be sure to let the MCRM Fertility staff know you are contacting us regarding Fertility Preservation for cancer care . This will allow us to expedite your process.

Risks of Permanent Amenorrhea in Women Treated with Modern Chemotherapy & Radiotherapy

HIGH RISK (>70%)
  • Any alklating agent* + total body irradiation
    *e.g., busulfan, cyclophosphamide, ifosfamide, lomustine, melphalan, procarbazine
  • Any alkylationg agent* + pelvic radiation
  • Total cyclophosphamide
  • Protocols containing procarbazine: MOPP, BEACOPP
  • Protocols containing temozolomide or BCNU + cranial radiation
  • Whole Abdominal or pelvic raditation doses
  • Total Body Irradiation (TBI) doses
  • Cranial Radiation
  • Total cycolphosphamide
  • AC for breast cancer
  • Monoclonal Antibodies (e.g., Bevacizumab(Avastin))
  • Protocols containing cisplatin
  • Abdominal/Pelvic radiation


LOW RISK (<30%)
  • Protocols containing nonalkylating agents or lower levels of aklylating agents
    (e.g., ABVD, CHOP, COP: multi-agent theapies for leukemia)
  • Protocols for breast cancer containing cyclophosphamide
    (e.g., CMF, CEF, or CAF)
  • Anthracycline + cytarabine
  • Multi-agent therapies using vincristine
  • Radioactive iodine
  • Monoclonal antibodies
    (e.g., Cetuximab (Erbitux), Trastuzamab (Herceptin))
  • Tyrosine kinase inhibitors
  • (e.g., Erlotinib (Tarceva), Imatinib (Glevvec))