Impact of Systemic Anticancer Therapy on Fertility

Advances in cancer therapy have led to substantially improved cure rates and to an increasingly higher number of young cancer survivors. Corresponding with recent trends toward delayed childbearing age, many young women have not yet completed their family plans by the time of cancer diagnosis. One of the potential long-term consequences of systemic cancer therapy is early loss of ovarian function and fertility. Knowing the risks of impaired fertility that are associated with anticancer agents is therefore crucial for the optimal management of young women that wish to pursue family plans. Risk of ovarian failure associated with chemotherapy has been extensively investigated and wide variations were described according to type of agent and schedule, with risk reaching over 80% for agents such as cyclophosphamide and for combinations used for conditioning before bone marrow transplantation. Potential fertility harms of commonly administered endocrine treatments in premenopausal women such as tamoxifen have been linked both to direct drug-related ovarian function impairment and to forced postponement of time of conception due to potential teratogenicity of tamoxifen. Fewer data are available describing potential fertility harms of other anticancer agents. In this chapter, we review the impact of systemic anticancer therapy on fertility in women with cancer, including the use of specific chemotherapeutics, endocrine therapies, anti-HER2 treatments, and other novel targeted agents.