Side effects of radiotherapy on fertility

Side Effects of Radiotherapy on Fertility

Radiotherapy, also known as radiation therapy, is a common treatment for various types of cancer. It uses high doses of radiation to kill cancer cells and shrink tumors. While it is an effective treatment method, radiotherapy can have several side effects, including effects on fertility. This article discusses the impact of radiotherapy on fertility in both men and women, the mechanisms behind these effects, and potential measures to preserve fertility.

Effects on Male Fertility

In men, radiotherapy can affect fertility by damaging the testes, where sperm is produced. The extent of the damage depends on the dose of radiation and the proximity of the treatment area to the testes. Even when the testes are not directly targeted, scattered radiation can still reach them and cause harm.

Spermatogenesis

Spermatogenesis, the process of sperm production, is highly sensitive to radiation. Doses as low as 0.1 Gy can reduce sperm count, and higher doses can lead to temporary or permanent azoospermia (absence of sperm in semen). Recovery of spermatogenesis may take years and is not guaranteed, especially after high doses.

Hormonal Effects

Radiation can also affect the Leydig cells, which are responsible for testosterone production. However, these cells are more resistant to radiation, and significant hormonal imbalances are less common.

Effects on Female Fertility

In women, radiotherapy can harm the ovaries, affecting both the quantity and quality of oocytes (egg cells). The impact on fertility depends on the woman's age, the radiation dose, and the area being treated.

Ovarian Function

The ovaries are highly sensitive to radiation. Doses above 2 Gy can cause immediate ovarian failure in women, leading to menopause. Younger women have a higher number of oocytes and may tolerate higher doses before experiencing ovarian failure, but the risk remains significant.

Uterine Effects

Radiation can also affect the uterus, making it less capable of supporting a pregnancy. This can lead to an increased risk of miscarriage, preterm birth, and low birth weight.

Preservation of Fertility

Given the potential impact of radiotherapy on fertility, patients of reproductive age should discuss fertility preservation options with their healthcare provider before starting treatment.

For Men

Options for men include sperm banking, where sperm is collected and frozen for future use. Testicular shielding during radiotherapy can also protect the testes from radiation exposure.

For Women

Women may consider oocyte or embryo cryopreservation, where eggs or embryos are frozen for future use. Another option is ovarian transposition (oophoropexy), a surgical procedure that moves the ovaries out of the radiation field.

Conclusion

Radiotherapy is a vital treatment for cancer but can have significant side effects on fertility. Understanding these risks and discussing fertility preservation options with a healthcare provider are crucial steps for patients of reproductive age undergoing radiotherapy.