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Challenge: Fertility in a patient with previous pelvic irradiation.

Background:

 With improved RT and chemotherapy techniques there is a significant increase in childhood cancer survival rates.

 The impact of radiation therapy on fertility depends on radiation dosage, age at the time of radiation exposure and extent of radiation field treatment.

 Ovarian dysfunction can manifest as premature ovarian failure or diminished ovarian reserve.

 Uterine dysfunction can present as reduction in uterine volume, endometrial thickness, uterine blood flow or distensibility.

 Pelvic irradiation increases the risk of pregnancy‐related complications, including spontaneous miscarriages, preterm labor and delivery, low birth weight infants and placental abnormalities (placenta accreta and percreta).

Prevention and management options:

 Ovarian transposition and other fertility preservation techniques such as gonadal shielding, donor oocytes and gestational surrogacy, embryo, oocyte or ovarian tissue cryopreservation may be useful.

 There have been no live births reported in patients with prepubertal pelvic irradiation. Postpubertal pelvic irradiation patients have had live births.