Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 177

Fertility potential relates to the total number and quality of oocytes in the primordial follicles in the ovary, and the ability of those follicles to respond to stimulation from the pituitary or exogenous hormonal stimulation. Chemotherapeutic agents act on the ovary directly by inducing apoptotic cell death and accelerated loss of primordial follicles, as well as indirectly by effects of reduced vascularity and fibrosis. Loss of follicles results in a decreased ovarian reserve and, if severe, in premature ovarian failure. The degree and rate of loss of follicles will determine whether ovarian failure is immediate or delayed, and whether temporary or permanent. Reversible amenorrhea results when only maturing follicles are destroyed; premature ovarian failure will result when all of the primordial follicles are destroyed.

The important predictors for women who will ultimately experience chemotherapy‐induced ovarian failure are: age of the woman, her ovarian reserve at the time of treatment, the type of chemotherapeutic agent used, the dose and duration of chemotherapy [4]. The risk of infertility increases in women over the age of 30 as there is a concomitant natural age‐related decline in ovarian reserve.

Early stage lymphoma treated with ABVD regimens has been shown to have a successful treatment outcome, and with similar birth rates compared to the general population [5–7]. However, regimens such as FEC (5‐fluorouracil, epirubicin, cyclophosphamide) administered for breast cancer, and BEACOPP for relapsed or refractory cases of HL contain the alkylating agent cyclophosphamide which carries a much higher risk of infertility [8,9].