The effects of cancer treatment on reproductive functions.

Approximately 11,000 adults in the age group 15–40 years are diagnosed with cancer each year in the UK. Although treatment and, where possible, cure are of paramount importance, the psychological effects of subsequent impairment of fertility or reproductive function, if this occurs, should not be underestimated. Remarkable advances have occurred in the management of cancer in the last 20 years with a marked increase in cure rates. This has been achieved at the expense of increasing exposure of these patients to treatment (eg adjuvant chemotherapy for breast cancer) and potentially gonadal toxicity. Meanwhile, very limited or no data are available on the risks of newer drugs, small molecules or antibodies in terms of gonadal toxicity. In a new intercollegiate report, representatives from the Royal Colleges of Physicians, Radiologists (RCR) and Obstetricians and Gynaecologists (RCOG) have combined to consider this important topic and make recommendations about patient management and funding of fertility services.1 The report incorporates sections on normal human reproductive physiology and the effects on this of chemotherapy and radiotherapy, with particular emphasis on those cancers which occur most commonly in young adults. The prevention and management of treatment-related gonadal toxicity are described in detail.