اختلال باروری در رادیوتراپی  Fertility impairment in radiotherapy

Introduction It is estimated that in 2010 more than 1.5 million people was diagnosed with neoplastic disease, 10% of whom were younger than 45 years. Retaining fertility and having children is an important aspect of life and antineoplastic therapy for these people [1]. It is estimated that 3/4 of people below the age of 35 who were diagnosed with neoplastic disease and treated during childhood will want to have children. Approximately 81% of adolescent girls and 93% of their parents are interested in their children’s fertility preservation during antineoplastic therapy [1]. It is estimated that 45% of physicians do not discuss the issue of fertility preservation and do not suggest appropriate consultations before starting antineoplastic therapy [1, 2]. Therapeutic methods used in antineoplastic treatment cause fertility impairment or sterilization due to permanent damage to reproductive cells [1]. The risk of sterilization depends on patient’s age during therapy, type of neoplasm, radiation dose and treatment area. It is known that systemic treatment and radiotherapy can lead to fertility impairment and the combination of these two gives an additive effect [1, 3]. Radiotherapy can cause pituitary dysfunction, leading indirectly to impairment of ovarian function, or result directly in inability to conceive and carry a pregnancy to full term [4]. The aim of this article is to raise the issue of infertility in these patients. It is of growing importance due to the increase in the number of children and young adults who underwent radiotherapy in the past. Still improving longterm results of these therapies mean that this issue must be addressed. Additionally, there is only a small number of studies concerning fertility impairment and radiotherapy, and their results are usually extrapolated from experimental studies or case reports.