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Treatment Impact on Fertility

The first step to fertility preservation is assessing the risk of developing infertility secondary to planned cancer treatment.  Various cancer therapies and regimens can be classified based on their known infertility risk in women (amenorrhea), children, and men (prolonged azoospermia).  For patients who wish to attempt pregnancy, it is important to take into account the patient’s age when planning their cancer treatment.  Women who are over the age of 35 may have reduced fertility preservation options.

Infertility Risk Associated with Specific Cancer Treatments and Regimens


High RiskTotal body irradiation (TBI)
Whole abdominal or pelvic radiation doses >6 Gy in adult women, >10 Gy in post-pubertal girls, and >15 Gy in pre-pubertal girls
Testicular radiation dose >2.5 Gy in men, ≥3 Gy in boys
Cranial/brain irradiation >40 Gy
Spinal irradiation 24-36 Gy
CMF, CEF, or CAF x 6 cycles in women >40 years
Cyclophosphamide 5g / m2 in women >40 years, 7.5g / m2 in girls <20 years, >7.5g / m2 in men, and >7.5g / m2 in boys
Alkylating chemotherapy (e.g., cyclophosphamide, busulfan, melaphan) conditioning for transplant
Any alkylating agent (e.g., cyclophosphamide, ifosfamide, busulfan, BCNU [carmustine], CCNU [lomustine]) + TBI or pelvic radiation
Protocols containing procarbazine:  MOPP, MVPP, COPP, ChIVPP, ChIVPP/EVA, BEACOPP, MOPP/ABVD, COPP/ABVD
Surgical removal of one or both testicles or the pituitary gland.
Intermediate RiskWhole abdominal or pelvic radiation 5 to <10 Gy in post-pubertal girls, 10 to <15 Gy in pre-pubertal girls
Spinal radiation doses >25 Gy CMF, CEF, or CAF x 6 cycles in women 30-39 years, or 18-24 Gy in children
Adriamycin / cyclophosphamidel in women >40 years
Testicular radiation dose 1-6 Gy (due to scatter from abdominal / pelvic radiation) BEP x 2-4 cycles in men, or 1-2 Gy in boys
Cumulative cisplatin dose <400 mg / m2 in men and about 500 mg / m2 in boys
Cumulative carboplatin dose ≤2g / m2 in men
Hormone treatments in men (prostate cancer)
Surgical procedures within the pelvis (prostate, bladder, lower large intestine, rectum)
Surgical removal of an ovary
Low RiskTesticular radiation dose 0.2 – 0.7 Gy
CMF, CEF, or CAF x 6 cycles in women <30 years
Non-alkylating chemotherapy:  ABVD, CHOP, COP, OEPA, NOVP
Adriamycin / cyclophosphamidel in women 30-39 years and children
No RiskRadioactive iodine
Methotrexate / 5-fluorouracil
Testicular radiation dose <0.2 Gy
Unknown RiskPaclitaxel, docetaxel (taxanes used in Adriamycin / cyclophosphamidel protocols)
OEPAOncovin / etoposide / prednisone / adriamycin (doxorubicin)
CMFCyclophosphamide / methotrexate / fluorouracil
CEFCyclophosphamide / epirubicin / fluorouracil
CAFCyclophosphamide / adriamycin (doxorubicin) / fluorouracil
MOPPMechlorethamine / oncovin (vincristine) / procarbazine / prednisonel
MVPPMechlorethamine / vinblastine / procarbazine / prednisolonel
COPPCyclophosphamide / oncovin / procarbazine / prednisonel
ChIVPPChlorambucil / vinblastine / procarbazine / prednisolonel
EVAEtoposide / vinblastine / adriamycinl
BEACOPPBleomycin / etoposide / adriamycin / cyclophosphamide / oncovin / procarbazine / prednisonel
ABVDAdriamycin / bleomycin / vinblastine / dacarbazinel
CHOPCyclophosphamide / hydroxydaunomycin / oncovin / prednisonel
COPCyclophosphamide / oncovin / prednisonel


The information provided on the CKN website is designed to support, not replace, the relationship that exists between a patient and his/her physician.  CKN thanks the Oncofertility Consortiumfor providing content on this site. If you’d like more information, or to make a suggestion: Contact us.


This entry was posted in Medical Professionals, Oncofertility. Bookmark the permalink.

One Response to Treatment Impact on Fertility

  1. baker says:

    Thanks for finally writing about >Treatment Impact on Fertility –
    Cancer Knowledge Network <Loved it!

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