Some chemotherapy medications destroy eggs which may lead to infertility after treatment. The greatest risk of infertility caused by chemotherapy is with alkylating agents, such as carmustine (BCNU, BiCNU, Bicnu, Gliadel), busulfan (Busulfex, Myleran), chlorambucil (Leukeran), cisplatin (Platinol), cyclophosphamide (Cytoxan, Neosar), cytarabine (ARA-C, Cytosar-U, DepoCyt), ifosfamide (IFEX), lomustine (CCNU, CeeNu), mechlorethamine (Mustargen, Nitrogen Mustard), melphalan (Alkeran, L-Pam), streptozocin (Zanosar), temozolomide, thiotepa (Thioplex) and vincristine. Other chemotherapy drugs, such as adriamycin (Doxorubicin, Rubex), procarbazine (Mutalane) and vinblastine (Velban), may also affect fertility. These drugs may be included in combination chemotherapy, such as MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) for Hodgkin's disease. Carboplatin has been found to be less toxic than cisplatin.
Radiation therapy to the pelvis or belly destroys eggs in a similar way to chemotherapy and may also damage the uterus, causing scarring. Women who receive high doses of radiation to the uterus will likely not be able to become pregnant. Women who receive lower doses of radiation are more likely to have a miscarriage or premature labor as their uterus may not be able to expand as the fetus grows.
Surgery or Radiation Therapy to the Brain
This may affect the brain’s pituitary gland that is responsible for releasing hormones that stimulate egg maturation and ovulation. However, this doesn’t damage the eggs in the ovaries, and medications that replace these hormones may allow the woman to become pregnant.
Types of Cancers
Surgery may require removal of the ovaries, uterus or testicles if that is where the cancer is located which directly impacts the physiology of fertility.