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Effet de la chimiothérapie sur la fonction testiculaire et ovarienne

Testicular and ovarian function after chemotherapy

Andrologie volume 6, pages 293–300 (1996)Cite this article

Resume

Les progrés en cancérologie permettent des guérisons fréquentes chez l’enfant et l’adulte jeune. L’oligo azoospermie et les troubles fonctionnels du spermatozoïde chez l’homme, l’aménorrhée et la ménopause précoce chez la femme sont fréquents et préserver la fertilité des patients doit être un soucis du thérapeute. Les alkylants sont fortement gonadotoxiques suivant une relation de dose-dépendance. D’autres drogues comme le cisplatine, les anthracyclines, les vincaalcaloïdes et les épipodophyllotoxines sont modérément gonadotoxiques tandis que les antimétabolites ont une toxicité gonadique mineure. La fertilité est plus altérée chez l’homme que chez la femme et diminue d’autant plus chez la femme qu’elle est proche de la ménopause. L’ovaire prépubertaire est moins sensible aux effets des chimiothérapies mais n’est pas totalement protégé. Aucune tératogénicité n’a pu être formellement attribuée à la chimiothérapie. Néanmoins une grossesse pendant une exposition à des agents cytotoxiques est fortement déconseillée et un délai de deux ans semble pouvoir être recommandé avant une conception.

Abstract

Recent advances in the treatment of cancer now permits long-term remissions and can cure a large amount of young. It is now well established that infertility and premature menopause are common consequences of successeful treatment. Much is known about the fertility and sexual effects of chemotherapy and allow development of new strategies to reduce infertilty. Alkylating agents are among the most commonly used chemotherapy agents and are for the most part highly gonadotoxic. Other drugs like cisplatin, vinca alkaloids, epipodophyllotoxins and antibiotics have moderate intrinsic toxicity whereas antimetabolites exert little if any toxic effect. Nevertheless, drugs are often used in combinations which are more toxic than single agents. Gonadal toxicity is usually dose dependant. Infertility is more frequent in males than in females and prepubertal girls have better prognosis though prepubertal ovaries are profoundly affected by chemotherapy. The onset of chemotherapy-related ovarian failure is age related but the risk of premature menopause still exists in women who recover menstrual cycles after amenorrhea. Fertility is usually worse after Hodgkin’s disease and testes cancer than after other cancers. No teratognesis in the offspring was published so far after chemotherapy. Nevertheless, men and women should be expressly discouraged from being party to a conception while they are receiving cancer therapy. Adults surviving to cancer should wait at least two years after completion of therapy before attempting parenthood.

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Authors and Affiliations

  1. Service d’Oncologie Médicale, CHRU Bretonneau, 2 boulevard Tonnellé, 37044, Tours Cedex

    C. Linassier & Ph. Colombat

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  1. C. Linassier
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  2. Ph. Colombat
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Note de la rédaction: Voir Andrologie, Vol. 5, no4, décembre 1995. Ce numéro est en grande partie consacré aux effets des traitements anti-cancéreux sur reproduction et sexualité.

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Linassier, C., Colombat, P. Effet de la chimiothérapie sur la fonction testiculaire et ovarienne. Androl. 6, 293–300 (1996). https://doi.org/10.1007/BF03035284

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  • DOI: https://doi.org/10.1007/BF03035284

Mots clés

  • grossesse
  • fertilité
  • chimiothérapie
  • cancer
  • leucémie

Key words

  • Testes
  • ovary
  • fertility
  • chemotherapy
  • cancer
  • leukemia

Basic and Clinical Andrology

ISSN: 2051-4190