Gonadal Function and Fertility Preservation in Cancer Treatment

Cancer therapies such as chemotherapy, radiotherapy and certain targeted agents can impair gonadal function in both males and females, leading to reduced hormone production and compromised fertility. The gonads—ovaries in women and testes in men—are highly sensitive to DNA-damaging agents, which can deplete germ cells and disrupt endocrine signalling. In women, damage may manifest as diminished ovarian reserve, premature ovarian insufficiency or amenorrhoea. In men, gonadotoxic regimens may reduce sperm count, impair spermatogenesis and alter testosterone production. Fertility preservation strategies aim to safeguard reproductive potential without compromising oncological efficacy. Techniques include surgical approaches (for example ovarian transposition), pharmacological ovarian suppression and cryopreservation of gametes or gonadal tissue. Advances in hormone assays, imaging and minimally invasive surgery have expanded the options available to patients of reproductive age. Multidisciplinary collaboration among oncologists, reproductive specialists and endocrinologists is essential to tailor interventions according to patient age, cancer type, treatment urgency and individual reproductive goals. Patient counselling now routinely addresses the long-term quality-of-life implications of treatment, with early referral for fertility assessment and preservation planning embedded in clinical pathways. Emerging research is refining risk stratification for gonadal toxicity and exploring novel adjuvant agents to mitigate damage, while long-term follow-up studies are elucidating the success rates and safety of different preservation modalities across cancer types.

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Gonadal Function and Fertility Preservation in Cancer Treatment publication trend

The graph below shows the total number of articles in gonadal function and fertility preservation in cancer treatment across all publications each year (not limited to Nature Index journals).

Technical terms

Gonadal function: The combined endocrine and gametogenic activity of the ovaries or testes, encompassing hormone production and germ cell maturation.

Ovarian reserve: The quantity and quality of oocytes remaining in the ovary, often estimated by hormone assays and follicle counts.

Ovarian transposition: A surgical technique that repositions the ovaries outside the field of pelvic irradiation to reduce radiation exposure.

GnRH agonist: A synthetic analogue of gonadotropin-releasing hormone used to temporarily suppress ovarian function and possibly protect against chemotherapy-induced damage.

Anti-Müllerian hormone (AMH): A glycoprotein hormone secreted by ovarian follicles, serving as a biomarker of ovarian reserve.

Cryopreservation: The process of freezing sperm, oocytes or ovarian/testicular tissue at very low temperatures for future use in assisted reproduction.

References

1. Ovarian transposition in order to preserve fertility before irradiation in a young patient with cervical cancer. Romanian Medical Journal (2022).
2. Laparoscopic ovarian transposition in patients with pelvic cancer. Acta medica Lituanica (2014).
3. Leuprolide Acetate Treatment for Ovarian Cysts in Breast Cancer Patients Under Tamoxifen Therapy. Gynecology Obstetrics and Reproductive Medicine (2022).
4. Effects of Oral Supplementation with Myo-Inositol and D-Chiro-Inositol on Ovarian Functions in Female Long-Term Survivors of Lymphoma: Results from a Prospective Case–Control Analysis. Journal of Personalized Medicine (2022).