The risk of infertiliy is generally related to the tissues or organs iolved in the cancer and the specific treatment used. Surgery and radiotherapy (RT) have local effects. Chemotherapy affects fertility depending on the type, dose, and combination of cytotoxic therapy. In addition, age at treatment, gender, and likely genetic factors also influence the risk of infertility.

　　不孕不育通常與受疾病 癥影響的組織或器官及特定治療手段有關(guān)。手術(shù)及放療會造成局部影響。而化療對生育能力的影響則取決于化療類型、用藥劑量及是否與細(xì)胞毒性治療結(jié)合。此外，年齡、或者遺傳因素都會影響不孕不育危險 的高低。

　　Chemotherapy

　　化療

　　Chemotherapy causes depletion of the ovarian pool of follicles [4]. The severity of damage depends on the dose, age of the patient, and type of cytotoxic agent used. Increasing age makes women more vulnerable to loss of ovarian function compared with younger patients. Most chemotherapeutic drugs affect mainly the dividing cells such as granulosa and theca cells. The most cytotoxic agents are alkylating agents such as cyclophosphamide, which can destroy primordial follicles [5]. Although most chemotherapy agents target dividing cells, cyclophosphamide is not cell cycle specific and can therefore damage the resting primordial follicles, which compromises ovarian reserve [5]. Resulting amenorrhea may be temporary or permanent. It has been suggested that destruction of maturing follicles causes temporary amenorrhea while destruction of primordial follicles causes permanent amenorrhea [6]. Depending on the nature of chemotherapy and age at chemotherapy, menstrual function and fertility may return variably after the cessation of therapy in the case of temporary damage to the ovarian follicles [7].

　　The testis is very sensitive to the detrimental effects of chemotherapy at any age. The germinal epithelium is more sensitive than the Leydig cells, and therefore oligospermia and azoospermia occur even if testosterone production continues.

　　化療會損耗卵巢中的卵泡儲存[4]，嚴(yán)重程度取決于藥物劑量、患者年齡以及患者使用細(xì)胞毒性物質(zhì)的種類。相較于年輕的疾病 癥患者，年齡較大的女性更有可能喪失卵巢功能。大多數(shù)化療藥物主要影響分化 中的細(xì)胞，如顆粒細(xì)胞及穎囊細(xì)胞。毒性的化療藥物是烷基化藥物如環(huán)磷酰胺，可破壞原始卵泡[5]。盡管多數(shù)化療藥物是對分化 中的細(xì)胞產(chǎn)生危害，環(huán)磷酰胺并不僅僅針對特定細(xì)胞周期，還可能破壞休眠狀態(tài)的原始卵泡。進(jìn)一步降低卵巢保留的可能性[5]。由此導(dǎo)致的閉經(jīng)可能是暫時的，也可能是長久的。證據(jù)顯示，對發(fā)育中的卵泡進(jìn)行破壞可導(dǎo)致暫時閉經(jīng)，而對原始卵泡的破壞則會導(dǎo)致長久閉經(jīng)[6]。根據(jù)化療的本質(zhì)及患者接受化療的年齡，如果只是暫時卵泡損傷，化療停止后，患者月經(jīng)可不同程度恢復(fù)[7]。

　　男性患者不論處于哪個年齡段，睪丸對化療帶來的不利影響都非常敏感。生殖上皮比睪丸間質(zhì)細(xì)胞更敏感，一旦化療破壞了生殖上皮，即使睪酮持續(xù)生產(chǎn)，也會出現(xiàn)少精癥和無精癥。

　　參考文獻(xiàn)：

　　4.Schilsky RL, Lewis BJ, Sherins RJ, Young RC. Gonadal sfunction in patients receiving chemotherapy for cancer. Ann Intern Med 1980; 93: 109-114.

　　5.Nicosia SV, Matus-Ridley M, Meadows AT. Gonadal effects of cancer therapy in girls. Cancer 1985; 55: 2364-2372.

　　6.Falcone T, Attaran M, Bedaiwy MA, Goldberg JM. Ovarian function preservation in the cancer patient. Fertil Steril 2004; 81: 243-257.

　　7.Minisini AM, Menis J, Valent F, et al. Determits of recovery from amenorrhea in premenopausal breast cancer patients receiving adjuvant chemotherapy in the taxane era. Anticancer Drugs 2009; 20: 503-507.

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