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.

　　不孕不育通常与受疾病 症影响的组织或器官及特定治疗手段有关。手术及放疗会造成局部影响。而化疗对生育能力的影响则取决于化疗类型、用药剂量及是否与细胞毒性治疗结合。此外，年龄、或者遗传因素都会影响不孕不育危险 的高低。

　　Chemotherapy

　　化疗

　　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.

　　化疗会损耗卵巢中的卵泡储存[4]，严重程度取决于药物剂量、患者年龄以及患者使用细胞毒性物质的种类。相较于年轻的疾病 症患者，年龄较大的女性更有可能丧失卵巢功能。大多数化疗药物主要影响分化 中的细胞，如颗粒细胞及颖囊细胞。毒性的化疗药物是烷基化药物如环磷酰胺，可破坏原始卵泡[5]。尽管多数化疗药物是对分化 中的细胞产生危害，环磷酰胺并不仅仅针对特定细胞周期，还可能破坏休眠状态的原始卵泡。进一步降低卵巢保留的可能性[5]。由此导致的闭经可能是暂时的，也可能是长久的。证据显示，对发育中的卵泡进行破坏可导致暂时闭经，而对原始卵泡的破坏则会导致长久闭经[6]。根据化疗的本质及患者接受化疗的年龄，如果只是暂时卵泡损伤，化疗停止后，患者月经可不同程度恢复[7]。

　　男性患者不论处于哪个年龄段，睾丸对化疗带来的不利影响都非常敏感。生殖上皮比睾丸间质细胞更敏感，一旦化疗破坏了生殖上皮，即使睾酮持续生产，也会出现少精症和无精症。

　　参考文献：

　　4.Schilsky RL, Lewis BJ, Sherins RJ, Young RC. Gonadal dysfunction 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.