Reproductive potential in survivors of childhood malignancy.
The aggressive use of multiple therapeutic modalities has led to a significant increase in the number of survivors of childhood malignancy. These forms of cancer therapy have important effects on multiple organ systems. This review article evaluates the long-term effect of therapy on the reproductive potential of both boys and girls. While alkylating agents have been shown to cause a 50% reduction in the fertility potential of boys, they have almost no adverse effect in girls. Other chemotherapeutic agents and combinations of chemotherapeutic agents have also been shown to cause a greater reduction in the reproductive potential of girls than boys. Radiation produces severe dose-related gonadal damage in both boys and girls. The effect of Hodgkin's disease, leukemia and their therapies are evaluated. Despite the known mutagenic potential of some forms of cancer therapy there has not been an increased frequency of congenital abnormalities in the offspring of survivors of childhood cancer. The use of oophoropexy and other forms of prophylactic therapy to limit toxicity are also considered.