Chemotherapy and Fertility in Patients With Lymphoma

Richard Anderson, PhD, the Elsie Inglis professor of Clinical Reproductive Science and deputy director at the Centre for Reproductive Health and The University of Edinburgh discusses the effects lymphoma treatments have on fertility.

According to Anderson, many chemotherapy treatments damage reproduction. Cytokine therapies are meant to kill growing cells, including the glowing follicles in the ovary. This can result in the loss of menstruation and the potential loss of fertility.

However, the primordial follicle pool is not clinically visible. According to Anderson, this means that short of looking at it under a microscope, there is no way to determine the number of eggs a woman has.

0:08 | Many chemotherapy treatments, damage female reproduction. The essence of it is that women are born with all the eggs they're ever going to have. They're all formed in fetal life. And so, you have this nonrenewable pool of primordial follicles, the non-growing follicles within the ovary, and over the course of reproductive life, they're progressively activated until ultimately, at the time of the menopause, there aren't any left. So, a lot of cytotoxic therapies will, by definition, are designed to kill growing cells, so that's particularly the growing follicles of the ovary. That will result in amenorrhea, loss of periods, and potential loss of fertility in women during treatment and a period of time afterwards. But the key thing is what's going on to the primordial follicle pool, because that will determine what potential there is for recovery, and how long that woman may have until her ultimate loss of fertility and menopause. The problem that we have in reproduction is that this primordial follicle pool is essentially invisible. You can only count those follicles by actually taking the ovary out and slicing it up, looking at it through a microscope in a lab, you can't do it clinically. The only tools we've got are things like having periods or not, or biochemically, things that reflect the growing follicle pool in the ovary. They are of course interrelated, but they don't directly tell us the number of eggs that that woman has at any time before, during or after treatments.