Chemotherapy and radiation treatments for cancer or other conditions can cause permanent infertility. The effects of therapy on fertility are drug and dose dependent. Alkylating drugs (e.g., busulfan and cyclophosphamide), whole body radiation and radiation to the gonads are particularly damaging to fertility.
To aid in counseling patients about the reproductive risk of their treatment we use the Cyclophosphamide Equivalent Dose (CED) calculator described by Dan Green and his colleagues at St. Jude Children’s Research Hospital and the Childhood Cancer Survivor Survey (Green et al., 2014). The Fertility Preservation Program in Pittsburgh considers a CED of 4000 mg/m^2 to be associated with a significant risk of infertility.
Radiation treatments, Cisplatin, and Carboplatin doses associated with infertility are listed in a table at the bottom of the page.
|Total body irradiation (TBI)||All doses|
|Testicular radiation||> 2.5 Gy in men|
|> 6 Gy in boys|
|Whole abdominal or pelvic radiation||> 6 Gy in adult women|
|> 10 Gy in post-pubertal girls|
|> 15 Gy in pre-pubertal girls|
- Green DM, et al. (2014) The cyclophosphamide equivalent dose as an approach for quantifying alkylating agent exposure: a report from the Childhood Cancer Survivor Study. Pediatric Blood & Cancer 61(1):53-67.
Cisplatin and Carboplatin Doses
|Carboplatin||≥ 2000 mg/m2 for patients with ovaries|
|Cisplatin||≥ 500 mg/m2 for patients with ovaries|
|≥ 500 mg/m2 for patients with testes|
- Lambertini M, et al. (2016) Cancer and fertility preservation: international recommendations from an expert meeting. BMC Medicine. 14:1
- Reinmuth S, et al. (2013) Impact of chemotherapy and radiotherapy in childhood on fertility in adulthood: the feCt-survey of childhood cancer survivors in Germany. J Cancer Res Clin Oncol. 139(12):2071-8.