I would like to get pregnant, but I am not sure if I will be able to since I went through chemotherapy (CAF). Who should I see to find out, and what would they do?

J.J.

Chemotherapy often results in irreversible infertility by damaging or destroying the eggs and the surrounding cumulus cells. The likelihood of this occurrence is related to the types of drugs used, interactions between the combinations of drugs, the doses chosen and the duration of therapy. Early studies suggested that suppressing the ovaries with a GnRH-agonist such as Lupron may provide protection. However, this has not been found to be the case.

Research on ovarian tissue cryopreservation, now under way, may someday allow us to surgically remove a portion of the ovary before chemotherapy and use it after chemotherapy is completed. From strips of ovarian tissue, we could culture immature eggs, which could be fertilized in the laboratory setting. Unfortunately, this option is not yet available on a routine basis.

For now, a simple blood test of your FSH level will enable your physician to determine whether your ovaries are still functional. If your FSH is elevated, you may need to consider the use of egg donation to achieve a pregnancy. One word of caution, though: While a high FSH level indicates a loss of ovarian function, some women experience a return of normal ovarian function during the first year or so after chemotherapy.

Patients who are about to embark on chemotherapy should discuss their drug treatment regimen with their oncologist to explore the risk of ovarian failure. The oncologist might be able to recommend an alternative therapy that may be less likely to destroy ovarian function.