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What factors contribute to impaired spermatogenesis?
Risk for permanent infertility is associated with radiotherapy
• Exposing testes at any dose
• Especially doses >2-3 Gy
• Especially TBI (level C)
There is no evidence of • Safe irradiation dose
Skinner et al. Lancet Oncol 2017; 18: e75–90
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Who are at risk of subfertility?
• Spinal tumors, CNS leukemia, pelvic sarcomas, testicular leukemia
‒ Localized pelvic, spinal or testicular radiotherapy
• Relapsed and resistant hematological malignancies
‒ Total body irradiation before HSCT
• Relapsed and resistant hematological malignancies, myelodysplastic syndrome, bone marrow failure, and hemoglobinopathies
‒ Preconditioning chemotherapy before HSCT with alkylating agents
• Hodgkin disease not responding standard therapy, metastatic sarcoma
‒ High dose alkylating agent based therapies
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