Fertility
Assessment of Fertility
Male Fertility:
History:
The patient may not know all the answers to the questions about therapy and usually the previous treatment records are an important source of this information.
- How old was the patient at the time of cancer treatment?
- What drugs did the patient receive?
- Start date
- Completion date
- number of cycles
- Total dose of drug
- Was any radiation given?
- Site of treatment
- Start date and finish date
- Total dose of RT/fractionation
- Was the chemotherapy given at the same time as the RT?
- Any surgery performed?
- Date
- Nature of operation
- Sexual function
Physical examination:
Investigations:
Leydig cell dysfunction:
- Decreased testosterone
- Elevated LH levels
Germinal dysfunction:
- Decreased testicular volume
- Elevated FSH
- Low sperm count (semen analysis)
Female Fertility
History:
The patient may not know all the answers to the questions about therapy and usually the previous treatment records are an important source of this information.
- How old was the patient at the time of cancer treatment?
- What drugs did the patient receive?
- Start date
- Completion date
- number of cycles
- Total dose of drug
- Was any radiation given?
- Site of treatment
- Start date and finish date
- Total dose of RT/fractionation
- Was the chemotherapy given at the same time as the RT?
- Any surgery performed?
- Date
- Nature of operation
- Failure to go into puberty or symptoms of menopause
- Date of menarche
- Menstrual cycle (regular/irregular)
Physical Examination:
Investigations:
Blood work:
In ovarian failure:
- Low estradiol levels
- Elevated serum gonadotrophin levels
- FSH (follicle stimulating hormone)
- LH (Luteinizing hormone)
Anti-Müllerian hormone (AMH) is a new marker for ovarian function:
- AMH is a marker for the size of the ovarian follicle pool
- Member of the transforming growth factor β family of growth and differentiation factors
- AMH has an inhibitory effect in the ovary on:
- Primordial follicle recruitment
- Responsiveness of growing follicles to follicle-stimulating hormone (FSH)
- AMH expression can first be observed in granulosa cells of primary follicles
- Expression is strongest in preantral and small antral follicles (≤ 4 mm).
- Expression disappears in follicles of increasing size and is almost lost in follicles larger than 8 mm
- Ovarian aging is associated with a decline in the size of the primordial follicle pool
- The number of primordial follicles is indirectly reflected by the number of growing follicles
- AMH is primarily secreted by growing follicles and levels reflect the size of the primordial follicle pool
- Ovary-specific expression pattern in granulosa cells of growing non-selected follicles makes AMH an ideal marker for the size of the ovarian follicle pool
