From the Guidelines
Women undergoing BEP chemotherapy face a relatively low risk of infertility, with reported rates ranging from 5% to 10%. This is based on the study by Solheim et al. cited in the 2018 Annals of Oncology guidelines 1, which found that the cumulative probability of achieving pregnancy after treatment was significantly higher in women who received no adjuvant treatment or no more than three cycles of cisplatin-based chemotherapy. The guidelines also note that the fertility outcome depends on age, with younger patients having a larger reserve of oocytes harvested after chemotherapy.
Key factors influencing fertility outcomes in women undergoing BEP chemotherapy include:
- Age: younger patients have better odds of preserving fertility
- Cumulative dose and duration of therapy: higher doses and longer treatment durations increase the risk of gonadal dysfunction
- Type of chemotherapy: cisplatin is viewed as moderately gonadotoxic, but the risk of infertility is still relatively low
The study cited in the guidelines 1 suggests that the risk of infertility in women undergoing BEP chemotherapy is relatively low, with reported rates comparable to those of age-matched women in the general population. Fertility preservation options, such as egg or embryo freezing, should still be discussed before starting treatment, especially for women over 30 or those receiving higher cumulative doses of cisplatin-based chemotherapy. Hormonal measurements, such as AMH and FSH, can help assess remaining fertility potential after completion of therapy.
From the FDA Drug Label
The effects of bleomycin on fertility have not been studied.
The FDA drug label does not answer the question.
From the Research
Infertility Rates in Women Undergoing BEP Chemotherapy
- The risk of infertility in women undergoing Bleomycin, Etoposide, and Cisplatin (BEP) chemotherapy is a significant concern, as chemotherapy can cause early ovarian follicle depletion and ovarian damage 2, 3.
- Studies have shown that the gonadotoxic effect of various chemotherapeutic agents, including BEP, can lead to infertility and premature menopause in young women 4, 5.
- However, one study found that 75% of women who attempted conception after undergoing fertility-sparing surgery and BEP chemotherapy for ovarian yolk sac tumor were able to achieve pregnancy 6.
- This suggests that while BEP chemotherapy can have a negative impact on fertility, some women may still be able to conceive after treatment.
- The overall 5-year survival and disease-free survival rates for women treated with BEP chemotherapy for ovarian yolk sac tumor were 94% and 90%, respectively, indicating that the treatment is effective in achieving complete remission 6.
Fertility Preservation Options
- Several options are available for preserving female fertility despite gonadotoxic chemotherapy, including ovarian transposition, cryopreservation of embryos, unfertilised metaphase-II oocytes and ovarian tissue, and administration of gonadotropin-releasing hormone agonistic analogs 4.
- However, none of these methods is ideal and none guarantees future fertility in all survivors, highlighting the need for further research into fertility preservation strategies 3, 4.
- Cryopreservation of ovarian tissue, oocytes, or embryos may offer an opportunity for pregnancy after cancer cure if natural fertility is not possible 5.