Recovery Following Human Ovarian Irradiation

Abstract

TWO of the fundamental but probably least well understood effects of irradiation upon living tissues are the processes of destruction and repair. In some organs and tissues it is difficult, if not impossible, to determine the degree of recovery which has taken place following radiation therapy. But human ovarian tissue is one in which return of function can be observed by the re-establishment of the menstrual and child-bearing functions. The production of temporary sterilization by irradiation is a well-recognized and safe clinical procedure used throughout the world. Radiologists are familiar with the variability of the ovaries in relation to x-ray sensitivity, and with the strong recuperative power even a small amount of ovarian tissue may possess. It has been our custom to consider 500 r delivered to the ovaries sufficient to produce permanent castration in the majority of patients. However, a young individual may require a larger amount than a patient approaching the menopause because of the greater power of recovery in young ovaries. We all know that some of our patients menstruate again after varying periods of amenorrhea following the customary roentgen castration exposure. The effect of irradiation on future offspring is not well understood. Whether an ovary irradiated so as to suppress the menstrual phenomenon for an extended time can recover to produce healthy ova capable of fertilization and development into normal children is not so definitely proved, but such occurrences, as reported here and elsewhere (2 and 10), tend to bear out this assumption. After studying several hundred pregnancies, Murphy (6) stated that ovarian irradiation, prior to fertilization, has no detrimental influence upon the health or development of subsequent children. Riboni (7) reports the case of a 27-year-old woman who was subjected to presumably permanent roentgen sterilization for a freely bleeding fibroid. She noticed mild menopausal symptoms and no menstrual periods for two years, at the end of which time she became pregnant and gave birth at term to twins. One was born dead after forceps delivery; the other was delivered spontaneously, and was in perfect health 15 years later. After 15 years of normal menstrual periods, the fibroid again caused symptoms and was removed surgically. Kaplan (4) describes a 30-year-old woman with severe acute pulmonary tuberculosis, who received roentgen therapy to produce a therapeutic abortion. Since this did not occur in six weeks, a simple vaginal hysterotomy was done. She did not menstruate after the operation, but conception occurred ten months later. The pregnancy was allowed to go to term and a normal male child was delivered without difficulty. Fourteen months following birth, the child was healthy and normal in development. Again, Kaplan (3) reports the case of a 36-year-old woman who was presumably permanently castrated by roentgen rays because of recurrent carcinoma in both breasts.