Abdominal irradiation in childhood; the potential for pregnancy

TLDR

The study examined how childhood whole abdominal irradiation causing premature ovarian failure affects uterine size, blood flow, and response to sex steroid replacement. The authors compared 10 irradiated women with 22 non‑irradiated premature ovarian failure controls, measuring uterine length, blood flow, and serial endometrial thickness during hormone replacement. Irradiated women had significantly shorter uteri, no endometrial thickening, and most lacked detectable uterine blood flow, demonstrating irreversible damage that may limit pregnancy potential after ovum donation or embryo transfer.

Abstract

ABSTRACT Objective To investigate the impact of premature ovarian failure due to whole abdominal radiotherapy (DXT) in childhood on uterine physical characteristics and blood flow and measuring the uterine response to exogenous sex steroid replacement Design A comparative observational study Subjects 10 women with premature ovarian failure due to treatment with whole abdominal irradiation in childhood. A comparison group of 22 women with premature ovarian failure who had not received whole abdominal DXT. Main outcome measures Uterine length and uterine blood flow measurement plus serial assessment of endometrial thickness during a cycle of exogenous sex steroid replacement. Results Uterine length was significantly less ( P <0.01 ) in women who had been exposed to whole abdominal DXT in childhood (mean 4.1 cm, 2SE 0.8) compared with a mean of 7.3 cm (2SE 0.6) in the comparison group. The three women in the DXT group who were studied serially had no increase in endometrial thickness in response to physiological sex steroid replacement therapy and most of the 10 irradiated women had no detectable uterine blood flow with Doppler ultrasound. Conclusions Uterine musculature and blood flow are irreversibly affected by high dose irradiation in childhood. Non‐invasive assessment of this nature may predict potential for pregnancy following ovum donation and embryo transfer.