Some types of chemotherapy are gonadotoxic and may cause infertility.^[29] Chemotherapies with high risk include procarbazine and other alkylating drugs such as cyclophosphamide, ifosfamide, busulfan, melphalan, chlorambucil and chlormethine.^[29] Drugs with medium risk include doxorubicin and platinum analogs such as cisplatin and carboplatin.^[29] On the other hand, therapies with low risk of gonadotoxicity include plant derivatives such as vincristine and vinblastine, antibiotics such as bleomycin and dactinomycin and antimetabolites such as methotrexate, mercaptopurine and 5-fluoruracil.^[29]
Patients may choose between several methods of fertility preservation prior to chemotherapy, including cryopreservation of semen, ovarian tissue, oocytes or embryos.^[30] As more than half of cancer patients are elderly, this adverse effect is only relevant for a minority of patients.