In addition to impairment of steroidogenesis and sperm production, there has been concern that cytotoxic chemotherapy may also result in transmissible genetic damage. Animal studies have demonstrated untoward effects in offspring of animals treated with cytotoxic agents, but no clear evidence for this has been reported in humans. Increased aneuploid frequency has been observed in human sperm after chemotherapy for Hodgkin's disease (45,46), and an increase in chromosomal abnormalities has been demonstrated several years after treatment for testicular cancer (47). However, data concerning the outcome of pregnancies have not shown any increase in genetically mediated birth defects, altered sex ratios, or birthweight effects in offspring of cancer survivors (48), possibly as a result of selection bias against genetically abnormal sperm. On the evidence thus far, it is reasonable to conclude that patients treated with cytotoxic chemotherapy who remain fertile are not at increased risk of fathering children with genetic abnormalities.
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