Cancer Treatments and Fertility

Chemotherapy, radiation therapy, and other treatments can be very effective at doing their job. But what makes them good at fighting cancer or other illnesses also can cause side effects: As these treatments attack harmful cells, they may affect some healthy cells too.

Your doctor has probably talked about whether you'll have any side effects from your cancer treatment. Side effects like reduced all depend on your diagnosis, the type of treatment you're getting, and the doses of medicines or radiation. Everyone is different, so it's best to bring any questions or worries up with your medical team.

Which Treatments Can Affect Fertility?

Your doctor can tell you if there's a chance that cancer treatment might affect your reproductive organs. It helps to be aware of what might happen so you can manage the possibilities, both physically and emotionally.

Here's how some cancer treatments can affect fertility:

Chemotherapy

Some chemotherapy medicines are more likely to lead to infertility than others. Cytoxan (also known as cyclophosphamide) is part of a group of chemo medicines called alkylating agents. These medicines damage the DNA of cancer cells so they can't make copies of themselves. Alkylating agents are more likely to affect the reproductive organs when given at higher doses.

Other chemotherapy medicines and combinations of medicines also may affect your fertility. Because there are so many different chemotherapy medicines, it's best to ask your doctor or nurse if the ones you are taking put you at risk for fertility problems.

Radiation Treatments

Radiation treatments also can damage sperm and eggs, whether the treatment is focused on these areas or scattered elsewhere. Radiation that's focused on or near the pelvic area can damage a girl's ovaries or reduce sperm count in guys. These changes may go away after treatment ends, but can be permanent.

The radiation therapy technicians may shield the ovaries or testicles from damage by placing a protective shield over these areas. Sometimes a surgeon moves the ovaries out of the path of radiation by doing surgery before radiation therapy begins.

Some cancer treatments involve radiation to the head as a way to kill cancer cells that may be in the central nervous system. Sometimes this can injure the parts of the brain (and the pituitary gland) that make that control puberty and the menstrual cycle. If that happens, doctors can give these hormones to patients so they can have normal pubertal development, sexual function, and fertility.

Surgery

For patients who need surgery to remove tumors, doctors may sometimes need to remove part of the reproductive organs if the cancer is nearby.

What Are My Options?

Don't hesitate to ask questions and raise any concerns. And, don't worry that fertility isn't a topic for your doctor. It may seem like your doctor is focused only on getting rid of the cancer. But getting better is also about your future quality of life.

You may want to ask your doctor these three questions:

1. Is this treatment likely to affect my fertility?
2. Can doctors do something to protect my fertility during treatment?
3. After treatment, how will I know if my fertility was affected?

Ask your doctor about all your options. Then come up with a plan together. If you don't feel comfortable talking to your doctor about fertility, find someone on your medical team — like a nurse or social worker — to talk to instead.

In some cases, it may be possible to preserve (or "bank") some of your sperm or eggs. The technical term for this process is cryopreservation, and it happens in a special facility that can freeze and save sperm, eggs, or ovarian tissue. When you're ready to have children, your sperm or eggs can be unfrozen and used to try to have a baby.

For males, sperm banking has been around for a long time and is a common procedure, although not all hospitals offer it. You may have to go to a clinic that specializes in sperm banking.

For younger teens and boys, a more experimental procedure called sperm aspiration may be possible. This process removes immature sperm cells for later use in in vitro fertilization. This is when:

• Sperm is used to fertilize the egg outside of the woman's uterus.
• The fertilized embryo is then transferred to the uterus.

Talk to your doctor about your options.

For females, it's a little trickier. Doctors can attempt to freeze eggs or ovarian tissue, but many of the techniques are still experimental and not all hospitals or clinics have access to the technology. Ask your doctor about the options available for you.

In some situations, your doctor may tell you that it isn't a good idea to bank your sperm or eggs, because using them later could put you at risk of cancer cells getting into your body.

Looking Ahead

It's normal to worry about the side effects that go with cancer treatment. These tips can help:

Build a positive self-image. Coping with the side effects of cancer treatment at a time when you're developing your own identity can make everything seem even more complicated.

Sexuality is an important part of a person's identity (even if you're not yet ready to have sex). But sexuality has little to do with fertility. People who can't have kids are as feminine or masculine as people who can. And fertility has nothing to do with a person's ability to give and receive love. In fact, some cancer survivors develop qualities that may make them more attractive to others, like a greater passion for life and the desire to make the most of their experiences.

Find support. You're not alone. Other teens have gone through what you're feeling now. You can connect and share experiences through online networks and cancer blogs. It also may help to find a support group or counselor who can help you work through the feelings you're bound to have during your treatment. Find support online at:

• Cancer.Net
• Teenage Cancer Trust
• Teen Cancer America

Stay positive. Many people who go through cancer treatments later have children. Others become parents through adoption or other methods. By thinking about the many different options for parenthood, you can be realistic and positive at the same time. Planning for the future helps you heal. And, if you are having sex, you'll still need to use condoms to protect against STDs.

Right now, you're focused on recovering — and on the treatments that can save your life. But it's also natural to think about your future. Talk to your health care team, parents, and friends about your options, your plans, and your feelings.