When your child has cancer, it can be hard to think beyond the next few days or
months. Yet because today's treatments are increasingly effective — the majority
of children with childhood cancers survive, thanks to medical breakthroughs —
it's important to understand how they could affect your child's fertility.
While some treatments have little to no effect on reproductive health, others are
likely to damage the testes or ovaries, resulting in temporary or permanent infertility.
Your doctor can tell you if there's a chance that treatment might affect the reproductive
Once armed with this knowledge, you and your child can consider what preventive
measures (like sperm banking or egg preservation) to take before or after cancer treatment
to help improve your child's ability to start a family later in life.
Risks of Treatment
Chemotherapy, radiation, and surgery all can have lasting effects on reproductive
health. Your child's risk depends on the diagnosis, the type of treatment, and the
dose of medicine — but even your doctor can't predict with 100% certainty what
the lasting effects will be.
Some chemotherapy drugs are more likely to lead to infertility
than others. The high-risk drugs most likely to affect reproductive organs are cyclophosphamide
(known commercially as Cytoxan), lomustine, ifosfamide, procarbazine, busulfan, and
melphalan. Others, like vincristine and methotrexate, are typically less likely to
harm fertility. Some of these drugs also may interrupt menstruation in girls and/or
cause early menopause.
Radiation treatments can damage testes or ovaries. If radiation
is focused on or near the pelvic area, abdomen, spine, and/or the whole body, it may
cause damage to sperm or eggs. Also, radiation to the abdomen, pelvic area, or entire
body may affect a girl's uterine function and cause difficulty in carrying a baby
to full term. It also can interrupt menstruation in girls or reduce sperm count and
motility in boys — these conditions may be permanent or may reverse after the
treatment. Kids who have radiation to certain areas of the brain also may have their
If the cancer involves the reproductive organs, surgery might
be recommended and doctors might need to remove part of the reproductive organs to
remove the cancer.
Sperm and Egg Preservation Options
If your child's treatment carries a high risk of infertility, here are some options
For boys who have gone through puberty, sperm banking or "cryopreservation" is
a common, non-invasive option to consider. Sperm are collected and frozen for storage
in a specialized facility. Some hospitals have sperm bank programs, but you may have
to go to a clinic that specializes in sperm banking.
For younger teens and boys who have not yet hit puberty, a more experimental procedure
called "sperm aspiration" may be possible. This process removes immature sperm cells
for later use in in vitro fertilization (sperm are used to fertilize an egg
outside of the uterus, then the fertilized embryo is transferred to the uterus).
It also may be possible to preserve sperm by freezing testicular tissue. This is
still experimental and its effectiveness hasn't been determined. Your doctor may advise
against it because of the risk that cancer cells could be reintroduced when the tissue
is grafted back into your son's body.
Boys who have delays in puberty or growth delays due to chemotherapy and/or radiation
should see an endocrinologist to discuss treatment options. For boys who collect sperm
for preservation after having chemotherapy, there is a potential risk of damage to
the genes in the sperm. If you have questions, make sure to ask your doctor.
Embryo freezing — in which eggs are harvested from the ovaries, fertilized
in a lab, and then frozen and stored — is more widely available and has a higher
rate of success. However, since it requires mature eggs, this method only works for
girls who have gone through puberty. It's less commonly used in pubescent girls than
adult women (because it requires sperm from a partner), but it is possible to user
donor sperm to fertilize the eggs. Since this method requires a period of ovarian
stimulation, it is not ideal for girls who need to start treatment as soon as possible.
Therefore, many girls are not able to have eggs harvested.
If embryo freezing is not a possible option for the girl, unfertilized eggs (after
puberty) can be frozen and preserved for later in vitro fertilization (IVF)
and implantation. Pregnancy is possible through this method, though success rates
are lower than with traditional IVF.
Depending on the specifics of a girl's condition, it may be possible to freeze
ovarian tissue (before or after puberty). However, these are experimental processes
— not all hospitals or clinics have the technology and success rates vary. In
some cases, your doctor may recommend against preserving ovarian tissue because of
the risk of reintroducing cancer cells later on.
Depending on the type and target area of treatment, it may be possible to shield
the ovaries from damage or even move them out of the path of radiation (called transposition).
What to Ask the Doctor
When thinking through the options above, be sure to get all the facts from your
care team. It might be helpful to see a fertility specialist about which option (if
any) would be best for your child.
Some questions to ask:
Is this treatment likely to damage my child's reproductive organs? If so, what
areas may be affected and how will this impact fertility?
What are the chances this treatment will cause my daughter to experience an early
menopause? Can the treatment affect some organs (like the lungs or heart) in a way
that will make it hard for her to carry a pregnancy to term?
Will this treatment have any affect on my son's reproductive health? If damage
to sperm is likely, will the damage be temporary or permanent?
Will this treatment have any effect on development through puberty?
Are there ways to prevent infertility before we start treatment? Will any of these
interfere with how well the cancer treatment works?
What proactive measures, like sperm banking or egg preservation, are possible
for my child? Are any experimental options available?
After treatment, how will we know if my child's fertility has been affected?
If infertility is a possibility, it's important to know about other options for
the future, including adoption or surrogacy. A surrogate mother carries a child to
full term for a woman who is not able to do so herself, for health reasons or due
to infertility. The surrogate mother may carry a child who is her genetic offspring
or may be implanted with an infertile couple's embryo via in vitro fertilization.
As you explore the options, it's important to share as much as you can with your
This probably won't be easy — sexuality and reproduction are often difficult
subjects for parents and kids to discuss, and the risk of infertility carries complex
emotions that can be hard for a child to process. Even in the very young, the concept
of infertility can be powerful and intense.
Kids can have a deep sense of loss, or feel less feminine or masculine if faced
with fertility problems — especially adolescents, for whom sexuality and reproduction
are important parts of their developing identity.
Here are some ways to help your child cope with these potential changes:
Keep talking. An open discussion with your son or daughter will
help you plan for treatment and know what to expect afterward. It's also important
to let your child know that he or she is not alone, and that many teens who were told
that their treatments would likely lead to infertility go on to have children; others
go on to become parents through adoption, surrogacy, or other methods. Planning for
the future can help your son or daughter stay positive and concentrate on getting
Seek support. The hospital or clinic may have a support group
or counselor who can help work through the complex feelings your child is bound to
Keep hopes realistic. Be open and honest about the risk of infertility,
the success rates of fertility preservation options, and any possible risks or complications.
Be sure you and your child understand that nothing is guaranteed. Offer reassurances
that your child is still the same person, no matter what happens long-term. And remember,
even if unable to physically conceive, your child can still become a parent one day.