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Fertility and Cancer Fertility and Cancer FS23 in a series providing the latest information for patients, caregivers and healthcare professionals. Highlights Introduction y Fertility describes the ability to conceive a Chemotherapy and radiation can cause “late” side biological child. Some cancers and some cancer effects that may appear months or years after treatments affect fertility in males and females. treatment has ended. One possible late effect is infertility, the inability to conceive a child without y The risk of infertility caused by cancer and its medical intervention. When first diagnosed with a treatment is based on several factors, including blood cancer, your primary concern may be your the type of cancer; the type, duration, and doses upcoming treatment and long-term survival. You of treatment; and the patient’s age at the start may not be thinking about whether you can or want of treatment. to have children in the future. However, information y Addressing fertility and sexual health is an about the potential effects of your treatment can help essential part of cancer treatment and follow-up you take steps to leave your options open, which care. It is important to talk with members of your includes conceiving a child after cancer treatment. oncology team before treatment begins about the potential effects of your treatment. This publication provides only general information about this topic. Speak with members of your y There are many options available to help you healthcare team about the specific effects of your preserve the ability to have biological children treatment and the fertility preservation options that are in the future. Some of these choices require available to you. that action be taken before treatment begins. Not all patients starting cancer treatment will Visit www.LLS.org/booklets to read more about other need or want to consider this subject, but it is late effects in the free LLS publications, Long-Term important to discuss fertility concerns with your and Late Effects of Treatment for Childhood Leukemia treatment team. or Lymphoma Facts and Long-Term and Late Effects of Treatment in Adults Facts. y Sperm cryopreservation (sperm banking) is the fertility preservation method with the highest likelihood of success for male cancer survivors. Cancer and Fertility Embryo/egg freezing is the method with Not all cancer treatments affect fertility. The risk to your the highest likelihood of success for female fertility depends on several factors, including cancer survivors. y Your age at the time of diagnosis y Most cancer survivors who can conceive after treatment have normal pregnancies and healthy y The type and dosage of chemotherapy drug(s) you babies. However, patients should talk with their receive oncologists about any potential risks they face {{Alkylating agents—for example, cyclophosphamide, regarding conception or pregnancy. ifosfamide and procarbazine, along with the drug y There are many ways to build a family, whether cisplatin—have the most significant effect on fertility. through natural conception, using assisted Other drugs are generally less toxic to sperm-forming reproductive technology, or adoption. Patients cells and eggs, but can also cause infertility, especially who want children should consider and discuss when used as part of a combination of therapies. all options. FACT SHEET Fertility and Cancer y The location and dosage of radiation y Disruption of the menstrual cycle (periods), which may be temporary or permanent {{Exposure to the testes may destroy cells that form sperm. y Premature ovarian failure (POF), also called premature menopause. This is a loss of ovarian function in a {{Exposure to the ovaries may destroy eggs. female younger than 40. When POF is caused by {{Exposure to the pituitary gland in the brain may cause cancer treatment, it is unlikely that a female will have changes in secretion of hormones that regulate subsequent menstrual periods or be able to become puberty and fertility. pregnant without medical intervention. Generally, POF y The duration of treatment is managed with hormone (estrogen and progesterone) replacement therapy. y Whether you received a blood or marrow stem cell transplantation, which is associated with a high risk {{Females with POF are encouraged to eat a healthy of infertility diet and exercise regularly (aerobics and weight training) to decrease the health risks of osteoporosis y The type of cancer. Certain cancers cause decreased and heart disease. Calcium and vitamin D sperm counts. For example, patients with leukemia, supplements for bone health may also be prescribed. Hodgkin lymphoma and testicular cancer may have a low sperm count at the time of diagnosis. {{Females who retain a degree of ovarian function after treatment or those who restart menstruation may still Other medical issues unrelated to cancer can also develop POF and have trouble conceiving later in impact fertility. life. If you are at risk for POF, you may want to start a family early. If you are fertile after treatment but not Possible effects on males ready to start a family, you may want to consider egg y Sexual dysfunction, that is, the inability to achieve or or embryo freezing (see page 3). maintain an erection y Radiation to the pelvic area can cause damage to y Lower-than-normal testosterone production the uterus (womb) and increase the risk for infertility, miscarriage, or premature birth y Loss of sperm production, which may be temporary or permanent y Chemotherapy and/or radiation may cause sexual dysfunction, including loss of desire, pain during {{If sperm production recovers, it can take 1 to 3 years, intercourse and inability to achieve an orgasm. and sometimes longer y Females who undergo cancer treatment as children Analysis of a semen sample can indicate whether you tend to have fewer fertility problems than females are making sperm. This can be done after treatment is treated during the teen or adult years, but they can still completed. Talk with your doctor about when to be at risk for infertility. be evaluated. y Changes in your body or difficulty conceiving may Possible effects on females or may not be related to the effects of your cancer y The ovaries (organ where eggs are produced) are treatment. Talk with your doctor if you have: especially susceptible to damage during cancer {{Irregular menstrual cycles treatment because they contain germ cells that {{Hot flashes cannot be regenerated after birth. When female babies are born, nearly one million follicles that {{Breast tenderness contain eggs are present in their ovaries; but females {{Painful intercourse cannot produce new eggs. Therefore, the total effect of cancer treatment on fertility will depend on how {{Trouble getting pregnant many eggs remain after treatment has ended. {{A history of miscarriages Chemotherapy protocols containing alkylating agents can {{Early or delayed onset of puberty (in children) be especially damaging to ovarian tissue, causing: {{Any other questions or concerns 2 Fertility and Cancer Options to Preserve Fertility Before y Testicular sperm extraction (TESE). For males who Treatment have no sperm in the semen specimen, this surgical procedure, performed under anesthesia, can be You may be able to take steps before treatment begins considered. The doctor removes pieces of tissue from to preserve your fertility. The options available to you the testes, which are then examined for mature sperm. depend on These can be removed from the tissue and frozen for y Your age, sex and current fertility status possible future use. y Your overall health at the time of diagnosis y Testicular shielding. A shield can be used to protect the testicles during radiation therapy. This must be y How quickly you need to begin cancer treatment planned before treatment begins, and the shields must Some of the options to preserve fertility on the following be used every day of treatment. Not all patients will pages are available for children, even those who have be able to use shields, because sometimes there is a not gone through puberty. See Fertility Issues in Children need to treat the testes with radiation. and Adolescents With Cancer on page 5 to learn more y Testicular tissue cryopreservation (TTC). Males who about how to address fertility issues with your minor child have not yet gone through puberty do not produce and the healthcare team. mature sperm, so they cannot preserve their sperm in a sperm bank. Testicular tissue cryopreservation (TTC) Options for Males is considered an experimental approach. This method y Sperm banking (cryopreservation). This is a involves collecting and freezing a small amount of common, noninvasive option. It involves the collection testicular tissue with the hope that the tissue will of semen by masturbation. If there are sperm in the contain stem cells that would later produce mature semen, they can be frozen and stored at a special sperm. The healthcare team can later thaw and place facility (some hospitals have sperm bank programs) the tissue back into the testicle, or inject stem cells for possible future use. Sperm banking is a reliable taken from the frozen tissue. For some types of cancer, and effective fertility preservation option with the the doctor may advise against tissue freezing because highest likelihood of success for males. However, the of a concern that transplanted tissue could carry success of sperm banking may be limited in some cancer cells back into the body. Researchers are still patients, such as those with Hodgkin lymphoma and learning about these methods and further study testicular cancer, who may already have low sperm is needed. counts caused by the cancer. Options for Females The American Society of Clinical Oncology guidelines recommend that sperm banking be offered to all y Egg or embryo cryopreservation (freezing). These males who have gone through puberty and who have are procedures in which mature eggs are removed a recent diagnosis of cancer.
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