Some cancer drug treatments and radiation therapies can affect fertility - your ability to conceive. The effects may last for a short time or be permanent, depending on:
- your age at the time of diagnosis and treatment
- the drug and dosage used for treatment
- the location and dosage of radiation (blood or marrow stem cell transplantation is associated with a high risk for infertility)
- the length of your treatment time
Your diagnosis is usually not a risk factor for infertility. However, Hodgkin lymphoma is associated with low sperm count, which has been reported in about two in three patients.
For Parents of Childhood Cancer Patients
Chemotherapy and radiation can cause side effects and long-term effects and late effects, which can appear months or years after treatment, in boys and girls, such as infertility. As the parent of a child who has leukemia or lymphoma, you're focused on your child's well-being, treatment and survival. You may not be thinking about whether he or she can one day become a parent. However, knowing about possible fertility effects of treatment now may help you take steps to plan for the future.
More to Explore
- Understanding long-term and late effects in children
- Download or order The Leukemia & Lymphoma Society's (LLS's) free fact sheet, Long-Term and Late Effects of Treatment for Childhood Leukemia or Lymphoma.
Possible Treatment Effects
Cancer treatment can affect fertility in both males and females. Some therapies affect each gender specifically; other therapies affect both. Some chemotherapies and radiation therapies affect the endocrine system - the glands and cells that control growth, sexual development, sleep, hunger and the way the body uses food - triggering puberty and fertility changes. Changes to the endocrine system affect prepubescent children more often than older children or adults especially when it comes to physical development and growth, including sexual development.
Possible Effects on Males
- High radiation doses to the brain and certain chemotherapies can affect sperm production.
- High radiation doses may end sperm production permanently.
- A class of cancer-fighting drugs called alkylating agents, such as cyclophosphamide or procarbazine, have the most significant effect on fertility. Other drugs are generally less toxic to sperm-forming cells but may also cause infertility, especially when used as part of various combination medication therapies.
- If radiation reaches the testicles, sperm production can be affected for a while but could later return to normal levels. Chemotherapy's effects on sperm production may also be temporary. If you're experiencing temporary infertility, you should be reevaluated periodically. Discuss with your doctor how often you should have follow-up evaluations.
- Radiation can affect testosterone levels. This side effect can also cause impotence and, in boys, either delay or speed up puberty. If your child seems to be going through puberty early (before age 13) or late (after age 15), talk with his doctor or pediatrician, who can prescribe drugs to improve hormone balance. Also ask the doctor about performing a semen analysis as your son grows older to learn whether his body is making sperm.
Possible Effects on Females
- Some chemotherapies can delay menstruation.
- Some females who receive cancer treatment have premature ovarian failure (POF), also called premature menopause. Unlike menopause, this isn't a natural occurrence. When cancer treatment causes POF, it's unlikely that females will have subsequent menstrual periods or the ability to become pregnant naturally. There's no treatment to restore fertility for women with POF. Generally, you can manage POF with hormone therapy that includes estrogen, progesterone and, sometimes, testosterone. To decrease the health risks of osteoporosis and heart disease, eat a healthy diet and exercise regularly (aerobics and weight training). Your doctor may prescribe supplements or drugs for bone health.
- Radiation to the pelvic area can cause damage to the uterus, increasing the risk for infertility, miscarriage, spontaneous abortion or premature birth. Young girls who receive cancer treatment tend to have fewer fertility problems than teenagers and adults who do. If your daughter enters puberty early (before age 8), talk with her doctor or pediatrician, who can prescribe drugs to delay development. If she doesn't enter puberty by age 15, she may have POF or another condition causing the delay.
In all women, changes take place during the reproductive cycle. Talk with your doctor to learn if any changes such as those below are normal or a result of disease or treatment:
- irregular menstrual cycles
- hot flashes
- breast tenderness
- painful intercourse
- trouble getting pregnant
- a history of miscarriages
Talking with Members of Your Oncology Team
Talk with your oncology team members about the effects treatment may have on your or your child's fertility. If possible, gather this information before treatment begins. The American Society of Clinical Oncology recommends that patients interested in fertility preservation consider their options as soon as possible to maximize the likelihood of success. Your oncology team members may not be able to answer all your questions, but they can refer you to fertility specialists who can help you understand and explore your options.
As you consider your treatment and fertility options, you may want to also talk with:
- a genetic counselor
- an obstetrician-gynecologist or urologist
- a reproductive endocrinology specialist
Cancer treatment-related infertility may be associated with emotional distress, so counseling may also be beneficial for some individuals.
Questions to Ask Your Doctor
Some questions you may want to ask your doctor are:
- What are the chances the treatment will affect my [or my child's] fertility?
- What can we do to protect fertility before, during or after treatment?
- How will I know if treatment has affected my [or my child's] fertility?
- Have other people been able to have a child after receiving this treatment?
- Can you recommend a fertility specialist I can speak with?
- Can you suggest a local support group of patients or parents who have been through the same challenges?
- Can you put me in touch with patients or parents who have already completed this treatment?
- If I have a period of infertility after treatment, should I have my fertility status reevaluated in the future? If yes, how soon should I have a follow-up evaluation?