Late Effects
Physical Late Effects

Fertility

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Fertility is a sensitive and emotional topic. It’s especially difficult for cancer survivors, because some cancer treatments cause fertility problems in both men and women. In our 2023 Annual Survivor Survey, 40% of survivors told us that fertility is one of their top health concerns.

Before getting into infertility, let’s talk briefly about fertility.

If you are already pregnant, ask your long-term follow-up team if you face risks that non-survivors don’t. If so, consider enlisting a high-risk obstetrician. In particular, female survivors who received pelvic radiation are at risk of complications including premature labor or a low birth-weight baby.

The good news is that modern medicine continues to make advances, both in treating infertility and in minimizing the late effects of cancer treatment related to fertility.

If you are still in the process of considering whether biological parenting is right for you, one of the biggest questions you might have is whether your childhood cancer is genetic.

In most cases, the offspring of childhood cancer survivors are not at any increased risk. But if the risk of cancer to your future children would impact your choices about becoming pregnant, you might want to consider genetic testing and/or talk to a genetic counselor. Only your medical team can provide the best information about your specific case and risk factors.

Fertility News:

  • This 2017 study found that treatment with abdominal radiotherapy increases the risk of developing hypertension complicating pregnancy in Wilms tumor survivors, and diabetes mellitus and anemia complicating pregnancy in all survivors.

  • This 2018 study found that female childhood cancer survivors have an increased risk of premature delivery and postpartum haemorrhage, but their offspring are not at increased risk for low birth weight or congenital abnormalities.

  • If you are infertile, and you’d like to have a child, many options are available, including fertility cycle enhancement, donor insemination, donor eggs, testicular sperm extraction, in-vitro fertilization, and surrogacy or gestational carriage. You’ll need to discuss with your health care team which of these might be viable options for you to pursue.

  • Many infertile couples choose adoption rather than infertility treatments, or they decide to adopt after infertility treatments have failed. If you are considering adoption, you have a variety of choices, including domestic parental placement, domestic waiting child/foster care adoption, or international adoptions. Each has its own benefits and risks. Several factors to consider prior to adoption are cost, ethnic, heritage, age of child you wish to adopt, whether you’re prepared to handle a child who has been abused or neglected, and whether you can travel at a moment’s notice to complete the process. It’s important to know up-front that the adoptive process can be very lengthy and sometimes very expensive.

  • Some infertile couples choose to remain childless. This can be a rewarding choice if you have accepted infertility and chosen other ways to fulfill your desires to have children in your life. For example, you might volunteer at a school or camp, or you can take an active role in the lives of children that you are close to - nieces, nephews, and children of friends.

Infertility is the inability to start or maintain a pregnancy.

The American Society of Reproductive Medicine defines infertility as the inability to conceive after one year of unprotected intercourse in women under the age of 35.

Some cancer treatments, including radiation to the testes or ovaries or treatment with alkylator drugs, may cause infertility, may increase the difficulty of conception, or may make maintaining a pregnancy more difficult. Higher doses of certain chemotherapy agents or certain combinations of drugs can increase the risk of permanent infertility.

Brain tumor patients who received treatment to the hypothalamus and pituitary gland may have had their sperm and egg development impacted - but each case is unique and should be discussed with your medical team.

Other factors that may affect a childhood cancer survivor’s fertility include:

  • Type and location of cancer (most risky: direct radiation in the pelvic area);

  • Age and developmental age at time of diagnosis;

  • Types and dosages of drugs (most risky: high doses of alkylating agents, high doses of radiation, or total body irradiation).

If you are concerned about infertility, talk with your doctor about the type of cancer and treatment you had as a child. Some treatments that were previously thought to cause infertility have actually not affected fertility. This information may affect your decisions regarding birth control - but you should never assume that the treatment you received is a substitute for contraception. You may also want to consult an infertility specialist.

This article from December 2019 about new clinical trials for male and female survivors explores the experimental procedures that may help broaden the fertility options for childhood cancer survivors.

The Psychological Impact of Fertility

The overwhelming medical decisions and uncertainties associated with infertility can create one of the most distressing life crises facing a couple or individual. The long-term inability to conceive a child can evoke significant feelings of loss. If you find yourself feeling anxious, depressed, out of control or isolated, you are not alone. However, if those feelings persist, seek professional help.

There are certain times during infertility treatments when discussion with a mental health care professional about infertility options and your feelings can both clarify and aid in your decision making. For example, consultation with a mental health care professional may be helpful to you and your partner if you are:

  • At a treatment crossroad;

  • Deciding between alternative treatment possibilities;

  • Exploring other family building options;

  • Considering third-party assistance; or

  • Having difficulty communicating with each other other or if you have different ideas about directions to take.

Fertility Resources

Are you reading this as a parent of a child newly diagnosed?

Oftentimes, especially in the case of a young child with cancer, the family’s panic to start life-saving treatment as quickly as possible overrides questions about future fertility. It isn’t until many years later that a lot of childhood cancer survivors come face-to-face with the effect their treatment had on their fertility.

If you are reading this and you (or your child) haven’t yet undergone treatment, or are early in treatment, make sure you do thorough research and discuss your options for fertility preservation with your medical team.

The American Academy of Pediatrics issued updated guidance for physicians related to fertility preservation in children with cancer in 2020.