Cancer and its treatments affect the body, including the reproductive system, in many different ways. Chemotherapy, radiation and surgery can all be toxic to the ovaries and testes.
In general, the higher the dose and the longer the treatment, the greater the chance for reproductive problems. Other risks depend on age, type of drugs/chemotherapy used, the area receiving radiation and additional factors.
Talk to you or your child’s pediatric oncologist about how treatments may affect fertility. It may be necessary to consider options for preserving fertility prior to starting any planned treatment.
Factors that influence fertility
- Cancer diagnosis: Cancer itself can cause infertility. Testicular cancer and Hodgkins lymphoma can produce low sperm counts in some men even before treatment begins. The same holds true for breast cancer and other cancers located in the pelvis in females.
- Chemotherapy: Chemotherapy can be damaging to sperm and eggs. Chemotherapy drugs in the alkylating class are the most detrimental to fertility. Platinum-based and other chemotherapy drugs can also cause damage. Individual factors such as age, type of drug(s) and total dose may also affect the risks of becoming infertile. Some chemotherapy drugs are newer and there long-term impact on fertility isn’t yet known.
- Radiation therapy: Radiation therapy can impair the reproductive system. Radiation to the brain may affect fertility by damaging areas that control hormone production. Radiation therapy aimed at or near the pelvic area can directly affect the testes, uterus, or ovaries, causing infertility.
- Cancer surgery: Surgery that removes part or all of the reproductive system can impair or even eliminate fertility. If cancer involves the testes, ovaries, uterus, cervix, or nerves and lymph nodes in the abdomen and pelvis, talk to the surgeon. Ask you or your child’s pediatric oncologist how surgery may affect fertility or the ability to establish or maintain a pregnancy.
- Blood and marrow transplant (BMT): Prior to receiving a blood or marrow transplant, patients are treated with high-dose chemotherapy and/or radiation to destroy cancer cells. Side effects of this life-saving therapy occur when normal cells in the body are also destroyed by the treatment. Cells in the male and female reproductive system fall into this category, and BMT survivors might suffer moderate or severe, permanent damage affecting future fertility.
Male Fertility Preservation
Infertility occurs when men can no longer make sperm, when the sperm count is low or when sperm have been damaged by cancer treatment. After intensive or prolonged treatment, sometimes very few sperm — or no sperm at all — are found in the semen.
Options for preserving fertility
- Sperm banking: Sperm banking is a simple, proven way to try to preserve fertility before cancer treatment for male patients who have undergone puberty. Sperm can be frozen and stored for future use and can remain safely frozen indefinitely. We usually have patients collect a sample on two consecutive days prior to starting therapy to ensure an optimal reserve. Banking may still be worthwhile to you or your child even if the sperm count is low or if only one sample is able to be collected. Advanced reproductive technologies require only a few sperm to achieve pregnancy.
- Testicular tissue freezing: Testicular biopsy can be performed to retrieve sperm directly from the testicle in post-pubertal males who are unable to provide a semen sample. For boys who have not yet started puberty, testicular tissue freezing may be utilized. This technique is experimental in boys and only available through a research protocol that has been approved by the Institutional Review Board at the Cleveland Clinic. Talk to your child’s Pediatric Oncologist to see if he may be eligible for this option to preserve fertility.
- Radiation shielding: If there is a chance that radiation will affect fertility, it’s important to consider radiation shielding (protection) during these treatments. Covering one or both of you or your son’s testes with lead-lined shields or planning the radiation treatment to reduce the dose to the testes may reduce the risk of damage when radiation is delivered to the lower abdomen or pelvis.
Am I going to be able to have kids? Are they going to have birth defects? Are they at risk for cancer? These are all frequently asked questions of childhood cancer survivors. Through a series of videos, our experts discuss fertility preservation options for male patients before and after starting cancer treatments, as well as options for prepubescent boys.
Female Fertility Preservation
Females are born with a certain number of eggs in their ovaries. Some or all of these eggs may be damaged or destroyed by cancer treatments. Because women do not grow new eggs, the loss of eggs can cause infertility, primary ovarian insufficiency, or early menopause. Infertility occurs when females can no longer produce mature eggs or when another condition prevents them from establishing or maintaining a pregnancy.
Options for preserving fertility
- Embryo freezing and egg freezing:
- Ovarian shielding and ovarian transposition:
- Ovarian shielding is a technique that can minimize exposure of the ovaries and eggs to radiation during cancer treatment. This may reduce risks of damage and help preserve fertility.
- Ovarian transposition is a surgical technique that moves you or your child’s ovaries out of the field of radiation. This can lower the amount of radiation your ovaries are exposed to during your radiation therapy.
- Ovarian tissue freezing: This is a newer technique but is no longer considered experimental. Ovarian tissue freezing is an option for women who can’t delay the start of treatment, or for girls who have not yet started puberty. It is also an option for women who cannot undergo hormonal stimulation to retrieve eggs or embryos for freezing for different reasons. Ovarian tissue is surgically removed and frozen until you or your child is ready for re-implantation when you or your child is older or ready to try for pregnancy.
- Suppressing ovarian activity during chemotherapy: Some studies indicate that suppressing ovarian activity during chemotherapy, while controversial, may lessen the treatment’s negative impact on fertility. The benefits of medications that suppress ovarian activity, which are called gonadotropin-releasing hormone agonists, are being studied. Ask you or your child’s pediatric oncologist or reproductive endocrinologist about this alternative.
- Embryo freezing is a proven, successful method for preserving fertility for females who have undergone puberty. Because it requires sperm, this is an option for female patients who have a committed partner or who are willing to use donor sperm.
Egg freezing is a newer option for females who have undergone puberty but are not yet ready to start a family. Although embryo freezing is more efficient, egg freezing allows women to preserve eggs for future fertilization with a partner’s or donor’s sperm. The process of retrieving and freezing eggs or embryos takes about two weeks, so this is a viable option only if starting cancer therapy can be delayed.
Seth Rotz, MD
Fertility Preservation Program Director
Stefanie Thomas, MD, MS
Director of Adult and Young Adult Oncology Program
Any questions? Please email PedsHemeOncFertility@ccf.org.