Patient education: Preserving fertility after cancer treatment in children (The Basics)

What is fertility? — Fertility is the medical term for the ability to get pregnant or get a partner pregnant. Some types of cancer treatment can affect a person's fertility. "Preserving fertility" means taking steps to help a person's chances of having biological children after cancer treatment.

It might seem strange to be thinking about your child's fertility. But it's important to think about this issue before your child starts cancer treatment. That's because some types of cancer treatments can cause fertility problems in the future, even years later. There are things that can be done now to prepare for this, even if your child is still young.

What are "fertility problems"? — Fertility problems can mean:

●For females, having trouble getting pregnant

●For males, having trouble getting a partner pregnant

Which cancer treatments can cause fertility problems? — Cancer treatments that can cause fertility problems include:

●Chemotherapy – Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing.

●Radiation therapy – Radiation involves getting high doses of X-rays.

●Surgery on the sex organs – The sex organs include the testicles (in boys) and the ovaries and uterus (in girls) (figure 1 and figure 2). If these are removed or damaged during treatment, it can cause fertility problems.

Both chemotherapy and radiation can damage cells in the sex organs. But these treatments do not always lead to fertility problems. With chemotherapy, it depends on the medicine and dose a person gets. With radiation, it depends on the dose and part of the body treated.

What should I do if I want to preserve my child's fertility? — You should talk with your child's doctor BEFORE your child starts cancer treatment. It might be possible to choose treatments that have a lower chance of affecting future fertility.

Are there other ways to preserve fertility? — Yes. They depend on your child's sex, whether they have gone through puberty, and the type of treatment planned.

●For boys and girls who have not yet gone through puberty:

•If radiation therapy is planned – The main way to preserve fertility is to shield the sex organs during radiation treatment. This involves wearing a special type of shield on the outside of the body. The shield covers and protects the sex organs, so they aren't damaged by the radiation.

•If chemotherapy if planned – The options for preserving fertility are still being studied. For girls, eggs or small pieces of tissue from the ovary can be frozen and stored. For boys, small pieces of tissue from the testicle can be frozen and stored, although this procedure is still being studied.

●For boys who have gone through puberty, ways of preserving fertility can include:

•Shielding the testicles during radiation treatment

•Sperm banking – This involves collecting and freezing sperm before cancer treatment starts. To collect the sperm, your child will need to ejaculate. If he can't, or if there is no sperm in the semen, the doctor can do a procedure to remove sperm from the testicle. After the sperm is collected, it is frozen and stored until needed.

•Freezing and storing small pieces of tissue from the testicle. Doctors are still studying this procedure to see if it works.

●For girls who have gone through puberty, ways of preserving fertility can include:

•Shielding the ovaries or uterus during radiation treatment

•Moving the ovaries – If the ovaries are in the path of the radiation, the doctor can do surgery to move them slightly to keep them from getting damaged.

•Freezing and storing eggs or small pieces of tissue from the ovary

How do I decide which option is right for my child? — The best way to preserve your child's fertility depends on your child's cancer, treatment, age, and individual situation. Talk with your child's doctor about the possible choices. To make your decision, you might want to think about:

●The benefits and downsides of the choices

●How well the doctor thinks they will work

●How much they cost – For example, it costs money to collect, freeze, and store sperm. Health insurance sometimes pays for these things.

More on this topic

Patient education: Radiation therapy (The Basics)
Patient education: Hodgkin lymphoma in children (The Basics)
Patient education: Leukemia in children (The Basics)
Patient education: Normal puberty (The Basics)