Effects of Cancer Treatment on Fertility

Because of modern medical care, the majority of children with pediatric malignancies survive. Some therapies have little or no effect on reproductive health. Others, on the other hand, can have a significant impact on fertility later on. However, alternatives such as sperm banking or egg freezing, which may be done before or after cancer treatment, can enable many children to grow up to create their own families.

Some cancer therapies have the potential to harm the testes or ovaries. This can result in infertility, either temporary or permanent. Chemotherapy, radiation, and surgery can all have long-term consequences on fertility. The risk a child faces is determined by their diagnosis, treatment, and medication dosage. Even yet, physicians can't predict for sure what the long-term consequences will be.

Some chemotherapy medications are more likely than others to harm reproductive organs. Cyclophosphamide (Cytoxan), lomustine, ifosfamide, procarbazine, busulfan, and melphalan are the medicines with the highest risk. Others, such as vincristine and methotrexate, are less likely to cause reproductive problems. Some of these medications can also cause early menopause in women.

Testes and ovaries can be damaged by radiation therapy. Radiation directed at or near the pelvic area, abdomen, spine, and/or the entire body has the potential to harm sperm and eggs. Radiation to the abdomen, pelvis, or entire body can also impair the uterus's function, making it difficult to carry a baby to full term. It can also cause menstrual irregularities in girls and a reduction in sperm count and motility (the ability of sperm to move) in boys. These issues may be permanent or they may go away following therapy. Radiation to some parts of the brain may potentially have an impact on fertility. Surgery for cancer of the reproductive organs may necessitate the removal of a portion of those organs in order to eradicate the malignancy.

Many childhood cancer survivors can use options like sperm banking or egg freezing to help them create a family when they're ready. There are plenty of options to consider if your child's therapy has a high risk of infertility.

Sperm banking or "cryopreservation" is the most common, non-invasive option for boys who have gone through puberty. Sperm are collected and frozen for storage in a special facility. Sperm is harvested and frozen before being stored in a separate freezer. Some hospitals provide sperm banking services, or you can visit a clinic that specializes in the procedure.

A more experimental procedure called "sperm aspiration" might be possible for boys that have not gone through puberty. They'll be put under anesthesia so they don't feel any pain. The doctor then inserts a needle into the testes to collect immature sperm cells for later use in in vitro fertilization. IVF is a procedure in which sperm fertilize an egg outside of the uterus and then transfer the fertilized embryo to the uterus.

Cryopreservation of testicular tissue is another option. Doctors freeze testicular tissue in the hopes of producing sperm later. Its usage in prepubescent males is still experimental, and it's unclear how effectively it works. Your doctor can advise you on whether or not this is a viable choice for your child.

Boys who have experienced puberty delays or stunted growth as a result of chemotherapy or radiation should consult an endocrinologist to explore treatment options. If you have any concerns, see your physician.

Some treatment options for girls are egg freezing or freezing of ovarian tissue. Because mature eggs are required for egg freezing, it is only suitable for girls who have reached puberty. They'll take medications to assist the eggs in their ovaries develop. The eggs are then removed during a process performed by physicians. The eggs that have been extracted are stored frozen. Because this technique necessitates ovarian stimulation, it may not be a choice for females who need therapy as soon as feasible. Egg freezing is the greatest approach to preserve fertility if treatment can be postponed safely. These eggs can then be fertilized with a partner's sperm or donor sperm and used in IVF to make embryos.

It may be feasible to freeze ovarian tissue depending on a girl's health (before or after puberty). However, these are experimental procedures, and not all hospitals or clinics have the necessary equipment. One ovary is removed, then sliced into strips and frozen during this operation. Later, this tissue might be reintroduced into the body.

Your doctor may advise against keeping ovarian tissue in specific situations. Because implanting the tissue poses a danger of reintroducing cancer cells, this is the case. Doctors may be able to protect the ovaries from harm depending on the type and target region of cancer treatment. They may be able to relocate them such that they are no longer in the radiation's path (called transposition).

As you research your alternatives, it is your job as the guardian to tell your child as much as you can. This may be difficult; parents and children can frequently find it difficult to talk about sexuality and reproduction.

Even for young children, however, the concept of infertility can elicit complicated emotions that are difficult to understand. When faced with reproductive issues, children may feel bereft or less feminine or manly. This is especially true for teenagers, as sexuality and reproduction are crucial aspects of their growing identities.

Some ways to help your child cope with these potential changes are by talking about all possible risks and outcomes with them. Also, try to be positive and optimistic with them while also keeping their hopes realistic. Make sure that you and your child are getting the right support that you need. To help you do this, here are some things to keep in mind:

Maintaining communication with your child will assist you in planning for therapy and what happens following. Assuage your child's fears by reassuring them that they're not alone, and that many adolescents who undergo therapies that are thought to cause infertility go on to have children. Others become parents through surrogacy, adoption, or other means. Making plans for the future might help your child remain optimistic and focused on getting better.

Be upfront and honest about the possibility of infertility, the success rates of fertility preservation alternatives, and any dangers or issues that may arise. Make certain that both you and your child are aware that nothing is certain. Remind your child that no matter what occurs in the long run, they are still the same person. Even if they are unable to conceive, they can still become parents in the future.

Your child's care team is there to assist you and your family. Inquire about available resources, such as local support groups. A support group or counselor at the hospital or clinic may be able to assist your child deal through the emotions that come with cancer therapy and its side effects.

Whatever outcomes are possible, keep in mind that your child will need all the support they can get. There are lots of options available to avoid infertility for children, but sometimes it is inevitable; being there for your child can offer a lot of emotional support. But the most important thing to remember is listening to your child.