If you’re a parent of a child who has cancer, you know it can be physically and emotionally draining to navigate the diagnosis and treatments, heartbreaking to have to communicate with your child about what they’re facing and challenging to find ways to enjoy time together as a family.
Depending on your child’s age, you may not have thought much about their future fertility before they were diagnosed. But cancer treatments can affect fertility, so it’s important to find out what challenges your child might face down the road and what you can do to best preserve it.
Laurel Truscott, MD, a pediatric oncologist with Banner Children’s, offered words of hope. She said, “Many cancer survivors go on to have children. And in pediatric oncology, our knowledge of, and focus on, later effects continue to expand. As part of this, fertility preservation is becoming a more integral part of the comprehensive care for every child.”
She answered some questions about cancer treatments and fertility in children.
What cancer treatments can potentially impair a child's future fertility?
Chemotherapy, radiation and surgery are all used to treat cancer. In some instances, they can all affect fertility:
- Chemotherapy can affect fertility if a category of chemotherapy agents, called alkylators, are used. They are known to have a higher impact on fertility.
- Radiation can affect fertility, depending on the location and dose needed.
- Surgery can affect fertility, depending on where it needs to be performed.
What types of cancer are more likely to affect fertility?
If the cancer affects the reproductive organs, there’s a bigger chance that it could harm fertility. Cancer in the ovaries or testicles can be especially damaging, as can any cancer in the pelvis. The risk is higher if surgery or radiation are needed in these areas. Risk of impact on fertility also increases if higher doses of alkylator chemotherapy are required.
What can you do to help preserve your child's fertility?
“Make sure your oncologist knows this is a priority for you, as this will help dictate the next steps,” Truscott said. Options vary based on what type of cancer your child has and how healthy they were when they were diagnosed. Your doctor may recommend a consultation with a fertility specialist.
According to the American Cancer Society, options for preserving fertility vary based on your child’s gender and whether they have reached puberty. (Talk to your care team about options if your child is transgender or gender nonconforming).
- Girls before puberty. At this stage of life, girls’ eggs aren’t mature. So, the recommended treatment is to remove and freeze ovarian tissue in an outpatient procedure. You may also want to consider seeing a fertility specialist soon after your daughter reaches puberty and her eggs mature. That’s because some cancer treatments can cause early menopause, so freezing mature eggs might be recommended.
- Girls after puberty. Sometimes, doctors can shield the ovaries or move them aside to protect them from damage from radiation in the abdomen. If there’s a risk of early menopause, your daughter may want to freeze eggs.
- Boys before puberty. We don’t yet have good options for preserving fertility in younger boys, since they don’t make sperm. An experimental technique, called testicular tissue extraction and freezing, is used in some fertility centers. The idea is that the cells in the testicular tissue can be used to produce sperm later.
- Boys after puberty. After about age 13, most boys have sperm in their semen, so sperm banking is an option. Electroejaculation and sperm extraction procedures may also be things you and your son want to consider.
Once therapy is complete, monitoring and consultations with subspecialists can help ensure your child has the best chance of having children of their own when they are ready.
How should the child be included in these discussions?
Children should be included in all discussions about their health care, including those about fertility risk and preservation. “These are just as important for us to discuss at the time of diagnosis as the treatment plan is, so this is information the child should have along with their parents,” Dr. Truscott said.
For children who aren’t old enough to understand discussions about fertility, you may need to talk to them as they approach puberty.
The bottom line
Preserving fertility is an important consideration in treating children with cancer. If your child is old enough to understand, you and your child should talk to their oncologist about options for preserving fertility. To connect with a pediatric oncologist or a reproductive specialist who can help you review the options, reach out to Banner Children’s.