Fertility Concerns After Childhood Cancer for (Cis)Girls and Women
Fertility (or the ability to have children) after cancer therapy is a very complex topic. It can be hard to tell if and how treatment will affect your fertility. It is related to:
- The doses and types of medications given.
- If radiation or surgery to reproductive organs was done.
- Your age at the time of treatment.
What therapies cause the most risk?
Certain treatments are thought to have a higher risk of affecting fertility. These are:
- Certain anti-cancer medications:
- Alkylating agents: Cytoxan, busulfan, melphalan, BCNU.
- Some FOLFOX regimens.
- Total body irradiation.
- Bone marrow transplant.
- Radiation to the pelvis or brain can affect fertility. Learn more about the risks related to radiation.
We do not know if newer cancer treatments like targeted and immunotherapies will impact reproductive health.
How can I learn about my fertility?
It is very hard to know if you will be fertile after treatment. You could still go into menopause before your peers. There is no way of knowing when this will happen. This is something to think about if you want to have children one day.
It can be very helpful for a survivor who wants to become pregnant to be seen by a fertility specialist who works with cancer survivors. They are often called oncofertility specialists. Testing can be done to check your fertility, including certain hormone levels and a follicle count (a measure of your remaining egg supply).
Learn more about fertility preservation here.
Should I be followed by a high-risk doctor for my pregnancy?
(Cis)women/girls who have had cancer treatment may be at higher risk for issues during pregnancy. You may want to see an obstetrician with experience in high-risk pregnancy. This is important if you had radiation to the abdomen or pelvis area, had surgery involving female reproductive organs, or if you had chemotherapy that can cause heart damage.
Preventing Unplanned Pregnancy
Not having a period does not mean you can’t get pregnant. While your provider does their best to predict if you will be able to get pregnant, this is not a guarantee. Use effective birth control during and after treatment even when you think you cannot get pregnant.
Resources for More Information
Provides education and information to cancer patients regarding fertility risks as well as referrals to access fertility preservation discounts.
Offers support for embryo, semen, oocyte, and ovarian tissue freezing and storage, as well as fertility preservation information.
The Oncofertility Consortium
Provides a telephone support hotline, education, and clinic/center search options for people with cancer coping with infertility or potential loss of fertility due to cancer treatments.
Website of the National Infertility Association. Provides education, advocacy, and information about fertility preservation as well as a database of support groups. Includes information about insurance coverage.
Long-Term Follow Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. Version 5.0, 2018. Accessed at: http://www.survivorshipguidelines.org/pdf/2018/COG_LTFU_Guidelines_v5.pdf