Future fertility can be impaired after treatment with chemotherapy that includes alkylating agents or heavy metals, radiation to the ovaries/testes or hypothalamus, bone marrow transplant and surgery on the reproductive system. Male survivors are more likely to have infertility that female survivors. In females, being older and pubertal seem to increase risk for treatment-related infertility. Age at diagnosis does not seem to have an impact in males. Consults for fertility preservation should be offered to patients when appropriate.
- Infertility has been self-reported in 2 of 3 males and 1 of 7 female childhood cancer survivors.
- Infertility is one of the top concerns of young adult survivors of childhood cancer.
- Many survivors have incorrect perceptions of their personal risk for infertility.
- Younger age (especially being pre-pubertal) is protective in females.
- Fertility status assessment should be offered as part of long-term follow-up for survivors.
- Infertility is defined as the inability to achieve pregnancy after 1 year of regular, unprotected sexual intercourse. As such it is a very late (in onset) treatment related late effect and this outcome can be difficult to measure and can only be collected through self-report.
- It is more common in male survivors.
- In female survivors it is more common in those who started puberty and were older at the time of treatment.
- Cancer treatments associated with infertility include:
- Alkylating agent or heavy metal chemotherapy
- Radiation exposure to the ovaries/testes
- Radiation exposure to the hypothalamus
- Tumor or surgery on the hypothalamus, pituitary, ovaries/testes or genitourinary system.
- Bone marrow transplant
- Standard of care fertility preservation options prior to gonadotoxic therapy include:
- Sperm cryopreservation for males who have achieved Tanner III genitalia.
- Ovarian stimulation and oocyte harvest for cryopreservation for females who have achieved menarche.
- Ovarian tissue cryopreservation for females at high risk for future infertility (experimental label lifted 12/2019).
- There is limited data on live births from tissue harvested from pre-menarchal and pre-pubertal girls.
- Experimental fertility preservation option
- Testicular tissue cryopreservation for prepubertal males at high risk for future infertility. Currently, there have been no human births using this option.
- Adolescent young adults survivors should be offered personalized information about their risk for future infertility and fertility status assessment.
- For some females post-treatment ovarian stimulation and oocyte harvest may be an option.
Continuing Education Module
Health Links - Teaching Handouts from the Children's Oncology Group