Parents of children diagnosed with cancer face many difficult issues in a time of severe emotional distress. They are often so focused on their child's treatment and survival that it is hard to think beyond the present. But about 3 out of 4 children treated for cancer live a long time, and infertility can become an issue for survivors when they reach young adulthood. Not only should the oncology team discuss fertility with the parents, but it should also be mentioned to children as soon as they are old enough to understand. If children are not old enough to discuss fertility while they are being treated for cancer, parents may need to tell them about it around the time that puberty begins. A follow-up visit at the oncology clinic is often a good time to bring up the topic.
Given the chance, many parents will want to save their child's fertility. If children are old enough to understand fertility when they are being treated, they should be asked if they will agree to the treatment. Even though they are not able to give full legal consent because of their age, a child who can understand must generally agree (this is called assent) before these procedures can be done. The parents also must give consent before the procedure, after being told the risks, complications, and success and failure rates. Current options are very limited for boys and girls who are diagnosed with cancer before puberty.
Girls
Preserving fertility
After puberty, a girl can have eggs or embryos frozen, but girls do not produce mature eggs until they go through puberty. Most girls begin puberty between ages 9 and 15. Before puberty, ovarian tissue can be removed in an outpatient surgical procedure and frozen for the future. But even in adult women, ovarian tissue grafted back into the woman's body after treatment has led to very few successful pregnancies. See "Ovarian tissue freezing" in the section called "Preserving fertility in women."
Radiation
If your daughter is getting radiation to her pelvic area, it may damage her uterus. This could make it hard to maintain a pregnancy later in life. Scarring from radiation can hinder blood flow and keep the uterus from expanding fully. If radiation is to be aimed to the abdomen (belly), sometimes the ovaries can be shielded. In some instances, the ovaries may be surgically moved aside, out of the radiation area. They can be put back into the normal position after treatment. See "Ovarian transposition" in the section called "Preserving fertility in women."
Other fertility effects
You will want to talk with your daughter's doctor about the risk of infertility linked to the specific cancer treatment she will get. Sometimes, chemo and radiation can destroy or damage eggs and cause complete infertility.
Puberty and beyond
Some girls will go through puberty and start having periods, but may still need to have hormone levels checked to find out if they are fertile. Some who are fertile in young adulthood may go through early menopause before they have time to have a family. It will be important for your daughter to know that even if she has normal periods, she may still need to see an infertility specialist. It is best to see a specialist early in your daughter's reproductive years, soon after puberty. If available, mature eggs or embryos can be frozen to preserve her fertility in case of early menopause. (See the section called "Preserving fertility in women.")
Boys
Preserving sperm
When boys go through puberty, they begin to make mature sperm. Most boys have some sperm in their semen by about age 13. If a boy has already gone through puberty, sperm banking is a good option, since the frozen samples are not damaged by long periods of storage. Young teens often feel very anxious about masturbating to produce a semen sample, especially if they must talk about it with their parents. Some teens may have an easier time if they are given a vibrator to use in the collection room. Electro-ejaculation or epididymal sperm aspiration has also been used. See the section called "Sperm banking" under "Preserving fertility in men" for more information.
Testicular tissue freezing (an experimental procedure for young boys)
At this time there are no proven fertility preserving methods for boys who have not gone through puberty. Testicular tissue freezing is the only current option, and it is completely experimental in pre-pubertal boys, with no live births so far. Some tissue from the testicles is collected with a biopsy needle. It is expected that the tissue will contain stem cells that will later produce mature sperm. The tissue is frozen with the hope that in the future, it can be used to treat infertility. The thawed tissue might be grafted on to the young man's testicle or stem cells might be taken out and injected into the testicle. One concern is that tissue taken from a boy or man with cancer before treatment could re-introduce cancer cells and possibly cause a return of the disease. The average cost of testicular tissue freezing varies from one center to another. A few centers may be doing research studies that pay for the costs.
Radiation
If your son is getting radiation, it may be possible to shield the testicles. As with adults, chemo and bone marrow transplants can cause infertility in some children.
Other effects
You may want to talk with your doctor about the risk of infertility linked to the cancer treatment your child is going to get. Chemo and radiation can destroy or damage sperm and cause lifelong infertility.
Puberty and beyond
Even with no special measures to preserve fertility, many boys have normal puberty after cancer treatment and are able to have children naturally. After puberty starts, a doctor can check your son's semen to see if he is making sperm. Even if he does not produce normal amounts of sperm, your son may be able to have sperm removed surgically to fertilize an egg.
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