Preserving Fertility in Children and Teens with Cancer

Children treated for cancer can live a long time, and fertility can become an issue for survivors when they reach young adulthood. Talk with your child’s doctor about the risk of infertility with the specific cancer treatment they will get. Sometimes, cancer treatment can cause complete and irreversible infertility.

Not only should the oncology team discuss fertility with the parents, but it should also be mentioned to the child as soon as they are old enough to understand. If not old enough to discuss fertility while 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 the child is old enough to understand fertility issues when being treated, they should be asked if they agree to the treatment. Even though they’re not able to give full legal consent because of age, a child who can understand must generally agree (this is called assent) before a procedure can be done. The parents also must give consent before a procedure, after being told the risks, complications, and success and failure rates.

Fertility options for girls

Before puberty

At this time the only proven option to preserve fertility in girls who had cancer treatment before puberty is to remove and freeze ovarian tissue. (Girls do not produce mature eggs until they go through puberty.)

Tissue from the girl’s ovaries is removed in an outpatient surgical procedure and frozen for the future.  Research is being done on finding and freezing partially mature eggs for the future as well. For more detail on this, see Ovarian tissue freezing in Preserving Fertility in Women With Cancer.

You might want to check into other experimental options to find out what may be available for your daughter. When you see a fertility doctor, ask about any clinical trials that are going on. Depending on where you are, you may have to travel to a larger city or a research center if you’d like to have the option of being part of a research study.

Even without special measures to preserve fertility, most girls will go through puberty and start having periods after cancer treatment, but they may still need to have their hormone levels checked to find out their potential for fertility and/or early menopause. Some who are fertile in young adulthood may go through early menopause before they have time to have a family. Even the best hormone tests cannot always accurately predict the future. It’s best to see a fertility specialist early in your daughter’s reproductive years, soon after puberty. Some young women may choose to freeze eggs to preserve fertility in case of early menopause. See Egg (oocyte) freezing and Embryo freezing in Preserving Fertility in Women with Cancer for more on these procedures.

After puberty

After puberty, a girl can have eggs or embryos frozen. Most girls begin puberty between ages 9 and 15.

If radiation is to be aimed at the abdomen (belly), sometimes the ovaries can be shielded (see Ovarian shielding in Preserving fertility in Women with Cancer). In some cases, the ovaries can be surgically moved aside, out of the radiation area. They can be put back into the normal position (or might move back on their own) after treatment (see also Ovarian transposition).  

Almost all girls treated after puberty will have their periods return, but many who are fertile as young adults may go through early menopause. It’s important for your daughter to know that even if she has normal periods, she could still need to see a fertility specialist. It’s best to see a specialist early in your daughter’s reproductive years, soon after puberty. She may choose to freeze eggs in her late teens or early twenties to preserve her fertility in case of early menopause.

Fertility options for boys

Before puberty

At this time, there are no proven ways to preserve fertility in pre-adolescent boys. Pre-adolescent males have not yet started to make sperm, so there is no sperm to freeze and bank (cryopreserve). Given these circumstances, some centers offer purely experimental techniques called testicular tissue extraction and freezing for the pre-adolescent male. Although there are no sperm available to freeze in these boys, the hope is that the germ cell stem cells that are cryopreserved with testicular tissue the hope that one day, techniques will be developed that will enable this tissue to produce mature sperm.

Testicular tissue extraction in pre-adolescent boys

A small incision is made in the scrotal skin of the testicles. One or more small pieces of testicular tissue is then extracted through this small opening in the skin. These experimental procedures are often done while the patient is undergoing another needed procedure in the operating room, such as surgery to put in a vascular access device or a bone marrow biopsy. The hypothesis is that the tissue will contain sperm stem cells that will one day in the future be used to produce mature sperm. Sperm stem cells from his tissue might one day be transplanted back into the patient’s testicle in the hope that sperm production will develop within the testicle. Alternatively, the sperm stem cells might be grown in a laboratory dish and transformed into mature sperm.

This tissue is removed from a boy with cancer before treatment has begun.  As a result, transplantation of this tissue could possibly re-introduce cancer cells into the patient and thus might cause a return of the cancer.

The average cost of testicular tissue freezing in the pre-adolescent male varies from one center to another, so you will want to ask about the extraction, freezing and annual storage costs. Some  centers will cover the associated costs given that these procedures are done as part of research studies.

It is important to stress that at this time, testicular tissue frozen in pre-adolescent males has not yet resulted in the production mature sperm, and no live births have resulted from this experimental technique, either. The oncology team should discuss fertility issues with the parents, and any available experimental protocols should also be reviewed and considered before beginning cancer treatment.   

After puberty

For adolescent males who are producing sperm, the discussion of fertility threats and fertility preservation methods are best begun at the time of cancer diagnosis. These young males will have varying levels of maturity and understanding of their reproductive development. However, most of these young males will have already have learned about puberty and development at school. Mention of these prior educational sessions can be used as a springboard into the discussion about fertility preservation.

When boys go through puberty, they begin to make mature sperm. Studies have found that testicular volume, not age or reproductive hormone levels, is the best way to know if a boy is able to make sperm. It’s been suggested that all boys with testicular volumes of more than 5 ml should be offered semen banking before cancer treatment – this may be something you want to talk to your son’s doctor about.

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.

But both emotional and physical maturity must be considered. Young teens often feel very anxious about masturbating to produce a semen sample, especially if they must talk about it with their parents or have not done it before. Some teens may have an easier time if they are given a vibrator to use in the collection room. Infertility clinics often have medical grade vibrators, making collection into a more “medical” procedure that may be less distressing.

Even if their testicles make normal levels of testosterone, sperm production might still be damaged. Boys who do not have a normal puberty can take replacement hormones to trigger and support development of an adult male body type. 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.

Electroejaculation or sperm extraction procedures have also been used. See Electroejaculation and Sperm extraction and aspiration procedures in Preserving Fertility in the Man with Cancer.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: November 8, 2016 Last Revised: June 29, 2017

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