Fertility and Women With Cancer

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Preserving fertility in girls and teens with cancer

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’s hard to think beyond the present. But about 4 out of 5 children treated for cancer live a long time, and infertility can become an issue for survivors when they reach young adulthood.

Talk with your daughter’s doctor about the risk of infertility with the specific cancer treatment she will get. Sometimes, chemo and radiation can destroy or damage eggs and cause complete infertility.

Talking to a child or teen about fertility

Not only should the oncology team discuss fertility with the parents, but it should also be mentioned to the child as soon as she is old enough to understand. If she is not old enough to discuss fertility while she’s being treated for cancer, parents may need to tell her 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 when she’s being treated, she should be asked if she agrees to the treatment. Even though she’s not able to give full legal consent because of her 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 the procedure, after being told the risks, complications, and success and failure rates.

Options before puberty

Although it’s being studied, at this time there are no options that have been proven to preserve fertility in children who haven’t gone through puberty. (Girls do not produce mature eggs until they go through puberty.)

One possible option before puberty is ovarian tissue freezing -- having ovarian tissue removed in an outpatient surgical procedure and frozen for the future. In fact, this is the only option at this time to spare a girl’s eggs if she has not entered puberty, but this is experimental. Even in adult women, ovarian tissue grafted back into the woman’s body after treatment has so far led to very few successful pregnancies. See “Ovarian tissue freezing” in the section “Preserving fertility in women with cancer” for more on this.

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 a research facility.

Even without special measures to preserve fertility, some girls will go through puberty and start having periods after cancer treatment, but they may still need to have hormone levels checked to find out if they are fertile. It’s best to see a fertility specialist early in your daughter’s reproductive years, soon after puberty. If available, mature eggs or embryos can be frozen at that time to preserve her fertility in case of early menopause. (See “Egg (oocyte) freezing” and “Embryo freezing” in the section “Preserving fertility in women with cancer” for more on these procedures.)

Options 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 the section called “Preserving fertility in women with cancer”). In some cases, the ovaries may 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 “Ovarian transposition” in the same section.

Some girls will have their periods return after cancer treatment, but they 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’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. If available, mature eggs or embryos can be frozen at that time to preserve her fertility in case of early menopause. See “Egg (oocyte) freezing” and “Embryo freezing” in the section “Preserving fertility in women with cancer” for more on these procedures.


Last Medical Review: 11/06/2013
Last Revised: 11/06/2013