Preserving fertility in boys 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 son’s doctor about the risk of infertility with the specific cancer treatment he will get. Sometimes, cancer treatment can 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 he is old enough to understand. If he is not old enough to discuss fertility while he’s being treated for cancer, parents may need to tell him 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 he’s being treated, he should be asked if he agrees to the treatment. Even though he’s not able to give full legal consent because of his 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 are proven to preserve fertility in children who haven’t gone through puberty. 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.

Testicular tissue freezing (testicular cryopreservation) has been used in young children, but to date there are no reports of successfully putting the tissue back into the testicle after treatment or of fathering a child as a result.

You might want to check into experimental options to find out more. 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.

Options after puberty

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.

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. Electro-ejaculation or epididymal sperm aspiration has also been used. See “Electro-ejaculation” and “Testicular sperm extraction and epididymal sperm aspiration” in Preserving fertility in men with cancer for more information.

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.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: November 6, 2013 Last Revised: November 6, 2013

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