Can I Still Have Children?

Childhood cancer survivors may worry that the treatment they received will affect their ability to have children.

Infertility can be a side effect of certain cancer treatments. Infertility is the inability to achieve a pregnancy after a year or more of regular sexual intercourse without using any birth control methods.

Radiation and surgery to specific parts of the body and certain chemotherapy drugs may have an impact on fertility. Certain treatments may also affect a woman’s ability to carry a pregnancy.

Female cancer survivors may be at risk for early menopause. Menopause refers to the time in a woman’s life when she stops having a menstrual period and is no longer fertile. After menopause women no longer mature and release eggs.

There are some treatments for infertility.

Possible fertility and childbearing outcomes after treatment

Normal fertility
Reduced span of fertility — the timeframe in which pregnancy can occur is shortened
Compromised fertility — getting pregnant may be hard
Sterility — inability to get pregnant
Difficulty with carrying a pregnancy until it is time to give birth

Use protection during sex

Some survivors may mistakenly think they are not able to get pregnant. This assumption can lead to unintended consequences.

Sexually active survivors who are not trying to have children should always use effective birth control.
All survivors should use condoms during sexual intercourse to prevent sexually transmitted infections (STIs).

Treatments that may affect fertility and childbearing

Chemotherapy

Alkylating agents and similar chemotherapy drugs can cause problems with fertility:

Alkylating Drugs	Heavy Metal Drugs
Busulfan Carmustine (BCNU) Chlorambucil Cyclophosphamide (Cytoxan®) Ifosfamide Lomustine (CCNU) Mechlorethamine (nitrogen mustard) Melphalan Procarbazine Thiotepa	Carboplatin Cisplatin
	Non-classical alkylators
	Dacarbazine (DTIC) Temozolomide

It is not yet known if newer treatments such as immunotherapy and targeted therapies have any effects on fertility.

Radiation therapy

Radiation therapy to the pelvic area can have an impact on fertility. It can harm reproductive organs as well as reduce the number and quality of a woman’s eggs or a man’s sperm.

Radiation therapy to the pelvic and abdominal area may also affect a woman’s ability to carry a pregnancy.
Surgery

Surgical procedures that affect reproductive organs can have an impact on fertility.
Treatments to brain

Treatment to the region of the brain that contains the hypothalamus and pituitary gland can affect hormone production that regulates sperm and egg development.

But each case is different. Having these therapies does not automatically mean the affected person will not be able to have children.

Knowing your treatment history can help prepare you to make informed choices in the future.

Survivors are encouraged to talk to their care provider about whether to consider fertility testing. Having this knowledge can help people make decisions about family planning.

Fertility tests for females

Screening may start with a physical exam, including a pelvic exam or pelvic ultrasound, and blood tests to look at overall health. The provider will also order tests to measure the level of certain hormones in the blood. These hormone tests may include:

Follicle-stimulating hormone (FSH): FSH stimulates egg production and a hormone called estradiol. High FSH levels may mean that a woman has ovarian failure, is perimenopausal or in menopause. Low levels of FSH may mean a woman has stopped producing eggs.
Estradiol (estrogen): Estradiol is a form of the hormone estrogen. Estrogen is the hormone that helps develop and maintain female sex characteristics.
Luteinizing Hormone (LH): In women, LH causes the ovaries to release an egg during ovulation. In men, it stimulates the production of testosterone in the testes. Testosterone stimulates sperm production and causes physical changes in men such as development of sex organs, deepening of voice, increasing the growth of facial and body hair, and enhancing muscular development. Levels of LH that are too low or too high may cause infertility.
Progesterone: This test can tell whether ovulation has occurred and whether the ovaries are producing a normal amount of this hormone.
Anti-Müllerian hormone (AMH): Levels of AMH can help determine the quantity and quality of a woman's remaining egg supply. In women, AMH levels typically start to drop after puberty and throughout adulthood until she reaches menopause.

In some cases, the provider may recommend further testing.

These tests may include imaging studies to examine the fallopian tubes and uterus.

Imaging tests for fertility

X-ray hysterosalpingogram (pronounced HISS-tuh-roh-sal-PING-goh-gram). A health care provider injects a liquid into the cervix to fill the uterus. If the fallopian tubes are clear of blockages, the liquid will flow out the end of the fallopian tube into the peritoneal cavity. Movement of the liquid is monitored by X-ray fluoroscopy.
Laparoscopy (pronounced lap-uh-ROS-kuh-pee) is a surgery in which a small viewing instrument, called a laparoscope, is inserted through a small cut in the abdomen to examine the female reproductive organs. If the procedure identifies blockages in the fallopian tubes, the blockages may be surgically treated with instruments attached to the laparoscope.
Transvaginal ultrasound — An ultrasound looks at the internal organs using sound waves. A wand inserted into the vagina applies sound waves to the body. This gives a better view of the female reproductive organs.
Hysteroscopy (pronounced hiss-tuh-ROS-kuh-pee) — A hysteroscope is a long, thin camera that is inserted through the vagina and into the uterus.
Saline sonohysterogram (pronounced sah-noh-HISS-tuh-roh-gram) — A provider injects sterile saline into the cervix to fill the uterus. Organs are visualized with transvaginal ultrasound.

Fertility tests for men

Screening may start with a physical exam and medical history.

The provider may order a semen test and blood tests to measure the level of certain hormones in the blood, such as testosterone, follicle-stimulating hormone (FSH), thyroid, and prolactin.

Semen is the bodily fluid in men that contains sperm. A pregnancy happens when sperm from a man and an egg from a woman unite. A semen analysis, also called a sperm count, measures the quantity and quality of a man's semen and sperm.

Results of the analysis include:

Volume — Amount of semen
Sperm count — Number of sperm per milliliter
Sperm movement — How active the sperm is
Sperm shape — Abnormal shape can affect fertility.
White blood cells — May be a sign of an infection

If any of these results is not normal, the provider may order more tests.

These tests may include:

Biopsy of the testicle — Sperm is taken from the testicle and analyzed.
Genetic testing — Testing can find chromosome abnormalities that may cause the lack of sperm or lead to developmental problems in offspring.

Fertility preservation options

Survivors who are interested in knowing more about their fertility should consider talking to their health care provider. They may be eligible for fertility preservation options such as egg or sperm banking.

Family planning options

There are several family planning options for survivors who are infertile or who have trouble carrying a pregnancy.

Survivors are encouraged to discuss family planning options with their health care provider. These options may include:

Donor egg or sperm
Donor embryos
Surrogacy
Adoption

Financial resources

Fertility options can be expensive and often are not covered by insurance. Survivors are encouraged to talk with a social worker at their survivorship clinic or through their primary care provider about financial support resources.

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Reviewed: June 2020