Concerns about fertility after treatment

Various treatments for cancer cause concern about whether you will be able to have babies in the future. Both chemotherapy and radiotherapy, in certain cases, may have a temporary or permanent effect on your fertility (ability to have children). If you are a girl and get the rare (when you are young) cancer of your ovaries or of your uterus (womb) it may mean that you have to have these removed surgically and then it will not be possible to get pregnant the usual way (although you might be able to if you only have one ovary removed).

Certain cancer treatments also reduce boys’ sperm counts, or it may mean that your sperm may not be able to reach and fertilise the egg during sex. If a cancer affects both your testicles, or your prostate (both rare when you are young) you may need to have them removed surgically, and then it will not be possible to father a child in the usual way.

During cancer treatment you may also need treatment with certain hormones which can (usually temporarily) affect both male and female fertility. However, having chemotherapy treatment can sometimes cause you to go through an early menopause (see TIC - Teen info on cancer website for more details).

It is often not possible to predict whether a young person’s fertility will be affected by the treatment they are given for their cancer, and if it will return after their treatment finishes. So young men may be advised to consider ’sperm storage’ before their treatment (see TIC - Teen info on cancer website for more details). This needs to be decided before your treatment - and, when you may still be deeply anxious from being told that you have cancer in the first place, this can be really difficult. Therefore being informed about the possibility of future fertility problems can become just one more issue that you are advised about and that you may also feel that you don’t want to make an immediate decision about. But many of the young men we interviewed were glad that they decided to take the option of having their sperm stored.

None of those we talked to had been able to talk to a counsellor before making the decision. However one man thought that this would have definitely been a good idea, especially since he had to take an HIV test before his sperm was stored.

There are a lot of things to do and decide before treatment. He was advised to store sperm and is pleased that he did.

When he was 14 he decided not to have his sperm stored but now regrets making that decision.

He saw the storing of sperm as part of his treatment, as something he needed to do.

Sometimes the question of storing your sperm does not seem to have been discussed by the doctors - and this can be much regretted if the young person knows they would want a family. One young man, who asked the consultant why this had not happened in his case, was told that the type and quantity of chemotherapy that he was given was thought to be too small to have an affect on his fertility (Interview 11).

He was never offered the possibility of sperm banking and felt devastated when at the age of eighteen he was told that he was infertile.

Very occasionally it is not possible to protect your fertility in the best way, because chemotherapy has to be started straightaway, or there is a need for emergency surgery to remove your reproductive organs. For some of you it was very upsetting to realise that you have no choice. But for others the initial question ’Am I going to live?’ still seems much more important than whether they might want to have children in a future. Those who thought that they would not be able to have children often pinned their hopes on medical advances in being able to treat infertility, or otherwise talked about the possibility of future adoption or fostering.

Discusses that not everyone who wants to will be able to adopt or foster a child.

He is not concerned about whether he will be able to father children in the future -and says he would have sacrificed anything to stay alive.

Did not necessarily want children, but now that she has no ovaries she does not have the choice any more.

There was considerable discussion about the clinic where you (the young men amongst you) had to go to produce samples of your sperm. Several said that it would have been rather less embarrassing if the ’setting’ had been more private but none the less those who had stored their sperm felt reassured that they had done so.

Could hear people talking and laughing from the cubicle where he went to produce his samples. Says that more information should be given about sperm banking.

From the interviews it appeared that doctors are not all equally good at raising the issues concerned with your fertility and what to do about protecting it. Some doctors dealt with it really well, but others were overly formal, or seemed uncomfortable or embarrassed when discussing sperm collection. Sometimes the nurses were better at explaining the details of what was needed.

Explains that the doctors that told him about sperm banking seemed uneasy and embarrassed A young nurse explained it much better afterwards.

Although fertility can return after treatment you will not know when this might happen, and it is important to use contraception (if you don’t want a pregnancy) whenever you have sex. It is also a good idea to use a condom to avoid sexually transmitted infections (see Youthhealthtalk - sexual health website).

His doctor did a good job explaining about sperm banking and also said that he must use contraception and not rely on being infertile.

Girls who are undergoing treatment for cancer may also be advised to store their eggs or their ovarian tissue. For instance a 16-year-old girl was offered a new treatment in which ovarian tissue is frozen (cryo preservation) because it was almost certain that she would become infertile after chemotherapy. However the methods for doing this are still at the experimental stage and there are only a few places where it can even be attempted. Again, because such procedures need time to carry out they may not be possible if treatment is needed urgently.