Cancer and Fertility: Protecting Your Options

Some cancer treatments can affect your ability to have children later. This is a real, well-documented side effect. If having children someday matters to you, raise it with your care team as early as you can. The best options to protect fertility usually need to happen before treatment starts.

NCI says certain chemotherapy drugs, called alkylating agents, present a high risk to fertility. They can damage sperm-forming cells, and they can cause the ovaries to stop developing mature eggs. Radiation to the pelvis or brain can affect fertility too. So can hormone therapy in men, and surgery on reproductive organs or the pelvis. Risk depends on the exact treatment, the dose, and your age. Your team can explain what your plan likely means for you.

Sperm banking is the most common option for men. You give a sample before treatment. It is frozen for later use with in vitro fertilization. Testicular sperm extraction is another option, for males who cannot produce semen or have not yet gone through puberty. NCI says testicular shielding, a protective cover placed on the outside of the body, can shield the testicles from scatter radiation during pelvic treatments.

For egg and embryo freezing, hormone stimulation produces mature eggs, which are collected and frozen for later use with in vitro fertilization. Ovarian tissue freezing is another option. NCI says it can help girls before puberty and people who cannot delay cancer treatment. NCI also lists GnRH agonists, drugs that cause the ovaries to shut down, and ovarian shielding. Ask your team whether any of these fit your situation.

NCI says to discuss fertility before cancer treatment begins. NCI says discussing fertility before starting treatment is essential. Collection takes time to arrange, which can feel hard when you need to start treatment quickly. Ask your oncologist directly whether a delay is safe for your specific case. Never delay or change treatment on your own.

Fertility preservation can cost money. NCI lists the Oncofertility Consortium, the Alliance for Fertility Preservation, and Livestrong Fertility as sources of information on financial help and clinic referrals; the Alliance details insurance coverage laws by state. Ask your cancer center's social worker about these resources directly. Cost alone should not be a silent barrier.

Some people feel embarrassed bringing up fertility when they are focused on surviving cancer. That feeling is understandable, but this concern is worth real attention. You are not distracting your team from more important things by asking. This is part of your care.

You do not need a firm plan for parenthood to ask about fertility. NCI notes that survivors had fewer regrets after talking with fertility specialists, whatever they chose. Ask your team even if children feel like a distant, uncertain question right now.

• Is my specific treatment plan likely to affect my fertility?
• Is a short delay in treatment, to arrange fertility preservation, safe for me?
• Can you refer me to a fertility specialist before treatment starts?
• Is there financial help if cost is a concern?

• National Cancer Institute — Fertility Issues in Boys and Men with Cancer.
• National Cancer Institute — Fertility Issues in Girls and Women with Cancer