Effects of Cancer Treatment on Fertility

When your child is fighting cancer, it can be hard to think beyond the next few days or months. Yet because today's treatments are increasingly effective — the survival rate for childhood cancers is nearly 80%, thanks to medical breakthroughs — it's important to understand how they could affect your child's fertility.
While some treatments have little to no effect on reproductive health, others are likely to damage the testes or ovaries, resulting in temporary or permanent infertility. Your doctor can tell you if there's a chance that treatment might affect the reproductive system.
Once armed with this knowledge, you and your child can consider what preventive measures (like sperm banking or egg preservation) to take before or after cancer treatment to help improve your child's ability to start a family later in life.

Risks of Treatment

Chemotherapy, radiation, and surgery all can have lasting effects on reproductive health. Your child's risk depends on the diagnosis, the type of treatment, and the dose (higher doses are more likely to lead to infertility) — but even your doctor can't predict with 100% certainty what the lasting effects will be.
In general:
Some chemotherapy drugs are more likely to lead to infertility than others. The high-risk drugs most likely to affect reproductive organs are Cytoxan (known generically as cyclophosphamide), Ifosfamide, Procarbazine, Busulfan, and Melphalan. Others, like vincristine and methotrexate, are typically less likely to harm fertility. Some of these drugs also may interrupt menstruation in girls and/or cause early menopause.
Radiation treatments can damage testes or ovaries. If radiation is focused on or near the pelvic area, abdomen, spine, and/or the whole body, it may cause damage to sperm or eggs. Also, radiation to the abdomen, pelvic area, or entire body may affect a girl's uterine function and cause difficulty in carrying a baby to full term. It also can interrupt menstruation in girls or reduce sperm count and motility in boys — these conditions may be permanent or may reverse after the treatment. Kids who have radiation to certain areas of the brain also may have their fertility affected.
If the cancer involves the reproductive organs, surgery might be recommended and doctors might need to remove part of the reproductive organs to remove the cancer.