For children and adolescents

Sunday 1 May, 2016

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On this page: Fertility options for girls | Fertility options for boys | Ben's story

When a child or adolescent is diagnosed with cancer, there are many issues to consider. Often the focus is on survival, so children, teens and parents may not think about fertility. However, the majority of young people survive cancer, and fertility may become important as they reach puberty (sexual maturity) and adulthood.

Some cancer treatments do not affect a child’s growing reproductive system. Others can damage a girl’s ovaries, which contain eggs, or a boy’s testes, which contain sperm. Sometimes this damage is temporary, but sometimes it’s permanent. For a general overview of how cancer treatments affect fertility, see women’s fertility and cancer treatments, or men’s fertility and cancer treatments. Talk to your health care team about how your cancer treatment will affect fertility.

For an overview of ways to prevent or lower the risk of infertility, see below. In many cases, decisions on fertility preservation need to be made before treatment begins. For young people under 18, parents will be required to consent to procedures. If the young person is old enough to understand puberty and fertility, they should be involved in the discussion.

Resources for young people

CanTeen’s resource Maybe later baby? provides age-appropriate information about the impact of cancer on fertility.

You can also read information specific to children and adolescents at Future Fertility.

Fertility options for girls

The options will depend on whether the girl has been through puberty. Most girls go through puberty between 9 and 15 years old.

Before puberty
  • Undeveloped, immature eggs may be collected, matured in a laboratory, then frozen. This technique is experimental and not widely available at this stage.
  • Ovarian tissue can be removed and frozen, and transplanted later when needed. This is called ovarian cryopreservation.
After puberty
  • Mature eggs can be removed and frozen.
  • Taking GnRH may reduce activity in the ovaries and protect eggs from damage.
  • Hormone levels can be checked to assess fertility. It’s possible for young women to be fertile, but then go through early menopause.
Before or after puberty
  • The abdominal area can be shielded during radiotherapy to the pelvis.
  • The ovaries can be surgically relocated so they are out of the radiation area (ovarian transposition. If the ovaries aren’t protected, the risk of ovarian failure is higher (premature ovarian failure.

Fertility options for boys

Before puberty
  • There are no proven fertility preservation methods for boys who have not gone through puberty.
  • Testicular sperm extraction is being tested on young boys. Immature sperm cells are removed, frozen and stored for later use with IVF. This technique is still experimental and not widely available at this stage.
After puberty
Before or after puberty
  • The testicles can be shielded during radiotherapy to the pelvis. If this area is not protected, sperm production may be affected, which could make the boy infertile.

Ben’s story

"I was diagnosed with leukaemia when I was 13. I had six weeks of chemotherapy followed by a bone marrow transplant. After this, the doctors checked my fertility and told me I was sterile.

Obviously I wasn’t thinking of having kids at that age, but the possibility of not being able to made me pretty upset. It sent me into a bit of a depression spiral.

Now when I talk about my diagnosis and fertility comes up, I still get upset. It’s patronising as well because a lot of people, even family members, say things like, “Oh you can still adopt.” But to me, it’s not the same.

I’m 20 now and I have a girlfriend. After we’d been going out for two years, I asked her if our relationship was to go any further and we couldn’t have kids, would that be an issue? She didn’t seem to have a problem with it.

But I’ve still got that in my mind that if I do find someone and it gets to that time, and I say, “Oh, I can’t have kids,” they’re just going to get up and go.

My brother told me recently that he was trying for a baby and that made me feel sort of shit, but at the same time I was happy for him.

"After my treatment, the doctors said they’d give me more information later, so I’m waiting to hear about my other options. There are other ways of having kids, so I’ve got to wait and see what happens. No point getting worked up about it yet."

Reviewers: Prof Roger Hart, Medical Director of Fertility Specialists of Western Australia and Professor of Reproductive Medicine, School of Women’s and Infant Health, University of Western Australia, WA; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s and Prince of Wales Hospitals, Director of the Sydney Youth Cancer Service, NSW; Brenda Kirkwood, 13 11 20 Consultant, Cancer Council Queensland, QLD; Dr Michael McEvoy, Director of Clinical Services, Flinders Fertility, SA; Eden Robertson, Research Officer, Behavioural Sciences Unit, Sydney Children’s Hospital, NSW; Kayla Schmidt, Consumer; A/Prof Kate Stern, Head of Fertility Preservation Service, The Royal Women’s Hospital and Melbourne IVF, Head Endocrine and Metabolic Service, Royal Women’s Hospital and Clinical Director, Melbourne IVF, VIC; and Prof Jane Ussher, Centre for Health Research, Western Sydney University, NSW.

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