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 reproductive system. Others can damage a girl's ovaries, which contain eggs, or a boy's testicles, which make 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. You can also talk to the health care team about how cancer treatment will affect fertility.
For an overview of ways to prevent or lower the risk of infertility, see below. Some of these procedures are experimental and available only in specialised centres. In many cases, decisions about fertility preservation are made before treatment begins. This is a difficult time, and often the decision involves a multidisciplinary team of specialists, parents of the young person and the young person.
Resources for young people
CanTeen's resource Maybe later baby? provides age-appropriate information about the impact of cancer on fertility. To download a copy of the book, visit canteen.org.au and search for the resource.
You can also read information specific to children and adolescents at futurefertility.com.au.
"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.
"But I've still got it 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.
"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."
Tell your cancer story.
The options will depend on whether the girl has been through puberty. Most girls go through puberty between 9 and 12 years of age.
Ovarian tissue can be removed and frozen, and transplanted later when needed. This is called ovarian cryopreservation. The ovarian tissue contains underdeveloped immature eggs. Experiments are being done to mature the eggs in a laboratory before freezing, but this technique is under development and not widely available. There has only been one birth worldwide for ovarian tissue removed before puberty.
- Mature eggs can be removed and frozen.
- Taking a long-acting hormone called GnRH may reduce activity in the ovaries or ovarian tissue 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 radiation therapy 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 insufficiency).
The options will depend on whether the boy has been through puberty. Most boys go through puberty by the age of 13-14. At this stage, mature sperm is present in the semen.
- There are no proven fertility preservation methods for boys who have not gone through puberty.
- Freezing testicular tissue (testicular tissue cryopreservation) is being tested on young boys at high risk of infertility. Tissue that contains cells that make sperm is removed from the testicles through a small cut. This technique is experimental and there are no successful pregnancies to date.
Sperm banking ( cryopreservation) can be used to collect, freeze and store mature sperm for future use.
Testicular sperm extraction can remove sperm cells, which are frozen and stored for later use with IVF. This technique is not widely available.
Before or after puberty
The testicles can be shielded during radiation therapy to the pelvis. If this area is not protected, sperm production may be affected, which could make the boy infertile.
Key points about young people and fertility
Fertility and cancer treatments
- While some cancer treatments do not affect a child's developing reproductive system, others can damage the ovaries of girls or the testicles of boys.
- This damage may be temporary or permanent.
- Parents or carers of children under 18 will usually need to consent to any fertility preservation procedures.
- Options will depend on whether the child has been through puberty. The decision will often be shared between the parent, young person and doctor.
Fertility options before puberty
- For girls, ovarian tissue can be removed and frozen and then transplanted when needed (ovarian cryopreservation). This is an experimental procedure.
- For boys, the only available option is still experimental. Immature cells from the testicles are removed, frozen and stored for later use with IVF. This is called testicular tissue cryopreservation.
Fertility options after puberty
- For girls, it may be possible to remove and freeze mature eggs. Some girls are able to take GnRH to reduce activity in the ovaries or ovarian tissue and protect eggs from damage.
- For boys, it may be possible to collect, freeze and store mature sperm cells for future use. This is known as sperm banking.
Expert content reviewers:
Dr Yasmin Jayasinghe, Paediatric Gynaecologist, Royal Children's Hospital Melbourne, Co-chair Fertility Preservation Taskforce, Melbourne, and Senior Lecturer, Department of Obstetrics and Gynaecology, University of Melbourne, VIC; Dr Peter Downie, Head, Paediatric Haematology-Oncology and Director, Children's Cancer Centre, Monash Children's Hospital, and Director, Victorian Paediatric Integrated Cancer Service, VIC; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Aaron Lewis, Consumer; Pampa Ray, Consumer; Dr Sally Reid, Gynaecologist, Fertility SA and Advanced Gynaecological Surgery Centre, Visiting Consultant, Women's and Children's Hospital, and Clinical Senior Lecturer, School of Paediatrics and Reproductive Health, The University of Adelaide, SA; A/Prof Kate Stern, Head, Fertility Preservation Service, The Royal Women's Hospital and Melbourne IVF and Head, Endocrine/Metabolic Clinic, Royal Women's Hospital, and Co-chair, AYA cancer fertility preservation guidance working group, VIC.