Pediatric Oncofertility: A Guide to Fertility Preservation for Children Before Cancer Treatment
If your child has been diagnosed with cancer, protecting their fertility and ability to have a family in the future starts now
Cancer treatment for children, such as radiation and chemotherapy, can save your child’s life but also damage their current and future fertility, particularly the reproductive tissue and cells in the testes and ovaries, the building blocks of pregnancy. Fertility protection may be available for any age child.
Pediatric oncofertility: a key step in your child’s cancer treatment plan
Time is of the essence so schedule a conversation with one of our fertility specialists today.
Call us: 423-509-8094
- Call to request an appointment and let us know your child is a cancer patient so we can prioritize a fertility preservation consultation. Ask about same-day pediatric consult appointments ahead of urgent cancer treatment.
- Have your child’s cancer diagnosis and treatment plan ready for us to review (your pediatric oncologist can fax your child’s information to 423-643-0699).
- We have accessible options, financial counseling, insurance coordinators and medication discounts.
Protect your child’s ability to have a future family.
Pediatric oncofertility: Why consider fertility preservation before cancer treatment for your child?
When pediatric patients and their parents receive a cancer diagnosis, concerns about a child’s fertility and ability to have a family in the future don’t seem like the immediate priority – and may not even come to mind initially. But for many individuals, the ability to have a family in the future is extremely important, and taking steps to protect your child’s fertility now (ahead of or even during cancer treatment) can preserve your child’s choice to become a parent later.
In the past, there were many barriers to fertility preservation. Doctors, parents or pediatric cancer patients were not always comfortable discussing fertility, and there were many misconceptions about the cost and the availability of procedures.
But if your child has been diagnosed with cancer, protecting their future fertility starts now by planning for their life after cancer.
The goal of this guide is to help you work with a reproductive endocrinologist (fertility doctor) to minimize the risks that cancer treatments pose to your child’s ability to have children of their own someday.
What are the steps of pediatric oncofertility for children after a cancer diagnosis?
Once a child receives a cancer diagnosis, treatment both for cancer and fertility preservation should be pursued right away. Both your pediatric oncologist (cancer doctor) and reproductive endocrinologist can work together to swiftly create a treatment plan, typically following these steps:
- Understand your child’s cancer diagnosis.
- Create a pediatric cancer treatment plan.
- Meet with a TRM provider to create a pediatric oncofertility (fertility preservation) plan.
- Complete pediatric fertility preservation treatment and preventive measures (more details on these below).
- Begin (or resume) your child’s cancer treatment.
Infertility risks: How does cancer treatment impact a child’s fertility?
Radiation and most chemotherapies work by targeting rapidly multiplying cells. This is why slowly dividing cells (such as in brain tissue) are largely unaffected, but the cancer cells are destroyed. Sperm cells and some egg follicle cells are rapidly dividing, so they can be damaged by radiation and chemotherapy, thus damaging the child’s future fertility.
Cancer treatments can be classified according to how likely they are to threaten fertility: low, medium or high. The risk all depends on how cancer treatments affect germ cells:
- In boys, germ cells in the testicles are destined to become sperm.
- In girls, the germ cells in the ovarian follicles have already become eggs.
- In prepubescent children, the reproductive tissue that will ultimately be part of producing sperm and nourishing eggs is also at risk.
Radiation & chemotherapy impacts on a child’s fertility
Radiation to the ovaries or testicles, and certain chemotherapy agents, will destroy germ cells (future sperm) and eggs. Depending on the dose, the duration of treatment and the number of treatments, some treatments will destroy more eggs and sperm than others.
Immediate infertility impacts of cancer treatment
Some of these treatments pose a risk for immediate sterility (inability to have children) meaning a girl no longer has healthy eggs and a boy can no longer produce healthy sperm. Or, children who undergo cancer treatment before puberty may never produce healthy sperm or have healthy eggs after puberty.
Infertility in adulthood
The impact of cancer treatment may not always be immediately evident, especially for children whose infertility may not appear until years later when they try to conceive as adults. For example, boys may produce sperm in a limited manner as men (leading to reduced fertility), and girls may go through premature menopause as women several years after treatment (shortening their fertility time frame).
Age at time of cancer treatment
Younger girls’ fertility may be somewhat protected simply because they have more eggs in their ovaries compared with older women, such as cancer patients in their late 30s. In fact, the older a woman is at the time of cancer treatment, the greater the risk of female infertility. Age is less of a factor for boys.
The person to best quantify the risk is your child’s oncologist.
Fertility preservation options for children facing cancer
Pediatric oncofertility options prior to puberty: shielding, Lupron therapy & tissue freezing
For a child who has not yet reached puberty, parents should know that many fertility preservation options are experimental. If radiation is part of the treatment, sometimes the reproductive tissue of the testes and ovaries can be shielded. At times, the ovaries can be moved out of the way, so they receive a lower radiation dose.
Lupron (leuprolide acetate) is a drug that can temporarily decrease hormonal stimulation. This effectively “shuts down” the ovaries or testicles during chemotherapy, leading to decreased blood flow to these areas to potentially lessen the effects of chemotherapy on the ovaries or testicles. Lupron has no long-term detrimental effects on reproductive function.
Testicular or ovarian tissue can be harvested and frozen and potentially returned to the patient after cancer treatment; however, these options have few success stories. Because of this, Tennessee Reproductive Medicine does not offer reproductive tissue banking. If you are interested in this, we can direct you to centers that provide this service.
Pediatric oncofertility options for boys after puberty: surgery, shielding, sperm freezing & Lupron therapy
Once puberty has started, more options are available to male pediatric cancer patients, including surgery, shielding the testicles from radiation and freezing sperm for later use (cryopreservation). Lupron therapy prior to or during cancer treatment may also limit damage to the reproductive tissue that produces sperm.
More about sperm freezing (sperm cryopreservation)
Boys can produce a semen sample to allow for sperm to be stored. These samples can be obtained through masturbation or electrostimulation. Large numbers of sperm are not needed to use for future fertility treatment and pregnancy in adulthood, so frequently one collection is all that is required. However, multiple sperm collections ahead of cancer treatment may provide better opportunity for success by having more sperm to work with for fertility treatments in the boy’s future.
Pediatric oncofertility options for girls after puberty: surgery, shielding, egg freezing & Lupron therapy
Once puberty has started, more options are available to female pediatric patients, including surgery, shielding the ovaries from radiation, and freezing eggs for later use (cryopreservation). Lupron therapy prior to or during cancer treatment may also limit damage to the reproductive tissue that controls ovulation (the process of the ovaries maturing and releasing an egg that can be fertilized for pregnancy).
More about egg freezing (oocyte cryopreservation)
If treatments can be delayed for up to two weeks after cancer diagnosis, a reproductive endocrinologist can prescribe medications that will stimulate the girl’s ovaries to produce multiple mature eggs at once (instead of the normal one egg per monthly cycle). The fertility specialist then performs an in-office procedure to remove the eggs, which are then stored for future use through egg freezing (oocyte cryopreservation).
If later in life the girl goes through premature menopause as a result of her cancer treatment or finds the eggs she carries are too damaged to create a healthy pregnancy, her cryopreserved eggs can be used to achieve pregnancy. Egg cryopreservation with fertility treatment has excellent pregnancy success rates. If cancer treatment cannot be delayed, it is still worthwhile discussing fertility preservation options with a reproductive endocrinologist, either at the time of diagnosis or soon after completing chemotherapy.
How to make a pediatric oncofertility appointment with TRM
Talk with your child’s oncologist about fertility preservation as soon as possible. If deemed appropriate, you or the oncologist may arrange a consultation with one of our fertility physicians.
If cancer treatment is urgent, we will make efforts to speak with you about your child’s fertility preservation options immediately.
FAQ on pediatric cancer treatment & fertility preservation
What is infertility in children and adults?
Infertility is defined as the inability to conceive after trying for 1 year in women under age 35, or after 6 months in women 35 years and older. While a child would not be diagnosed with infertility before trying to conceive, testing can be done to measure egg and sperm reserves (quantity) to help understand the risk of potentially facing infertility in adulthood.
What is premature menopause in women after cancer treatment?
Menopause occurs when a woman runs out of eggs and has had 12 months without a menstrual cycle. Natural menopause occurs at age 51 on average. Premature menopause is defined as menopause occurring before age 40, and early menopause refers to menopause occurring in the early 40s rather than the 50s. Women who have had chemotherapy or radiation, including as girls, may experience premature menopause any time after cancer therapy. Ovulation after menopause is uncommon, so girls and women who experience premature menopause are usually considered infertile.
If a girl is having her periods after cancer treatment, does this mean she is fertile?
Not always. Some girls and women may have menses in the years following cancer treatment, but this does not always mean they are ovulating and potentially fertile. Some women do not ovulate but their ovaries produce enough hormones to allow the uterine lining to grow; this can grow too thick causing the body to shed some of the lining – mimicking a normal period, but with no ovulation.
How long can a girl’s frozen eggs or boy’s frozen sperm be viable (usable for future treatment)?
Although no one really knows how long eggs or sperm will remain viable after being frozen, a long history of reproductive medicine shows strong promise of success:
- Frozen sperm have achieved pregnancy nearly 30 years after being frozen.
- Egg freezing technology is more recent but has been considered a standard fertility preservation treatment for girls and women by the American Society for Reproductive Medicine since 2012, and frozen eggs have been used successfully even before then.
Will my child’s health insurance cover the cost of fertility preservation?
We file what we can with each patient’s health insurance. If your child has insurance coverage for fertility preservation, the cost can vary with your plan. If your insurance doesn’t cover pediatric oncofertility, we make every effort to make fertility services affordable. For example, we can often get ovulation stimulation medications (which are expensive) donated by the drug manufacturers or at a low cost from cancer patient savings programs like ReUnite and Livestrong.
Do fertility preservation treatments increase my child’s risk for cancer recurrence later in life?
At this time, fertility preservation is considered safe, and there isn’t any evidence that these procedures change a pediatric patient’s prognosis for recurrence.
If my child gets pregnant in the future after undergoing fertility preservation, is there an increased risk of birth defects or health problems in the baby?
Patients who conceive with in vitro fertilization (IVF) do have a slightly higher rate of babies with birth defects compared with the general public, but the risk is relatively low (2.6%-5%). This is the same rate as other infertile patients who conceived without IVF, so it is likely that the increased risk is due to patient characteristics and health history, and not the use of cryopreserved eggs or sperm itself. The vast majority of babies born from fertility treatment are healthy.
Will it be safe for my female child to carry a baby later in life?
Your child’s pediatric oncologist is most qualified to answer this. Some chemotherapies can affect the heart, lungs, uterus or other organs. In these cases, pregnancies can be higher risk for both the mother and the baby. If in the future a girl wants to have a baby using her own eggs (ovulated or eggs that have been frozen), but a medical provider determines it’s unsafe for her to carry the pregnancy herself, a gestational carrier (known as a surrogate) may be an option to have a biologically related child.
