Fertility in Childhood Cancer Survivors

Image from the2weekwait.blogspot.com
Image from the2weekwait.blogspot.com

Much has been written about infertility as a result of cancer treatments.  Multiple factors contribute to infertility including the type and stage of your cancer, chemotherapy and/or radiation regimen, the surgeries you endured, your age, gender and genetic factors.  While some survivors have had the opportunity to preserve their eggs or sperm prior to treatments many have not.  According to a 2015 North American Society for Pediatric and Adolescent Gynecology study “the reasons for not having a discussion about fertility preservation are lack of time, lack of knowledge, perceived poor success rates of fertility preservation, poor patient prognosis, patient already had children, was single, or could not afford fertility preservation costs.”

Published in 2013, a study titled Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study Cohort found that even though childhood cancer survivors have a greater risk of infertility, their ability to conceive after at least one year was comparable to all clinically infertile women.  A woman is considered to be clinically infertile if she has attempted conception without becoming pregnant for more than one year.  Dr. Lisa Diller, Chief Medical Officer of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and co-author of the aforementioned study notes “women who have a history of childhood cancer treatment should consider themselves likely to be fertile.  However it might be important to see an expert sooner rather than later if a desired pregnancy doesn’t happen within the first six months.”

It is important to seek and receive reproductive healthcare both before and after cancer treatment.  The personalized Survivorship Care Plan given to you at the AYA Program includes the appropriate specialist to see to these needs.  A first step is to ask your doctor to test your for fertility indicators; men can have their semen analyzed and women can undergo assessment of their antimullerian hormone (AMH) which can help predict your level of ovarian reserve.  For tips on starting what may feel like an uncomfortable conversation read our post, Difficult Conversations: Fertility after Cancer.

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