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After treatment and remission

Fertility

Fertility is the ability to have children. Leukaemia treatment sometimes affects it, but many people have children after treatment. This topic explains what the risk depends on, how fertility is checked and what options exist.

Last updated: ~3 min read
A glowing seed in cupped hands of warm light.
Figure 1.Fertility is the possibility of having children.

01Short answer

How leukaemia treatment affects fertility depends on the type of treatment, the dose and age. The highest risk comes with high doses of alkylating medicines (such as cyclophosphamide), total body irradiation and the conditioning given before a stem cell transplant. Many standard ALL treatment plans harm fertility less. In women, treatment can reduce the egg reserve: periods may stop for a time and then return, but menopause may come earlier (topic “Hormones”). In men, sperm counts may fall or sperm may temporarily disappear; sometimes they recover years later. Fertility is checked with tests: in women the AMH hormone and an ultrasound, in men a semen analysis. Before treatment, eggs, sperm or tissue can be frozen; after treatment, a fertility specialist can discuss options such as assisted reproduction, donor cells and adoption. If you are planning a pregnancy, discuss the timing with your doctor.

02Simple explanation

The risk depends on treatment type, dose and age.

High risk: alkylating medicines, total body irradiation, transplant.

Many people go on to have children.

Checks: AMH, ultrasound, semen analysis.

Options: freezing, assisted reproduction, other paths.

03Scientific explanation

Risk factors: according to the NCI, a high total dose of alkylating medicines, total body irradiation, abdominal or pelvic radiation and older age at treatment (in women) raise the risk to fertility.

In women: the COG recommends monitoring periods, puberty and hormones (FSH, LH, oestradiol, AMH) for those at risk; periods returning does not mean full fertility.

In men: the NCI notes that sperm production may recover over years after treatment, or may not; a semen analysis gives accurate information.

Preservation: ASCO and the ACS recommend discussing fertility risk before treatment and, where possible, freezing eggs, embryos, sperm or tissue.

04What happens in the body?

What is fertility?

It is the ability to have children. It depends on the health of the ovaries or testicles and on hormones.

Which treatment affects it?

High doses of alkylating medicines, total body irradiation, pelvic radiation and transplant. Many standard plans have less effect.

Preservation before treatment

When possible, eggs, embryos, sperm or ovarian/testicular tissue can be frozen. Sometimes urgent treatment leaves no time for this.

Ice-blue crystals in a protective capsule.
Figure 2.Cells can be stored frozen.

Checks after treatment

In women AMH, FSH and an ultrasound, and in men a semen analysis, give a picture of fertility. A fertility specialist explains the results.

Paths to a family

Natural pregnancy, assisted reproduction, using frozen cells, donor eggs or sperm, and adoption. Support from a psychologist and family helps.

There are different paths to a family
Figure 3.There are different paths to a family.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05The fertility path

Steps.

Ask — Ask about fertility early.1AskAsk about fertility early.
Test — Hormone tests, ultrasound, semen test.2TestHormone tests, ultrasound, semen test.
Specialist — See a fertility specialist.3SpecialistSee a fertility specialist.
Options — Different paths to a family.4OptionsDifferent paths to a family.
KnowledgeYou know your risk.
ChoiceOptions are clear.
SupportDecisions made together.

06Fertility and treatment (simplified)

TreatmentRiskWhat can be done
Many standard plansLow–moderateMonitoring, tests
Alkylating medicines (high dose)HighPreservation beforehand, tests
Total body irradiation, transplantVery highPreservation, fertility specialist
Pelvic radiationHighFertility specialist

* Your doctor assesses your own risk.

07Key terms

Fertility
The ability to have children.
AMH
A hormone that reflects the egg reserve.
Semen analysis
A test of sperm.
Alkylating medicine
A type of chemotherapy medicine.
Cryopreservation
Storing cells by freezing.
Fertility specialist
A doctor for fertility questions.

08Key points

  • Many people have children after treatment.
  • The risk depends on treatment.
  • Have your fertility tested.
  • Talk to a fertility specialist.
  • Discuss pregnancy timing with your doctor.
  • Ask about contraception too.

09Frequently asked questions

My periods came back — does that mean my fertility is normal?

Not necessarily; tests give more accurate information.

Are children born after a parent’s treatment healthy?

Studies show the risk of birth problems in survivors’ children is usually not raised.

When is it safe to get pregnant?

It depends on the treatment; discuss it with your doctor.

There was no time to freeze — what now?

There are options after treatment too; talk to a fertility specialist.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. My periods came back — does that mean my fertility is normal?

  2. Are children born after a parent’s treatment healthy?

  3. When is it safe to get pregnant?

  4. There was no time to freeze — what now?

  5. Does this information replace medical advice?

My questions

12Sources

  1. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  2. National Cancer Institute. Fertility Issues in Girls and Women with Cancer
  3. National Cancer Institute. Fertility Issues in Boys and Men with Cancer
  4. American Cancer Society. Fertility and Sexual Side Effects
  5. MedlinePlus (U.S. National Library of Medicine). Infertility
  6. National Cancer Institute (NCI). Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version
  7. National Cancer Institute (NCI). Follow-Up Medical Care
  8. National Cancer Institute (NCI). Cancer Survivorship
  9. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  10. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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