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After treatment and remission

Fertility after childhood treatment

Many people treated for leukaemia in childhood can later have children, but some treatments affect fertility. This topic explains the risks, checks and options.

Last updated: ~3 min read
Two glowing seeds in the earth.
Figure 1.A question for the future — fertility.

01Short answer

Fertility is the ability to have children. Most people treated for leukaemia in childhood go on to become parents naturally. The risk depends on the type and dose of treatment: with standard ALL treatment it is usually low; high doses of alkylating drugs (such as cyclophosphamide), total body irradiation, stem cell transplantation and radiotherapy to the testes, ovaries or pelvis raise the risk. Radiotherapy to the head can affect the pituitary gland and so change sex hormones (topic “Growth and hormones”). In girls, the ovaries can be damaged: puberty may be delayed or menopause may come early. In boys, sperm production may fall, while hormones often stay normal. Monitoring: the stages of puberty are checked; if needed, hormone tests (for example FSH, LH, AMH and testosterone) and, in adults, a semen analysis are done. These checks do not always give an exact forecast, but they help with planning. Options: if there is a risk, advice from a fertility specialist; using tissue or cells frozen before treatment, if any; freezing eggs or sperm in adulthood; donor cells; and adoption. This is a sensitive subject — give teenagers age-appropriate information and answer their questions openly. If fertility is a worry, a psychologist can also help.

02Simple explanation

Many survivors become parents naturally.

Risk depends on the type and dose of treatment.

High risk: transplant, irradiation, high doses.

Checks: puberty, hormones, semen.

There are options: talk with a specialist.

03Scientific explanation

Girls: the NCI notes that alkylating drugs and pelvic radiotherapy raise the risk of ovarian insufficiency and early menopause.

Boys: according to the NCI, some chemotherapy drugs and radiotherapy can reduce sperm production, while hormone production is often preserved.

Late effects: the NCI PDQ links fertility risk to the type of treatment and the cumulative dose.

Monitoring: the COG recommends checking puberty and hormones and offering reproductive counselling to survivors at risk.

04What happens in the body?

Who is at higher risk?

People who had high doses of alkylating drugs, total body irradiation, a transplant or pelvic radiotherapy.

Girls

The ovaries can be damaged: delayed puberty, irregular periods and early menopause. AMH and hormone tests help.

Boys

Sperm production may fall; testosterone is often normal. In adulthood, a semen analysis gives clarity.

Preservation options

Tissue or cells frozen before treatment, and freezing eggs or sperm in adulthood.

A clear vial with frost crystals.
Figure 2.Preserving fertility.

Ways to a family

Natural pregnancy, assisted reproduction, donor cells and adoption.

A young tree of light with buds.
Figure 3.Thoughts about a future 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 pathway

Steps.

History — Know the treatment history.1HistoryKnow the treatment history.
Puberty — Follow puberty.2PubertyFollow puberty.
Tests — Fertility tests.3TestsFertility tests.
Counselling — Specialist advice.4CounsellingSpecialist advice.
KnowingThe risk becomes clear.
CheckingYour situation is checked.
ChoosingOptions are discussed.

06Fertility risk (simplified)

TreatmentGeneral risk
Standard ALL treatmentUsually low
High-dose alkylating drugsModerate to high
Total body irradiationHigh
Stem cell transplantationOften high
Radiotherapy to the headThrough hormones

* This is a general guide; your doctor assesses your own risk from your treatment summary.

07Key terms

Fertility
The ability to have children.
Alkylating drug
A group of chemotherapy drugs.
AMH
A hormone that reflects ovarian reserve.
Early menopause
Periods stopping before age 40.
Semen analysis
A test of sperm number and quality.
Fertility specialist
A doctor for fertility.

08Key points

  • Know your treatment summary.
  • Follow puberty.
  • Discuss the risk with your doctor.
  • Have tests if needed.
  • Don’t forget contraception.
  • Discuss options with a specialist.

09Frequently asked questions

Will I be able to have children?

Many survivors can; your doctor will assess your risk.

Will my children be healthy?

Studies show that survivors’ children generally do not have a higher risk of birth defects.

When should I be checked?

In adulthood or before planning a family.

How do I tell a teenager?

In an age-appropriate, honest and gradual way.

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. Will I be able to have children?

  2. Will my children be healthy?

  3. When should I be checked?

  4. How do I tell a teenager?

  5. Does this information replace medical advice?

My questions

12Sources

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