April 24, 2013

Future Fertility among Survivors

Will I be able to have Children?

Lillian Meacham, MD

This is a tough question I hear almost every week in survivor clinic. We know the cost of cure can sometimes include ovarian or testicular damage which can affect a survivor’s ability to begin puberty, continue to make male or female hormones and affect their fertility. Some chemotherapies (alkylating agents or heavy metals) and radiation that includes the ovary or testes, total body irradiation and high doses of radiation to the center of the brain can affect ovarian/testicular function. It is also important to know there are lots of cancer therapies that DO NOT damage this endocrine system.

For girls, late effects can include not beginning puberty or never proceeding to their first period.

For women, late effects can include: premature menopause (menopause before the age of 40) and infertility.

We have tests that can tell us if you are already experiencing ovarian failure but current research is aimed at trying to determine who is in the very early stages of ovarian failure and with the help of reproductive endocrinologist may still be able to have a child. This can be sorted out by your survivor healthcare team in a cancer survivor clinic.

For boys, late effects can include: not beginning puberty or never proceeding to the final stages of puberty.

For men, late effects can include: inadequate testosterone production and infertility.

We can measure hormone levels and determine if you may need testosterone therapy. Semen analysis can also determine if you a normal sperm count and normal sperm motility. If semen analysis is abnormal, reproductive specialists can assist and often through special interventions are able to fertilize eggs even when sperm counts are very low.

The key to ensuring your reproductive health is regular survivor care directed by a SHP (Survivor Health Plan).

The good news is that if you have low male or female hormone levels these hormones can be replaced by pills, injections, gels or patches. And even if fertility is compromised there can be babies through the help of specialists.

LASTLY, if you don’t desire pregnancy, even if you are at risk for infertility, be smart and use contraception.



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