Reviewed by: HU Medical Review Board | Last reviewed: March 2018 | Last updated: November 2020
Some treatments for blood cancer may impact a person’s fertility, or the ability to have children. Though not everyone wants to have children, many people want to have the choice. Whether treatment for blood cancer will impact an individual’s fertility depends on several factors, including the exact type of treatment, the person’s age and general health, and their response to the treatment. Because some of the options that allow for preserving the ability to have children require action to be taken before treatment starts, it is best to talk to your doctor about the potential side effects of treatment, including its impact on fertility, prior to beginning treatment.1,2
Treatments that can affect fertility
Chemotherapy and radiation may affect a person’s fertility, and these potential side effects may occur years after treatment. Some chemotherapy agents, like alkylating agents (such as cyclophosphamide or procarbazine), can have a more significant effect on fertility than other drugs, however, it’s best to discuss all possible side effects with a physician before treatment begins. Stem cell transplantation, which involves high doses of chemotherapy and an infusion of stem cells, is also associated with a high risk of infertility. Radiation to certain areas may cause infertility, as exposure to the testes, ovaries, or the pituitary gland can all potentially cause infertility.1
Preserving fertility before starting treatment
If the recommended treatment has the potential to cause fertility issues, the patient may choose to take actions before treatment begins to preserve his or her ability to have children.
For males, options include:
- Sperm banking, also called cryopreservation, which freezes and stores a collection of semen, is the option with the highest likelihood of success for male cancer survivors. Semen may be collected through masturbation, electroejaculation (a procedure in which an electrical current is used to stimulate ejaculation while the man is under anesthesia), or by testicular sperm extraction (a procedure performed under anesthesia in which a sample of tissue is removed from the testes).
- Testicular tissue freezing is an experimental procedure that can be performed on boys who have not yet gone through puberty, as an option to freeze testicular tissue for possible future use (As this is still experimental, additional research is needed to determine the success rate).
- The testicles can be shielded from radiation by covering them with external shields. The shielding must be used for each radiation treatment. However, if the testicles need radiation, this will not be possible.1
For females, options to preserve fertility potential include:
- Freezing eggs involves taking hormone injections for approximately 10 days to stimulate the ovaries and then retrieving the eggs under anesthesia. The removed mature eggs are stored for possible future use.
- Freezing embryos also involves taking hormone injections for approximately 10 days to stimulate the ovaries and then retrieving the eggs under anesthesia. Next, the retrieved eggs are fertilized by a partner’s or donor’s sperm to create embryos. The embryos are frozen for possible future use. Freezing embryos is the option with the highest likelihood of success for female cancer survivors.
- Ovarian tissue freezing is a procedure that can be performed on girls who have not yet gone through puberty or on women who must begin treatment for blood cancer immediately and do not have the time to undergo hormone injections and egg retrieval. Part of an ovary or an entire ovary is removed under anesthesia and frozen for potential future use. Additional research is needed on this option, but a small number of pregnancies have resulted from re-implanting ovary tissue.
- Ovarian transposition involves moving the ovaries (during a surgical procedure) to another part of the body. This procedure may be performed if the ovaries are in the area where radiation may be directed.
- Another possible way to protect ovarian function during chemotherapy is by using gonadotropin-releasing hormones (GnRHs), which may protect the eggs from damage. Additional research is needed to determine the success of this option.1
Other ways to have a family after treatment
In some cases, prior action to preserve fertility is not an option, such as in cases where treatment must be started right away to control the blood cancer. Other options to have a family include:
- Using donor sperm or eggs to create an embryo, and implanting the embryo into the mother using in vitro fertilization (IVF)
- Using donor embryos, which may be donated by other couples who have undergone IVF for infertility
- Using a surrogate, a woman who can carry the embryo as a gestational carrier
- Adopting a child1