Reproductive health side effects in young adults

“Fertility” describes the ability to conceive a biological child. Human reproduction requires three elements: mature sperm, mature eggs, and a person with a uterus to carry the pregnancy and give birth. Some cancers and some cancer treatments affect fertility. 

When first diagnosed with a blood cancer, your primary concern may be your upcoming treatment and long-term survival. You may not be thinking about whether you can or want to have children in the future. However, information about the potential effects of your treatment can help you take steps to leave your options for family building open after cancer treatment. 

Before treatment considerations

Addressing fertility and sexual health is an essential part of cancer treatment and follow-up care. It is important to talk with members of your healthcare team before treatment begins about the potential effects of your treatment. 

Risk factors

Not all cancer treatments affect fertility. Your risk depends on several factors, including 

• Your age at the time of diagnosis and treatment
• The type and dosage of chemotherapy drug(s) you receive
• Alkylating agents, for example cyclophosphamide, ifosfamide, and procarbazine, along with the drug cisplatin, have the most significant effect on fertility. Other drugs are generally less toxic to sperm-forming cells and eggs, but can also cause infertility, especially when used as part of a combination of therapies.
• The location and dosage of radiation
• Exposure to the testes may destroy cells that form sperm.
• Exposure to the ovaries may destroy eggs.
• Exposure to the pituitary gland in the brain or thyroid at the base of the neck may cause changes in secretion of hormones that regulate puberty and fertility.
• Exposure to the uterus (womb) may cause damage making it difficult to carrry a pregnancy safely.
• The duration of treatment
• Whether you received a blood or marrow stem cell transplantation, which is associated with a high risk of infertility
• The type of cancer
• Certain cancers cause a decrease in the number of sperm. For example, patients with Hodgkin lymphoma may have a low sperm count at the time of diagnosis due to the effect of the cancer itself. 

Possible effects on eggs 

The ovaries (the organs where eggs are produced) are especially susceptible to damage during cancer treatment because they contain cells that cannot be regenerated after birth. When a person with ovaries is born, nearly one million follicles that contain eggs are present in their ovaries; but they cannot produce new eggs. Therefore, the total effect of cancer treatment on fertility will depend on how many undamaged follicles and/or eggs remain after treatment has ended. 

Cancer treatment can also cause: 

• Lower-than-normal estrogen production
• Estrogen plays a role in ovulation (when the ovary releases an egg), preparing the uterus for pregnancy, sexual functioning and desire.
• Disruption of the menstrual cycle (periods), which may be temporary or permanent
• Premature ovarian failure (POF), also called “premature menopause.” This is a loss of ovarian function in a person younger than 40. When POF is caused by cancer treatment, it is unlikely that a person will have subsequent menstrual periods or be able to become pregnant without medical intervention. Generally, POF is managed with hormone (estrogen and progesterone) replacement therapy.
• People with POF are encouraged to eat a healthy diet and exercise regularly (aerobics and weight training) to decrease the health risks of osteoporosis and heart disease. A doctor may also prescribe calcium and vitamin D supplements for bone health.
• Even though some people may retain a degree of ovarian function after treatment or they may start menstruating again, they may develop POF and have trouble conceiving later in life.  

Possible effects on ability to carry a pregnancy  

Cancer treatment can affect a person’s ability to carry a pregnancy safely. 

• Radiation to the pelvic area can cause damage to the uterus (womb) and increase the risk for infertility, miscarriage or premature birth.
• Treatment can also cause damage to organs (such as the lungs or heart) that could increase the risk of problems during pregnancy, labor and delivery. 

Possible effects on sperm  

Sperm is made and stored in the testes. Sperm production begins at the onset of puberty and continues throughout the person’s life, although the amount and quality of sperm can naturally decrease with age. Cancer treatment can cause: 

• Lower-than-normal testosterone production
• Testosterone is required for sperm production and plays a role in sexual functioning and desire.
• Loss of sperm stem cells that mature into sperm, causing sperm to stop producing.
• Changes to sperm production can be temporary or permanent.
• If sperm production recovers, it can take from 1 to 3 years, and sometimes longer. 

Analysis of a semen sample can indicate whether you are making sperm. This can be done after treatment is completed. Talk with your doctor about when to be evaluated. 

Learn more about fertility and reproductive health, including options for egg or sperm preservation, and questions to ask your doctor.