Protecting Fertility in Children With Cancer
If your child has cancer, it can be difficult to think of his/her adult years. But now, 4 from every 5 children endure their cancer. As these children turn into grownups, the impacts of cancer or its treatment on fertility, the capability to have children, becomes something to think about.
Some cancer treatments do not affect a child’s growing reproductive system. Others can damage a woman’s ovaries, which consist of eggs, or a kid’s testes, which contain sperm. This damage may make it difficult to have a baby for a short duration after finishing cancer therapy or for the rest of the individual’s life.
Numerous types of chemotherapy, radiation therapy, and surgery can affect the reproductive organs and have long-lasting impacts on a child’s reproductive health. These sort of side effects from cancer treatment are called late effects. Your child’s risk of having late results depends upon his/her cancer type and treatment plan. Your child’s doctor can tell you if the prepared treatments may have brief- or long-term effects on your child’s reproductive health.
Chemotherapy, radiation, and surgery all can have enduring effects on reproductive health. Your child’s risk depends on the medical diagnosis, the kind of treatment, and the dose of medicine– however even your doctor cannot predict with 100% certainty what the enduring effects will be.
Cancer treatments and fertility
Chemotherapy. A kind of chemotherapy referred to as alkylating representatives is more likely affect fertility than others. Examples of these drugs include:
- Cyclophosphamide (Neosar)
- Ifosfamide (Ifex)
- Procarbazine (Matulane)
- Busulfan (Busulfex, Myleran)
- Melphalan (Alkeran)
Other drugs, like vincristine (Vincasar PFS) and methotrexate (several trademark name), are less likely to impact fertility. A few of these drugs may cause short-term results on a woman’s menstrual cycle (frequently called “period”), but do not cause early menopause (the time of life when menstrual periods stop). The damage to egg reserve and sperm and whether this might result in future infertility depends upon the type and dosage of cancer drug. In general, high dosages of alkylating representatives will cause long-term damage. Treatment plans for pediatric cancers often use the lowest dosages of alkylating agents as possible. This lowers the risk of long-term damage to the reproductive organs. For many cancers, alkylating agents are not used at all.
Radiation. Radiation treatments can damage the ovaries or testes. The risk is biggest when the radiation is focused around the pelvic area, abdomen, spinal column, or whole body. Radiation therapy may harm eggs and affect the release of female hormonal agents (ovarian insufficiency), which might initially look like irregular or no menstruation. In boys, radiation can likewise damage sperm and impact the release of male hormones, which may lead to infertility during the adult years. Children who have radiation therapy to their brains might also have fertility side effects due to the fact that the signaling between the brain and the reproductive organs might be altered. However, this can be easily treated with hormones if the reproductive organs are not harmed.
Surgery. Often cancer is discovered in the reproductive organs. In these cases, the doctor might suggest surgery to eliminate part or all of these organs. These surgeries might affect an individual’s fertility.
Speaking to your child about fertility
You and your child’s healthcare team have to talk about the risk of fertility side effects of cancer and its treatment. You will also need to talk about this with your child in a way that is appropriate for his or her age and advancement. Ask your child’s doctors and nurses to help and support you with this hard discussion. This talk must occur when you feel your child is ready and will understand the news.
Fertility is a complicated idea, particularly for children. However if a child is old enough to comprehend fertility prior to starting treatment, she or he must be associated with the discussion about how treatment may affect fertility. Ask if he or she wants to have any treatments that are meant to help preserve fertility. Children and teens are not able to provide full legal permission due to the fact that of their age. Nevertheless, a child who can comprehend must usually concur (called “assent”) prior to these procedures can be done. Parents also must give approval prior to the procedure. Permission ought to just be given after you have been outlined a procedure’s risks, possible complications, and success and failure rates.
Fertility alternatives for children
Most parents want to make sure their children can have children of their own. There are options to assist protect fertility.
Existing fertility-preserving options are restricted for children who are identified with cancer prior to adolescence. The expenses of these choices can be high, too. Read the ASCO guidelines for fertility conservation.
Radiation therapy to the pelvic area might harm the uterus. Scarring from radiation therapy can slow blood flow to the uterus. This indicates that the uterus will not be able to expand during a pregnancy. This could make pregnancy challenging later in life or increase the risk of miscarriage and premature or low-birth-weight babies.
If radiation therapy is prepared for the abdominal area, often the ovaries can be safeguarded by surgically moving them far from the radiation area. If preventing damage to the ovaries is not possible, there are some other alternatives, including freezing eggs, embryos, or ovary tissue.
Egg or embryo freezing. After a girl has actually gone through the age of puberty, she can have her eggs or embryos frozen. The age of puberty normally happens between the ages of 9 and 15. Embryo freezing is a technique in which eggs are taken from the ovaries, fertilized in a lab, and after that frozen and saved. This method is not often used in girls and teens since it needs sperm from a partner or donor. A more useful and increasingly effective alternative is to freeze eggs. Experts now have the ability to freeze eggs from women as young as 12. This approach needs about 2 weeks of fertility drug treatment, so women who have to start cancer treatment immediately can not freeze mature eggs. When there is not enough time for ovarian stimulation, eggs can be collected with brief or no medication treatment. This yields immature eggs that have to be grown in a laboratory. This is employed vitro maturation and is being investigated. Success rates with this approach are lower than when you freeze mature eggs with complete ovarian stimulation.
Ovary tissue freezing followed by transplant. It is not useful to perform ovarian stimulation to freeze eggs in ladies who have not gone through the age of puberty. One method to preserve fertility is to freeze ovary tissue in ladies who have actually not gone through adolescence and after that transplant it later in life.
One experimental procedure involves eliminating ovary tissue and freezing it for future use. This usually is maded with outpatient laparoscopic surgery and takes about an hour. Laparoscopy uses a thin, lighted tube called a laparoscope. The laparoscope is placed through a little cut in the abdominal wall to remove ovary tissue. When the lady wishes to become pregnant, the tissues can be transplanted back into the hips during an outpatient procedure. If the surgeons do not think the hips is best for hair transplant, tissues can even be transplanted under the skin. This method is sometimes called ovarian cryopreservation.
Since this technique is relatively brand-new, a limited variety of specialists use ovarian tissue freezing in the United States and around the world. For some types of cancer, it may not be suggested because of concerns that the ovarian tissue might consist of cancer cells. A fertility expert who has experience in ovarian tissue freezing and transplant must determine whether you or your child is the right candidate for this procedure.
You may likewise choose not to take any action to preserve your child’s fertility if cancer treatment has a low risk of affecting fertility.
It is possible to avoid or lower the risk of damage in young boys, too. For instance, if your kid is getting radiation therapy, his testicles might be protected. There are a few other fertility choices offered, including sperm banking, testicular tissue freezing, and sperm goal.
Sperm banking. Sperm banking, likewise called cryopreservation, is a common, noninvasive alternative. It is just possible with young boys who have actually gone through adolescence. Most boys have some sperm in their semen by about age 13. Sperm are collected and frozen. The sperm are then stored in a special facility. Some hospitals have sperm bank programs. There are also centers that concentrate on sperm banking.
Testicular tissue freezing. Young boys who have not gone through adolescence might be able to save sperm by freezing testicle tissue. This is an experimental technique and is still being studied, so its chance of success is unknowned. Some tissue from the testicles is gathered and frozen. Ideally, the tissue includes stem cells that will later produce mature sperm. The thawed tissue may then be put into the young man’s testicle. Or stem cells might be secured of the frozen tissue and injected into the testicle. Presently, all of these alternatives are being investigated. There have actually been no reports of testicular transplants in patients. For some types of cancer, your doctor may recommend versus tissue freezing since frozen testicle tissue could bring cancer cells back into the body.
Sperm aspiration. This is another option that is being studied for boys who have actually not gone through adolescence. During this procedure, immature sperm cells are eliminated and saved for future use. The sperm would then be used to fertilize an egg in the lab by in vitro fertilization (IVF). After IVF, the fertilized embryo is taken into a lady’s uterus.
You may also decide not to take any action to protect your child’s fertility if cancer treatment has a low risk of impacting fertility. Numerous young boys go through puberty after cancer treatment and are able to have children naturally. After puberty starts, a doctor can examine your child’s semen to see if he is making sperm.
Questions to ask the doctor
Talk with your child’s doctor about how the treatment plan might impact fertility. Consider asking the following questions:
- Could my child’s treatment strategy affect his or her capability to have children?
- Will this treatment affect my child’s ability to go through adolescence?
- For daughters: What are the possibilities this treatment will lead to early menopause? Can treatment impact some organs (like the lungs or heart) in such a way that will increase the risk of problems during pregnancy or labor?
- Exist other treatments that are not as risky however just as efficient?
- What options are offered to maintain fertility before treatment begins? Will they impact how well the cancer treatment works?
- Would it be valuable to see a fertility specialist prior to treatment starts?
- I’m worried about the costs of maintaining my child’s fertility. Who can assist me with these issues?
- After treatment, how will we know if my child’s fertility has been impacted?