Sexuality and Infertility in Survivors of Childhood Cancer
Coordinator Follow-up Clinic, University of Rochester
Abstract of a paper presented at the 25th Anniversary Conference of Candlelighters, July 15, 1995, Washington, D.C.
Infertility can be one of the most devastating effects of cancer therapy. Some children treated for cancer are at risk of varying degrees of testicular or ovarian failure depending on their treatment protocols.
There are many factors that determine whether an individual will experience total or partial testicular or ovarian dysfunction following treatment. The patient's sex, the age at diagnosis, the dose and the area of radiation, and the dose and type of chemotherapy are all factors that affect fertility.
Primary failure occurs when treatment (chemotherapy or radiation therapy) directly damages the ovaries or testes. Chemotherapeutic agents most frequently used that cause infertility include Cytoxan, ifosfamide, and combination therapies like MOPP and COPP. Other drugs that have also been implicated in gonadal dysfunction include DTIC, Nitrogen Mustard, BCNU, Procarbazine, Melphalan and Busulfan. Radiation therapy to the pelvis and abdomen will affect both males' and females' fertility. Spinal radiation may affect ovarian function in up to 50% of women.
Secondary gonadal failure occurs when radiation is delivered (>4000 cGy) to the pituitary gland which is located in the brain. Patients who are treated for brain tumors are at the highest risk.
Patients attempting to determine their risk of fertility problems should first check with the treating institution to determine the specific treatment received. Second, women should be evaluated by a reproductive endocrinologist and men schould be evaluated at an andrology clinic.
Fertility issues should be handled thoughtfully and carefully. A full evaluation is necessary to determine the degree of damage, what future fertility potential exists for survivors (e.g. women who received ovarian toxic treatment are encouraged to have children prior to the age of 30 due to the risk of early menopause), and if specific procedures can result in pregnancy.
Fertility issues are constantly being studied and new procedures discovered that many enhance a survivor's chance for becoming a biological parent. Alternatives to infertile couples include adoption and foster parenting.