With more and more childhood cancer survivors, there are questions about how the treatment for cancer will affect the person’s ability to have children in the future. A recent long-term follow up study posted encouraging and informative results. The Childhood Cancer Survivorship Study followed patients diagnosed with cancer between the ages 15-44, evaluating over 6,000 men and 5,000 women. Their main outcome was whether the patients became pregnant (or fathered a child) at least 5 years after cancer treatment. They studied the types of cancer and the types of treatment to see if this made a difference.
- female cancer patients were 20% less likely to become pregnant compared to their siblings
- men were 50% less likely to father a child, especially if they were older at diagnosis
- men who did not have “high-risk” therapy were equally likely to father a child (high-risk alkylating agent procarbazine or high dose cyclophosphamide/Cytoxan)
- radiation to the testicles or the ovaries/uterus was associated with a higher risk of infertility
- chemotherapy with alkylating agents was associated with the highest rates of infertility
In addition to infertility, childhood cancer survivors after treatment with chemo or radiation can also experience hormone deficiency (testosterone in males and estrogen/progesterone in women). This can affect the child’s entry into puberty and cause other problems with bone formation, energy, and even cause miscarriages and preterm labor if the uterus is radiated. Some chemotherapy medicines can affect the heart and pregnancy can elicit cardiac problems.
There are several different treatment options for patients to preserve their fertility if they are starting cancer treatment. This includes freezing sperm for men. For women, using Leuprolide shots during chemo may prevent or delay premature menopause. In addition, eggs can be harvested and frozen in 2 weeks with an IVF-like cycle. If her partner wishes to use his sperm, the eggs can be fertilized and stored as embryos.
Luckily, the children born to childhood cancer survivors appear to have no increased risks of birth defects or developmental problems according to most studies. Specific types of cancer are genetic in origin, and testing can be done to see if a person is likely to pass this onto their child. If so, in vitro fertilization with pre-implantation genetic screening can allow identification of the embryos at risk and couples can choose not to transfer these embryos. To find out more about PGS, please review the other blogs and web information at our site www.rscbayarea.com.
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