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For LGBTQ+ youth

If your child or teenager identifies as lesbian or gay, and/or is a transgender or gender non-conforming person, please talk to their cancer care team about any needs that are not addressed here. 

Studies show that many doctors and nurses don't know the right questions to ask. 

Let the cancer care team know your child’s sexual orientation and gender identity, including what sex they were at birth, how they describe themselves now, organs they were born with and any gender affirming treatment they have received. Giving providers this information will help your child get the personalized care they need.

Causes of fertility problems in children and teens

The following types of cancer treatment may have long-term effects on fertility for children and teens.

Chemotherapy

A certain type of chemo medicines called alkylating agents are more likely to affect fertility than other types of chemotherapy. Some examples of alkylating agents include:

• Cyclophosphamide
• Ifosfamide
• Procarbazine
• Busulfan
• Melphalan

In general, high doses of alkylating agents are most likely to cause infertility. Doctors try to use the lowest possible doses for children. This lowers the risk of permanent damage to reproductive organs. Also, many pediatric cancers are not treated with alkylating agents. Ask the cancer care team about possible fertility risks with any anti-cancer medicines prescribed for your child.

Radiation therapy

Radiation therapy can damage the ovaries or testes. The risk is highest when radiation is focused on the pelvis, abdomen (belly), spine (back bone), or the whole body.

Girls: Radiation therapy that affects the ovaries can damage the eggs and decrease hormone production. Girls who have not yet started their periods (menstruation) may experience delayed puberty. Girls who have started their periods might have irregular periods, or their periods may stop during treatment.

Radiation therapy can also scar the uterus. This might prevent the uterus from enlarging enough during a pregnancy, increasing the risk of miscarriage and premature or low-birth-weight babies.

Boys: Radiation therapy might damage sperm and affect hormone production. For boys who have not gone through puberty, this might delay or prevent normal puberty. Damage to the testicles can cause temporary or permanent infertility.

All children: Radiation therapy to the brain may also cause fertility side effects. Radiation treatment might damage the brain’s signals to and from the reproductive organs. If reproductive organs are not damaged, hormone treatment helps fix this problem.

Surgery

If cancer is found in your child's reproductive organs, the cancer care team might suggest surgery to remove part or all of these organs. These surgeries can affect fertility.

Fertility preservation

Not all children who get treated for cancer will need fertility preservation. Some cancer treatments don’t affect fertility at all, such as surgery for cancers in the legs or chest. But some types of cancer treatment are more likely to cause fertility issues as a child or teen gets older.

Some children and teens lose their fertility for only a short time. For others, cancer treatment can cause complete and irreversible infertility. There may be ways to preserve your child’s fertility or to reduce their risk of infertility after treatment. The cancer care team or a fertility specialist can help you understand your child’s options.

Fertility options for girls

Girls are normally born with all the eggs they need for their entire life. But those eggs don’t mature until they go through puberty. Because of this, a girl’s fertility options will depend on whether she’s reached puberty.

Before puberty

Many girls treated for cancer before they’ve reached puberty are not at high risk for infertility. These girls won’t need fertility preservation. They will most often go through puberty and start having periods at a typical age.  

But some girls will get treatments that can damage the ovaries and other organs needed to conceive and carry a baby to full term. If a girl’s risk of fertility problems is high, ovarian tissue cryopreservation might be an option.

Ovarian tissue cryopreservation

This method of fertility preservation is the most effective for girls who haven’t gone through puberty yet. It involves taking out and freezing some ovarian tissue.

Before she begins cancer treatment, any girl who has not yet gone through puberty should be assessed to see if she is at high risk for future fertility issues. If the risk is high enough, tissue is taken from her ovaries during an outpatient surgical procedure. It is then frozen and stored for the future.

After cancer treatment is finished, the ovarian tissue can be placed back into the girl’s pelvis. Current studies show that the ovarian tissue regains normal function 9 out to 10 times. This provides the girl with female hormones so she can go through puberty. It also increases the chances of pregnancy in the future.

Not all girls getting cancer treatment need to get their ovarian tissue frozen. This procedure is mostly done if the girl is getting:

• Radiation to her abdomen (belly) or pelvis
• High doses of certain chemotherapies
• Stem cell transplants (because of the treatments given to prepare for the transplant)

Other options

Research is also being done to find other options for fertility preservation in girls who haven’t gone through puberty. If you would like to know more, ask a fertility doctor if there are any clinical trials that could provide other options.

After puberty

Most girls begin puberty somewhere between ages 8 and 13. After puberty, the eggs in a girl’s ovaries begin to mature.

Cryopreservation (freezing mature eggs or embryos)

Once a girl develops mature eggs, she has more fertility preservation options. This includes freezing eggs or freezing fertilized embryos (woman’s eggs combined with a man’s sperm).  

Freezing eggs: For this procedure, mature eggs are removed from the ovaries and frozen. This might also be called egg banking. When the girl is older and ready to try to become pregnant, the eggs can be thawed. The thawed eggs are then fertilized by a partner's or donor's sperm and implanted in her uterus.

Freezing embryos: In this procedure, mature eggs are taken from a girl or young woman’s ovaries and then fertilized with sperm. If she is older and has a male partner, his sperm may be used. The other option is donor sperm. Once the embryos have been frozen, they can be thawed and implanted in her uterus to try to achieve pregnancy.

You can find more information about cryopreservation in Preserving Your Fertility When You Have Cancer (Women).

Ovarian tissue freezing

This may be an option for girls after puberty if there isn’t enough time to harvest eggs or create embryos before cancer treatment starts. (See the previous section: Options for Girls Before Puberty.)

Ovary transposition

Radiation therapy to, or near, the abdomen (belly) or pelvis can damage a girl’s ovaries and uterus.

Ovarian transposition may be an option in situations like this. During ovarian transposition, the ovaries are surgically moved out of the radiation area.

It’s usually best to do this just before starting radiation therapy, since the ovaries tend to fall back into their normal position over time. If the ovaries have not gone back to their normal position after radiation treatment, they may have to be moved back during a second surgery in order for a woman to get pregnant.

The procedure is successful about half of the time. Because of radiation scatter, ovaries are not always protected.

Monitoring for fertility and early menopause

Many girls treated for cancer after puberty will have their periods return. They may be fertile as young adults, but they could go through early menopause. It’s also important for your child to know that even if she has normal periods, she might still need to see a fertility specialist because of hormone problems.

All girls who get cancer treatment before they go through puberty will likely need to have their hormone levels checked at times in the future.

Even after going through puberty, there is still a risk of fertility issues and early menopause. Some girls who are fertile in young adulthood may go through early menopause before they are ready to start a family.

Even the best hormone tests can’t always predict what will happen in the future. It’s best to see a specialist early in your child’s reproductive years, soon after puberty. If she develops mature eggs, she may choose to freeze them in her late teens or early twenties to preserve her fertility in case treatment causes early menopause.

Fertility options for boys

Boys don’t make sperm until they go through puberty. Because of this, a boy’s fertility options will depend on whether he’s reached puberty.

Before puberty

At this time, there is no proven way to preserve fertility in boys who have not gone through puberty. Before puberty, boys don’t yet make sperm, so there is no sperm to freeze and bank (cryopreserve).

However, some fe