Having children

Many childhood cancer survivors worry about what their family life will be in the future. If you were treated for cancer as a child, you may worry about:

• whether you will be able to have children
• birth defects or health problems in future children because of your treatment
• your child having cancer like you did
• getting sick again and not being able to parent a child to adulthood

You can put some of these concerns aside. Cancer survivors are not at greater risk of having children with birth defects or health problems than people without cancer. And research shows that children born to a cancer survivor do not have an increased risk of cancer. However, there are a small number of childhood cancer types that are hereditary. If you had one of these types, talk to your doctor or a genetic counsellor to find out more about risk.

Many childhood cancer survivors will still be fertile and so will be able to have children after cancer treatment. For some, the treatment that saved their life causes infertility and takes away their ability to have children. Some treatments that increase your risk of being infertile are:

• high doses of alkylating chemotherapy, such as cyclophosphamide (Cytoxan, Procytox), carmustine (BiCNU, BCNU), lomustine (CCNU), busulfan (Busulfex, Myleran), melphalan (Alkeran, L-PAM) or ifosfamide (Ifex)
• total body irradiation
• radiation to the testicles
• radiation to the ovaries
• treatment for cancer after puberty

Being told you are infertile is not necessarily birth control. If you do not want to have children use some form of birth control. Some survivors are surprised to find out that they or their partner are pregnant after they have been told they are infertile.

Female cancer survivors may also have early menopause, which affects their ability to have children. Normally fertility starts to decrease in our mid-30s but if you have had cancer treatment, this can start earlier. Those at risk for early menopause include:

• teen girls treated after puberty
• receiving both alkylating chemotherapy and radiation to the pelvis or ovaries
• cranial radiation causing early puberty

If you are at risk for early menopause, talk to your doctor about family planning. Your doctor will need to do special tests of hormone levels to determine fertility. Regular periods alone are not a measure of whether you are fertile. To find out about your best options for having a child, ask about fertility clinics in your community. There are also support organizations that provide information on fertility preservation and support services for cancer survivors.

It is also important to know that early menopause also puts you at increased risk for osteoporosis and heart disease.

There are a number of options for women who are infertile.

Assisted reproduction techniques include in vitro fertilization (IVF). IVF involves collecting a woman’s eggs and fertilizing them with sperm outside her body, and then later transferring the embryo back into her body for it to develop.

Donor eggs involves using another woman’s eggs to get pregnant. The donated eggs are fertilized in the lab with the sperm of the woman’s partner or a donor using IVF techniques. The fertilized eggs (embryos) are then transferred into the uterus of the woman wanting to get pregnant. The woman must take hormones before and after the embryo is inserted.

Donor embryos usually come from couples who have extra embryos from their infertility treatment. The embryo is transferred into the uterus of the woman wanting to get pregnant. The woman must take hormones before and after the embryo is inserted.

Some women may be able to get pregnant, but doing so may put their health at risk, or they may not be able to carry a child to term. Surrogacy and gestational carriers may be options for these women. Surrogacy is when another woman is injected with sperm of the man who is to be the child’s father (called artificial insemination) and carries the baby during pregnancy. Gestational carrier is when another woman carries the child that is created from the future mother’s egg and her partner’s sperm.

Find out more about female reproductive system problems.

Male cancer survivors who are infertile may consider donor sperm or testicular sperm extraction for having children.

Donor sperm involves using sperm donated to a sperm bank by another healthy male to become a father.

Testicular sperm extraction involves removing small pieces of testicular tissue to look for healthy sperm cells that can be used in IVF or frozen for future use.

Find out more about male reproductive system problems.

Another option for having children is adopting a child. Adoption is the permanent, legal transfer of parental rights of a child from the birth parent to another individual or couple.

Some questions you may have for your doctor include:

• When will it be OK for me to think about conceiving a child? How long after the end of treatment should I wait?
• What are my options for becoming a parent?
• How do I confirm that I am infertile?
• Are there ways to manage my anxiety about having children?
• Can you recommend a fertility specialist who can help me understand my options?
• Could fertility hormones cause my cancer to return or cause a new cancer to develop?
• Are there fertility clinics that specialize in treating cancer survivors?
• Does my age affect my options?
• What are the costs of various options?
• Where can I find information and support on surrogacy, gestational carriers or adoption?

For additional information on infertility, go to Fertility Matters Canada and The National Infertility Association.