Fertility options for children and adolescents

When a child or adolescent is diagnosed with cancer, there are many issues to consider. Often the focus is on survival, so children, teens and parents may not think about fertility. However, the majority of young people survive cancer, and fertility may become important as they reach puberty (sexual maturity) and adulthood.

Some cancer treatments do not affect a child’s reproductive system. Others can damage a girl’s ovaries, which contain eggs, or a boy’s testicles, which make sperm. Sometimes this damage is temporary, but sometimes it’s permanent. For a general overview of how cancer treatments affect fertility, see the effects of cancer treatment on women’s fertility or on men’s fertility. You can also talk to the health care team about how cancer treatment will affect fertility.

For an overview of ways to prevent or lower the risk of infertility, see the tables below. Some of these procedures are experimental and available only in specialised centres. In many cases, decisions about fertility preservation are made before treatment begins. This is a difficult time, and often the decision involves a multidisciplinary team of specialists, parents of the young person and the young person.

Learn more about:

• Fertility options for girls
• Fertility options for boys
• Resources for young people

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Fertility options for girls

The options will depend on whether the girl has been through puberty. Most girls go through puberty between 9 and 12 years of age.

Before puberty

• Ovarian tissue can be removed and frozen,and transplanted later when needed. This is called ovarian cryopreservation. The ovarian tissue contains underdeveloped immature eggs. Experiments are being done to mature the eggs in a laboratory before freezing, but this technique is under development and not widely available. There has only been one birth worldwide for ovarian tissue removed before puberty.

After puberty

• Mature eggs can be removed and frozen.
• Taking a long-acting hormone called GnRH may reduce activity in the ovaries or ovarian tissue and protect eggs from damage.
• Hormone levels can be checked to assess fertility (see pages 57–58). It’s possible for young women to be fertile, but then go through early menopause.

Before or after puberty

• The abdominal area can be shielded during radiation therapy to the pelvis.
• The ovaries can be surgically relocated so they are out of the radiation area (ovarian transposition). If the ovaries aren’t protected, the risk of ovarian failure is higher (premature ovarian insufficiency).

Fertility options for boys

The options will depend on whether the boy has been through puberty. Most boys go through puberty by the age of 13–14. At this stage, mature sperm is present in the semen.

Before puberty

• There are no proven fertility preservation methods for boys who have not gone through puberty.
• Freezing testicular tissue (testicular tissue cryopreservation) is being tested on young boys at high risk of infertility. Tissue that contains cells that make sperm is removed from the testicles through a small cut. This technique is experimental and there are no successful pregnancies to date.

After puberty

• Sperm banking (cryopreservation) can be used to collect, freeze and store mature sperm for future use.
• Testicular sperm extraction can remove sperm cells, which are frozen and stored for later IVF. This technique is not widely available.

Before or after puberty

• The testicles can be shielded during radiation therapy to the pelvis. If this area is not protected, sperm production may be affected, which could make the boy infertile.

Resources for young people

CanTeen’s resource Maybe later baby? provides age-appropriate information about the impact of cancer on fertility. To download a copy of the book, visit canteen.org.au and search for the resource.

You can also read information specific to children and adolescents at futurefertility.com.au.