Learn about my fertility
Fertility is the ability to have a biological child. A biological child is a child related to you by blood that is created when your egg or sperm join with another person’s egg or sperm.
Most people become fertile in their teen years (adolescence) during puberty. Having monthly periods or producing sperm may mean you are fertile. If you aren’t sure, your doctor or nurse can help you find out.
How do I know if I'm fertile?
Infertility is when you can’t have a biological child. Treatments for cancer and blood diseases can cause infertility, but some people can be infertile for other reasons. Genetic conditions, other diseases, or accidents can also affect fertility. But, sometimes, there isn’t a clear reason why someone can’t have a biological child.
What is fertility? How do I know if I am fertile?
Ovaries are two small organs in your lower belly. You were born with tiny eggs stored in your two ovaries. Eggs are cells that can join with (fertilize) sperm to make a baby.
Starting during puberty, the pituitary gland in your brain makes special hormones (chemical messengers) that signal your ovaries to mature eggs.
These hormones, such as follicle-stimulating hormone (FSH), cause follicles (sacs in the ovary) that contain a tiny egg to grow it into a larger, mature egg.
Each month, the mature egg is released from one of your ovaries, travels through your fallopian tube, and into your uterus. The uterus is where babies grow.
If the egg gets fertilized (joins) with sperm:
-
It can implant itself into the wall of the uterus and begin to grow into a baby.
If the egg does not get fertilized with sperm:
-
You get your period (menstruation). Your period is the blood your uterus sheds out of your vagina.
Over time, the number of eggs in your ovaries goes down. When there aren’t any more eggs in your ovaries, you’ll enter menopause. Menopause marks the end of your fertility and usually occurs in your 40s or 50s.
I have ovaries - what do I need to know about my body?
Testicles hang behind the penis in a pouch called the scrotum.
Starting during puberty, the pituitary gland in your brain makes hormones (chemical messengers) that signal the testicles to make millions of sperm.
Sperm are cells that can join with (fertilize) an egg to make a baby. When you ejaculate, the sperm come out of your penis in a fluid called semen.
I have testicles - what do I need to know about my body?
Learn how treatment affects my fertility
Surgery
Surgery could affect fertility, such as surgery to remove a cancerous tumor (growth) in these areas of your body:
​
-
Lower belly area or pelvis, including your reproductive organs: Uterus, ovaries, fallopian tubes, testicles, or penis.
​
-
Pituitary gland in your brain. This gland makes the hormones (chemical messengers) that signal the ovaries to mature eggs or the testicles to make sperm.
Chemotherapy or "chemo"
Chemo is medicine that kills cells in the body that are dividing quickly (cancer cells). Chemo can damage eggs and sperm cells.
​
Radiation
Radiation uses high energy beams to shrink tumors and destroy cancer cells. Radiation in these areas of the body could affect fertility:
​
-
Lower belly area or pelvis, including your reproductive organs: Uterus, ovaries, fallopian tubes, testicles, or penis.
​
-
Pituitary gland in your brain. This gland makes the hormones (chemical messengers) that signal the ovaries to mature eggs or the testicles to make sperm.
Immunotherapy or targeted agents
Immunotherapy is a treatment that helps your own immune system fight cancer. A targeted agent is a type of cancer treatment that works by attacking substances that help cancer cells grow.
​
Immunotherapy and targeted agents are fairly new, so doctors don’t yet know if they affect fertility.
Bone marrow or stem cell transplant
Bone marrow or stem cell transplants are treatments that replace unhealthy cells in your bones with healthy ones.
To prepare for a bone marrow or stem cell transplant, you may receive high levels of chemo or radiation, which can harm your fertility.
Which treatments can cause fertility problems?
-
How much of the chemo medicine you get. The more of these medicines you get, the more likely they may lower your fertility and chances of having biological children.
​
-
The type of chemo medicine you get.
There are many different types of chemo medicines. Not all of these medicines lower fertility.
But the chance of that happening depends on:
If you have ovaries:
Chemo can affect your fertility by lowering the limited supply of tiny eggs that have been in your body since you were born. An egg is what joins with sperm to grow into a baby.
​
If you’ve reached puberty: Chemo may damage more of your eggs than in kids who haven’t yet reached puberty.
If you have testicles:
Chemo can affect your body's ability to make sperm. This can cause a lower number of sperm or no sperm in your testicles. Sperm join with an egg to grow into a baby.
If you’ve reached puberty: There doesn’t appear to be a difference in chemo’s effects on sperm between kids and teens who have and who haven’t reached puberty.
One group of chemo medicines called alkylating agents (al-kuh-lay-ting) can lower your fertility more than others.
These medicines include cyclophosphamide, ifosfamide, and several others.
How does chemo affect fertility?
Learn about your choices
Do I have to decide right now if I want to have a baby?
​No, you don’t have to decide right now if you want to have a baby someday.
You are deciding now about fertility preservation, which may give you a higher chance at having a biological child in the future if you want to. You can choose fertility preservation even if you’re not sure you want to be a parent someday.
A lot of kids and teens aren’t sure if they want to be parents someday. Your feelings and decisions may change over time, and that’s ok.
You have a choice to make: whether to choose fertility preservation now or to wait and see what happens with your fertility in the future.
Fertility preservation:
Choosing one of the fertility preservation options that are available to you could be the right choice for you if:
​
-
You feel uncomfortable with the amount of risk to your fertility.
​
-
You are OK with completing the steps needed for fertility preservation.
​
-
Preserving your fertility seems important or worth it to you at this time.
​
The downsides of choosing fertility preservation are the risks and side effects, how much it costs, and that it might not help you have biological children in the future.
But, it may give you a higher chance of having biological children later if you decide someday that you want to have them.
Wait and see:
To wait and see what happens with your fertility in the future (such as after treatment for a cancer or a blood disease) could be the right choice for you if:
​
-
You feel OK with the amount of risk to your fertility.
​
-
You want to focus only on your treatment for cancer or blood disease.
​
-
Preserving your fertility doesn’t seem important or worth it to you at this time.
​
The downsides of choosing to wait and see are that you could have fewer options for having a biological child in the future, that may make you feel sad, and you could have costs for checking your fertility over time.
But, you may be able to have a biological child without fertility preservation or you may decide you are ok with not having biological children.
What are my choices, the benefits, and the downsides?
What if I'm under 18 years old?
If you are under the age of 18 and want to choose:
​
-
Fertility preservation, your parent or guardian will need to agree with your choice.
​
-
Wait and see, you can choose with or without your parent or guardian’s agreement.
Timing my treatment and my choice
Some kids and teens choose to focus first on finishing treatment for cancer or a blood disease. They choose to wait and see what happens with their fertility in the future.
But if you choose fertility preservation, doctors usually recommend that you try to do it before you start your treatment for cancer or a blood disease. This is because some treatments, such as chemo, can lower your fertility and chances of having biological children.
If you have already had treatment for cancer or a blood disease, you may still have fertility preservation options or other options for having children in the future.
What if I focus on getting better first?
Some fertility preservation options can be completed quickly without delaying the start of your treatment by very long.
Other options, such as egg freezing, can delay starting your treatment for at least a couple of weeks. For some cancers and blood diseases, this is okay. For others, it may be better to start your treatment sooner.
Talk to your doctor or nurse about the timing of your treatment and fertility preservation.