Your child’s cancer and its treatment might affect her ability to have children in the future. Not all treatments cause fertility problems. This depends on:
- Your child’s age.
- The child’s reserve of eggs before treatment.
- Type of cancer and its location.
- Type, dose and duration of chemotherapy.
- Dose and area of radiation.
- Type of surgery.
Discuss with your doctor any questions about the effect of cancer or its treatment on your child’s fertility. If needed, your doctor will refer you to a specialist at the start of treatment.
What is the female reproductive system?
The female reproductive system includes the following organs:
- Two ovaries
- Fallopian tubes
- At puberty, the ovaries start producing eggs and hormones. The menstrual cycle begins.
- Each menstrual cycle, eggs are released from the ovaries into the uterus through the fallopian tubes.
- When the egg is fertilized, it grows in the uterus. If not, menstruation begins.
What is the effect of cancer treatment on female reproduction?
Radiotherapy, chemotherapy and surgery might affect the health of the ovaries and the supply of eggs.Cancer treatment might cause the following:
- Temporary cessation of menstrual cycles. Many females who were already menstruating will stop having monthly periods during their cancer therapy. In most cases, menstrual cycles will resume sometime after cancer treatment ends, although the timing of this is unpredictable. In some cases, it may take up to several years to restart menstruation. Since eggs are released before the menstrual cycle, pregnancy can occur before the menstrual periods resume.
- Failure to enter puberty. Pre-pubertal girls who received cancer therapy that resulted in ovarian failure will need hormonal therapy in order to progress through puberty. It is important for young girls who had cancer treatment that can affect ovarian function to have their hormone levels checked before the expected onset of puberty.
- Permanent cessation of menstrual cycles (premature menopause). Menopause generally occurs in women between the ages of 45 and 55. Females who were already menstruating prior to their cancer therapy sometimes develop ovarian failure as a result of their cancer treatment and never resume menstrual cycles.
- Lack of female hormones. Females with ovarian failure do not make enough estrogen. Estrogen isn't just needed for reproduction - it is also an important hormone necessary for maintaining strong healthy bones, a healthy heart, and overall well-being. Young women with ovarian failure should see an endocrinologist for hormone replacement therapy, which will be necessary until they reach middle age.
- Infertility. Infertility is the inability to achieve a pregnancy after at least one year of unprotected intercourse. In women, infertility occurs when the ovaries cannot produce eggs (ovarian failure), or when the reproductive organs are unable to sustain a pregnancy. Infertility may be the result of surgery, radiation therapy, chemotherapy, or any combination of these.
- Pregnancy risks. Certain therapies used during treatment for childhood cancer can sometimes increase the risk of problems that a woman may experience during pregnancy, labor, and childbirth.
How does treatment affect young girls who have not reached puberty?
- If your child has not gone through puberty yet, she will be less affected by cancer treatment than the ones who have.
- Your child might have delayed puberty, problems in menstruation or earlier menopause.
- Chemotherapy might affect the ovaries depending on the type, dose and duration of treatment.
- Radiation to the pelvis might affect the uterus and ovaries.
- Radiation to the brain might affect hormones needed for the ovaries to work well.
- Surgery done to remove any part of the reproductive system has a direct effect on later fertility.
Which cancer treatments increase the risk of ovarian failure or infertility?
It is hard to know how cancer treatment will affect your child exactly. Some types of chemotherapy and radiation are known to affect fertility more than others.
- Nitrogen mustard
Radiation therapy (high doses of radiation therapy to testicles or brain leads to testosterone deficiency)
- Total lymph nodes
- Total body
- Removal of ovaries
- Removal of uterus
- Removal of cervix
- Removal of other part of the reproductive system
Are there ways to preserve my child's fertility?
There are ways to save your child’s chances to be fertile.
A. Egg preservation
- Eggs can be collected and stored before treatment begins.
- The eggs are then used when your child wants to have a child and she cannot produce eggs any longer.
B. Ovarian Transposition
- If your child has radiotherapy to her pelvis area, ovaries might be harmed.
- “Ovarian transposition” is a procedure done to move the ovaries outside this area before treatment.
When should my child follow-up?
- After treatment, your child should:
- Do a medical check-up before puberty.
- Check with her doctor for her menstruation history, hormone status, and puberty progression every year.
- consult an endocrinologist for any problems.
- If your child has ovarian failure, she should regularly test for bone weakening: osteoporosis.
Does my Insurance Policy cover fertility?
No. According to CCHI unified Policy terms and conditions, health insurance policies in Saudi Arabia doesn’t cover the treatment of fertility.Please Click Here to access the Unified CCHI Policy Wordings.
References:"Children Cancer and Female Reproductive System." Female Reproductive Health. N.p., n.d. Web. 12 Oct. 2016.
"Children cancer and female reproductive system." Rules. N.p., n.d. Web. Oct. 2016.