Bone marrow and stem cell transplants nearly always cause infertility because of the high doses of chemotherapy involved.
Sometimes it is possible for men and teenage boys to store sperm before they start their chemotherapy. This is called sperm banking and there is more information on this below. Ask your doctor if you think you would like to do this.

For women, chemotherapy can cause an early menopause. Doctors can treat this with hormone replacement therapy. Research is going on all the time to try to help women have children after cancer treatment.

For more information please go to:

http://cancerhelp.cancerresearchuk.org/about-cancer/treatment/transplant/side-effects-of-bone-marrow-and-stem-cell-transplants#infertility

There is more information on Early Menopause on this website.

What affects fertility?

  • Surgery, chemo and radiotherapy affect fertility in cancer patients, mostly on a temporary basis but in some there may be permanent and irreversible damage and sterility may result.
  • The degree to which patients are affected varies and mostly depends upon the dose, type and number of courses / intensity of chemotherapy required.
  • In women the reproductive potential reduces with age normally and therefore older women with the same treatment are more adversely affected than their younger counterparts.
  • In young men, the stem cells that produce sperm are much more sensitive to irradiation than those producing testosterone. Hence puberty may occur normally and there may be no change in the body’s general physical state for sexual function. Yet fertility may be affected more profoundly than realised.
  •  Testes and ovaries can usually be protected from irradiation but in some cases it is neither possible nor appropriate to do so.
  • Radiotherapy to the ovaries and testes invariably causes sterility.
  • Radiotherapy to the uterus can damage its ability to carry a child in the future.

What can be done?

      • In young women or men where natural puberty has already occurred, sperm or mature eggs can be stored. Please see these leaflets for more information on Mature Egg Storage and Sperm Storage prior to Chemotherapy or Radiotherapy
      • In women in stable or married relationship, embryo banking can provide a chance for fertility in the future.
      • It is neither possible to guarantee success nor can a pregnancy rate be given because there are many factors that affect success rate.
      • In boys or girls where natural puberty has not as yet occurred, theoretically testicular or ovarian tissue could be banked. However doing so requires extremely stringent laboratory conditions as per the European Union Tissue Directive and these cannot be met with in most clinical services.
      • Egg donation is also a consideration, for more information please see  Egg Donation for Recipients

What is the UK regulation?

In the UK, all services and research related to eggs, sperm or embryos are regulated by the Human Fertilisation and Embryology Act 1990.  The Department of Health has a regulating body – The Human Fertilisation and Embryology Authority (HFEA) which sets a Code of Practice for the profession in this field. This includes specific requirements and rights which are summarised below:

Procurement of sperm:

a)      Consent:

i)        Sperm can only be procured (obtained) and stored with patient’s written and informed consent. Storage of sperm without a legally valid consent is against the law and a crime.

ii)       The patient, if a child, has to be certified by the assessor to be Gillick competent. In the case of adolescents this will be the referring paediatrician or a trained paediatric counsellor.

iii)     In the case of adults, the sperm cannot be stored from those who are:

(1)     unable to fully understand the implications of sperm storage

(2)    unable to fully understand it’s posthumous use (use after death)

(3)    due to their illness unable to hold a reasonable conversation

(4)    mentally ill

(5)    heavily sedated

(6)    in a coma.

iv)     Guardians or spouses or next of kin cannot provide a legally valid consent.

b)      Site of procurement:

i)        As per HFEA regulations sperm can only be procured in HFEA licensed premises.

ii)       A special third party agreement needs to be written for procurement of very ill patients from non-licensed sites.

c)       Site of storage: All sperm have to be stored in HFEA licensed facility.

What happens after storage of sperm, eggs or embryos?

Patients will be offered different forms of follow up at different hospitals; you will need to contact your own Reproductive Medicine Centre to find out what is available.  Your local blood and marrow transplant team will be able to give you information about how to contact them.

 When to seek help?

Many patients would be referred to a Reproductive Medicine Centre by their oncologists or haematologists for assessment of fertility at 2 years post therapy irrespective of whether sperm, egg or embryo storage was performed.

In those referred patients fertility should be assessed with appropriate testing and the essential prognostic information should have been provided.

If you have not received such a referral, you may request one via your oncologist at the next review. You may also seek specialist fertility assistance:

      1. When trying to conceive and if a pregnancy has not been achieved within the 1st year of trying
      2. At 6 months of trying to conceive or even earlier if you were identified as someone ‘at risk’ because of ‘low sperm count’ in men or ‘reduced reserve of eggs’ in women
      3. In women, if the menstrual cycle is irregular and/or there are gynaecological symptoms, hot flushes or sweats
      4. In men if there are any abnormalities of sexual function

 

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