Family planning after a leukemia diagnosis can be a delicate and scary conversation. It is important to discuss your plans with your health care team so your treatment plan can be modified to help with fertility preservation, if possible.

Because cancer treatments can put you at a high risk for infertility, several factors are considered when discussing pregnancy and fertility options with your oncologist. These include:

• Type of cancer
• Age at diagnosis
• Type of cancer treatment needed
• Egg or sperm supply
• Family planning objectives

Consulting with a fertility specialist before undergoing cancer treatment is recommended, so you can learn about fertility preservation options and make a plan.

How Leukemia Can Impact Fertility

Infertility, which is the inability to conceive a child naturally, can be one of the side effects of both chemotherapy and radiation, which are commonly used to treat leukemia.

As chemotherapy and radiation, including total body irradiation (radiation of the entire body), work to destroy cancer cells, they can also interfere with the ovaries’ ability to produce eggs, and the amount and quality of sperm produced by the testes. Even small doses of radiation can result in infertility.

Leukemia treatment can also trigger early menopause in women. Early menopause can be treated with hormone replacement therapy (HRT) to reduce symptoms, balance the hormones estrogen and progesterone, and help prevent osteoporosis. However, this treatment will not restore fertility.

Fertility Preservation Strategies

Depending on the amount of time you have before you must start treatment, there are options for adults and children to help preserve fertility and increase the chances of conceiving a baby when the time is right.

Fertility preservation strategies are dependent on age, overall health, and how quickly treatment needs to begin.

There are various fertility preservation options available to people who are planning to undergo treatment for leukemia. When it comes to leukemia treatment, time is of the essence, and these options need to be done before your cancer treatment starts.

Egg or Embryo Cryopreservation

This procedure removes mature eggs from the ovaries. They can then be frozen and stored as eggs, or undergo fertilization with sperm to create an embryo before freezing.

Ovarian Tissue Freezing

This option is for females who have not yet gone through puberty or those who need to start cancer treatment quickly and don’t have time to undergo more time-consuming procedures. The procedure entails removing part or all of the ovary. It is then frozen and may be transplanted back into the individual at a later date. This is a newer procedure.

Ovarian Transposition

This process is a good option for individuals undergoing radiation. The surgical process moves the ovaries outside of the field that will be radiated to decrease damage and exposure. However, there is still a chance that the ovaries could be harmed.

Cryopreservation

Also known as sperm banking, cryopreservation is a noninvasive process that freezes semen for later use. This option is offered to all males diagnosed with cancer who have gone through puberty.

Electroejaculation

This procedure is used for males who can’t produce a semen sample through masturbation. This process entails the use of electrodes to encourage ejaculation while the person is under anesthesia.

Testicular Sperm Extraction

This procedure is an option for those whose semen samples do not contain sperm. Tissue is removed from the testicles to screen for mature sperm, which can then be frozen for later use.

Testicular Shielding

Similar to ovarian transposition, this process places a shield over the testicles for people undergoing radiation. It only needs to be used if the area of the body being radiated is close to the testicles.

Testicular Tissue Cryopreservation

This procedure is considered experimental. It is an option for boys who have not yet gone through puberty, or who do not have mature sperm. It involves removing tissue from the testicles with the hopes that the tissue contains stem cells that can later be used to produce sperm.

Considerations for Children

Treatment advancements have increased survivorship among children diagnosed with leukemia to 80 percent. However, the long-lasting effects of chemotherapy and radiation can leave children battling infertility and hormone inbalances later in life.

Many people who have survived childhood cancer go on to naturally conceive children of their own, but experts recommend including your child in the conversation about how cancer treatment can affect their ability to have children when they are older.

It is also recommended to speak with a fertility specialist to discuss ways to help decrease your child’s chances of infertility.

Having a Family After Treatment

After successfully undergoing cancer treatment, it is advised to wait two years before trying to have a child. If you are not able to conceive a child, there are a number of different routes to explore to help grow your family.

• In vitro fertilization (IVF) — Transfer of fertilized embryos to the uterus
• Artificial insemination — Delivery of semen to the female reproductive tract; intrauterine insemination is a common option
• Frozen sperm — Use of sperm frozen before treatment for in vitro fertilization or artificial insemination
• Donor sperm — Use of donated sperm for in vitro fertilization or artificial insemination
• Frozen eggs/embryos — Use of embryos frozen before treatment for in vitro fertilization
• Donor eggs/embryos — Use of donated embryos for in vitro fertilization
• Surrogacy
• Adoption

Children born to cancer survivors are usually healthy and don’t have an increased risk of birth defects or abnormalities.

If there are questions regarding whether there is an increased risk that your child will also develop cancer within their lifetime, your oncology team can refer you to a genetic counselor.

Managing Pregnancy With Leukemia

Creating a treatment plan for women who are diagnosed with leukemia while pregnant is very challenging, and many factors need to be considered when trying to preserve the health of both mother and baby. Sometimes, a viable, premature baby can be delivered early to enable the mother to begin treatment.

Delaying leukemia treatment because of pregnancy can have dire consequences for the mother, but the cytotoxic agents of chemotherapy and radiation can be devastating to the fetus.

A team of doctors with expertise in both obstetrics and neonatology should be included in the creation of the treatment plan to help carefully balance the outcome of both mom and baby.

One MyLeukemiaTeam member undergoing treatment shared that she was pregnant, “I'm six months pregnant and the baby seems to be doing well. Keep us in your prayers.”

Factors that will be considered when treating leukemia during pregnancy include:

• Pregnancy trimester (risk of malformation is reduced in later stages of pregnancy)
• Type of treatment medication
• Religious and cultural beliefs
• Potential side effects and negative outcomes for the fetus
• Effects of cytopenia (decrease in mature red blood cells) on both mother and fetus

Difficult questions will have to be considered when talking about the effects of cancer treatment on an unborn baby, including whether terminating the pregnancy is in the best interest of the mother and fetus.

You’re Not Alone

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Have you had experience with infertility? Did you use fertility preservation options before you started treatment? Were you pregnant when you were diagnosed? Share your experience in the comments below, or create a post on MyLeukemiaTeam. Your story may help others figure out how to plan for a family.