NCCN Guidelines for Patients® | Caring for Adolescents and Young Adults - page 28

NCCN Guidelines for Patients
: Caring for Adolescents and Young Adults
Version 2013
Part 3: Preparing for the future
Understanding the risks
The complete loss of the ability to have children is called
infertility. In men, infertility happens when the testicles can no
longer make sperm (a condition known as azoospermia) or
when the pathways that sperm travel through are blocked or
damaged. In women, infertility happens when:
The ovaries can no longer make eggs: a condition called
premature ovarian failure or early menopause,
There is damage to the uterus (where babies grow during
pregnancy) or other parts of the reproductive system that
makes it impossible for eggs to become fertilized, or
There is damage to the uterus or other parts of the
reproductive system that makes it impossible for a
fertilized egg to implant and grow inside the uterus.
Cancer treatment can lead to infertility because many cancer
therapies are designed to attack cells that divide rapidly.
Unfortunately, this includes a lot of normal, healthy cells that
have a high turnover rate, such as hair follicles, the mucus
membrane of the mouth and GI tract, and—you guessed it—the
ovaries and testicles. Cancers that develop in the reproductive
system also carry a risk for fertility problems.
The actual risk of infertility varies depending on the cancer,
the treatment, treatment dosage, and the age of the person
receiving cancer treatment. In general, the higher the dose
and the older your age, the more likely you are to experience
problems. High-risk treatment regimens include:
Radiation therapy
of the pelvis, abdomen/belly, brain
(for women), testicles (for men), or whole body;
Fertile Hope—an initiative launched by the
Foundation—offers online risk
calculators that can help you figure out if your
disease, or its treatment, will make it difficult for you to
have children.
Go to
for more information.
Assessing your risk
Combination therapy
, particularly if it includes
alkylating agents such as cyclophosphamide,
melphalan, or procarbazine; and
Conditioning regimens
, an aggressive form of
chemotherapy used to suppress the immune system
and kill as many cancer cells as possible in preparation
for a stem cell (or bone marrow) transplant.
Treatment-related infertility isn’t always permanent. Men
tend to have a better chance of regaining their fertility,
because the male body has stem cells that can be used
to make more sperm. Women, on the other hand, have
a limited supply of eggs, and if the ovaries are badly
damaged they may not be able to recover. Because cancer
treatments can decrease the overall number of eggs,
the risk for premature ovarian failure can last for months
or even years after completing chemotherapy, even if a
woman had normal menstrual cycles during and after
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