NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia
19 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 2 Treatment planning Fertility and pregnancy rtilit r | Starting treatment Fertility and pregnancy Some cancer treatments can limit your ability to have a baby. If you want the choice of having babies after treatment or are unsure, tell your doctors. It may also help to talk with a fertility specialist before you begin cancer treatment. A fertility specialist is an expert in helping people have babies. The fertility specialist can discuss with you how to have a baby after treatment. Some methods of fertility preservation are discussed next. If you are a woman of childbearing age, important information on pregnancy is also addressed. Sperm banking Men who want to have children after cancer treatment can use sperm banking. Sperm banking stores semen for later use. This is done by freezing semen with sperm in liquid nitrogen. Talk to your treatment team about the costs of and how well sperm banking works. Egg freezing Like sperm banking, a woman’s eggs can be removed, frozen, and stored for later use. Your frozen eggs can be fertilized with sperm beforehand. Also, a part of your ovary that contains eggs can be frozen and stored. Pregnancy test Some cancer treatments can harm an unborn baby. Get a pregnancy test before treatment if you may be pregnant now. Your treatment options will depend on the results. During treatment, take steps to avoid getting pregnant. Your doctors can tell you which birth control methods are best to use while on treatment. Starting treatment Not all people with CLL need to start treatment right away. Starting treatment is based on symptoms of CLL, test results, and the cancer stage. If the cancer is Rai stage 0, I, II, and III, your doctor will assess if treatment is needed now. There are several reasons to start treatment for stages 0–II CLL. You may be able to take part in a clinical trial. Results of blood tests may be getting worse. Some organs may be getting larger. Some organs may stop working well soon. Major symptoms of CLL may appear, such as: Drenching night sweats, Severe fatigue, Fever without proof of infection, and Unplanned weight loss. If these reasons are not present, watching and waiting (observation) are advised. Tests during observation include physical exams and blood tests. Treatment can be started when needed. Most people with stage III CLL need to be treated. In some cases, observation may be an option if blood cell counts aren’t too low and don’t drop more. Treatment is advised when blood cell counts start falling.