Cancer Treatment and Children's Fertility: Potential Solutions

A health crisis of any kind can make it difficult to navigate the concerns of everyday life for anyone. But when the crisis involves cancer and children, the barriers to clear thinking and right action can suddenly seem overwhelming.

Parents understandably want information, options, and above all else, hope – that their children will be cured, that they will be able to resume and enjoy a full life, and that the effects of treatment will not limit their lifestyle choices, now or in the future.

For men who are survivors of child cancer treatments, concerns about possible effects on their fertility can loom paramount. After all, adult men with cancer face significant obstacles to maintaining healthy fertility during and after treatment, though men can take proactive measures to protect themselves.

In fact, a new study from a team of researchers indicates that men who received cancer treatments as children could later grow human stem cells that could evolve into mature sperm. The findings were published in the journal Nature Communications.

In a press release, research team leader Sandra Ryeom, associate professor of Cancer Biology in the Perelman School of Medicine at the University of Pennsylvania, said, “For years researchers have been trying to find ways to grow and expand these cells from testicular biopsies donated by young patients prior to their cancer treatment, but until now, there has not been a consistently successful approach”.

The next step, Ryeom said, is to ascertain whether certain cells can be engrafted or re-injected into patients once they are cancer-free. Study co-author Jill Ginsberg, MD, added that this is especially critical given that there are currently no fertility options for prepubescent boys – though the Penn study findings amount to “a great first step forward” in that regard.

The problems attendant to child cancer treatments, while thankfully not found in epidemic proportions, are nonetheless potentially devastating to even one person. A study published in CA: A Cancer Journal for Clinicians, quoted childhood and adolescent cancer statistics from 2014: That year, an estimated 15,780 new cases of cancer were predicted to be diagnosed, with 1,960 deaths anticipated among children and adolescents up to the age of 19.

Furthermore, roughly 1 in 285 children were expected to be diagnosed with cancer before reaching the age of 20, and about 1 in 530 adults between the ages of 20 and 39 years would be classified as a childhood cancer survivor.

A 2013 study published in the journal Annals of Pediatric Endocrinology & Metabolism (APEM), provided an overview of reductions in male fertility in childhood cancer survivors. The study authors noted that more pediatric cancer patients had increased their life expectancy, thanks in part to the development of new cancer treatments. The authors also called for pediatric cancer patients to be tested and monitored, adding that, depending on the patient’s condition, semen cryopreservation was one measure that “should be provided”.

When it comes to dealing with the unknown – as encouraging as the findings from the Penn study are, more work remains to be done – information is power. So is knowing the right questions to ask your health providers.

According to the American Cancer Society, “[m]ost childhood cancer survivors can go on to have healthy children”, though some risks do exist. These include low sperm counts for men as well as “changes in the uterus” for women. The ACS re-iterates the APEM study suggestion that sperm banking be explored for older boys.

According to KidsHealth, parents of children receiving cancer treatments should take it upon themselves to ask their doctor the following questions, among others, bearing in mind that seeing a fertility specialist could help to clarify the best treatment in your child’s specific case:

·        Will this treatment damage my child’s reproductive organs? If so, how will fertility be impacted?

·        If damage to my son’s sperm is likely, will this damage be permanent or temporary?

·        Once treatment has been completed, how will we determine whether my child’s fertility has been impacted?

·        Could the treatment affect other organs, such as the heart or lungs, that might make it difficult for my daughter to carry a pregnancy to term?

·        Are proactive measures such as egg preservation or sperm banking available to my child?

It’s also important to address the emotional and psychological impacts of cancer treatments on your child. And, if you are a survivor of treatment yourself, consider testing of your assets and then, if prudent,  preserving them.