Sex – Straight Talk

What if I want to have a baby someday? (girls)

There are options that may be available to you to help you preserve your fertility. Some of these options require action to be taken before treatment begins, while others can wait until during or after treatment.

What are my options during cancer treatment?

• Ovarian shielding. If possible, the doctor can put a shield over your pelvic area to protect your reproductive organs from radiation.

• Gonadotropin-releasing hormones (GnRHs). Still experimental, this medicine may be used during chemotherapy to help lessen fertility damage.

What are my options before or after treatment?

• Ovarian tissue freezing. Under general anesthesia (where you aren’t awake at all) a surgeon may remove part of the ovary, or the entire ovary. It’s then frozen for later use. This is still an experimental option and is only available to girls who have already reached puberty.

• Ovarian transposition. A doctor surgically moves the ovaries away from the radiation field to minimize exposure and radiation damage.

• Egg freezing. Your doctor can remove mature eggs—which are then frozen and stored without being fertilized with sperm. Egg freezing is considered to be an experimental procedure that may only be an option for girls that have reached puberty.

What are some other after-treatment options?

• Donor embryos. This option enables a woman to become pregnant with a donated embryo (a baby made from anonymously donated sperm and egg).

• Donor eggs. A woman can receive donated eggs that have been fertilized with her partner’s sperm.

• Surrogacy. For a woman who is unable to be physically pregnant, there are different types of surrogacy options. “Surrogacy” is where another woman agrees to become pregnant and give birth to your baby for you.

What are the possible effects of cancer treatment? (girls)

• Some chemotherapies can cause you to start your period later.

• Some young women who receive cancer treatment have premature ovarian failure (POF), also called premature menopause. Unlike regular menopause, POF does not happen naturally. POF is when women the ovaries stop working in a woman younger than 40. If cancer treatment causes POF, it is unlikely that you would ever have a period again, or be able to have a baby. Generally, POF is managed with hormone treatments. Girls and women with POF should eat a healthy diet and exercise regularly. It will help strengthen your bones and protect against potential heart disease. Your doctor may give you medicine to keep your bones healthy. At this point, there is no treatment to bring back fertility if you have POF.

• Radiation to your pelvis can cause damage to the uterus, increasing your risk for infertility, miscarriage, spontaneous abortion or premature birth if you are pregnant. Girls who receive cancer treatment as children tend to have fewer fertility problems than young women treated during the teen or adult years.

Your period causes regular monthly changes. It is important to talk to your doctor if you notice ANYTHING new or different in your monthly menstrual cycle including:

• Irregular menstrual cycles

• Hot flashes

• Breast tenderness

• Painful intercourse

What do I need to know about birth control?

One of the toughest decisions that a lot of teens face is whether to have sex. If people decide to have sex, it means they must also take responsibility to protect themselves from unplanned pregnancy and sexually transmitted diseases (STDs).

In the United States, the teenage pregnancy rate is higher than in many other countries. Approximately 750,000 teens become pregnant every year and most didn’t plan on becoming pregnant. In addition to preventing unplanned pregnancies, people who have sex must protect themselves from STDs. For those having sex, condoms must always be used every time to protect against STDs.

The most effective way to prevent pregnancy and STDs is abstinence. Couples who do decide to have sex can choose from many effective birth control methods.

Talk to your doctor about what birth control method is best for you.

You may be surprised — some popular ones aren’t as effective as people might think.

What if I think I am pregnant?

What if I think I am pregnant?

It is possible to get pregnant while receiving treatment for cancer. If you think you might be pregnant, talk to someone, anyone, on your CHOC care team. We can help you figure out all of your options. Your treatment can then be tailored to what stage of cancer you have, and how far along you are in the pregnancy.

In most cases, pregnant woman under the age of 18 are protected by strict privacy laws. Anyone on your CHOC care team can facilitate a pregnancy test for you in private. If you think you may be pregnant, talk to your CHOC social worker, nurse or doctor.

There are a lot of decisions that need to be made if you get pregnant before or during cancer treatment—including delaying treatment to carry the baby to full term, changing treatment or pregnancy termination.

A pregnant woman with cancer is capable of giving birth to a healthy baby, and some cancer treatments are safe during pregnancy. Cancer rarely affects the fetus directly. For the safety of yourself, and your baby, you need to talk to your nurse or doctor if you think you might be pregnant.

What is fertility? (girls)

The word “fertility” is used to describe the ability to have children biologically. Some cancer treatments can affect your fertility. You may not be thinking about whether or not you want to become a mother someday. However, knowing about possible fertility effects of treatment now may help you take steps now to plan for the future.

Talk with your doctor if you think you may be going through puberty late (after age 15). The doctor may want to give you medicine to assist with the hormone balance.

Why do I need to talk to my doctor about my fertility?

It is important to talk your oncologist about the fertility effects of your treatment, ideally before you start treatment. Our specialists can answer any and all questions—even the ones that feel embarrassing—about fertility preservation.

We will keep your concerns and private information confidential.

An important conversation on a sensitive topic.

It is important to remember that even if you have been told by your doctor that you may have long-term fertility issues, it does not mean that you cannot become pregnant or get a sexually transmitted disease. So, always practice safer sex. For more information about birth control and safe sex, click here.

What about pregnancy? (girls)

While you are having cancer treatment is not a good time to get pregnant.

It is important to talk with your oncologist before making plans for pregnancy or if you have an unplanned pregnancy.

If you get pregnant during treatment, you may have to stop or change your therapy. This could affect the success of your cancer treatment and your health.

Think you might be pregnant?

Will treatment change my periods? (girls)

Your treatment may change your periods (menstrual cycle). Your periods may stop or become irregular. The amount of bleeding you have during a period may also change; it could be more or less.

It is important to know that even though your periods may stop or come less often, it is still possible to get pregnant.

When you have your period, you can use tampons if your platelets are at least “50” and your neuts are at least “1”. Follow the directions in the package of tampons to know what type to use and how often to change them.

If your platelets or neuts are too low, you should not use tampons. Use sanitary pads and change your pads often. Putting a tampon in your vagina can rub, scratch or tear the delicate lining inside. This could cause bleeding or infection. Also, if a tampon is left inside for too long, it could cause infection.

Your platelets may be very low at times while you are getting chemotherapy. This could cause heavy bleeding during your periods. To prevent this loss of blood, your oncologist may recommend controlling or stopping your periods during your treatment. This is done by taking birth control pills or a contraceptive medication called Depo-Provera.

What methods of birth control are safe? (girls)

Protect yourself by using a latex condom with spermicide every time you have vaginal sex. Condoms also protect you from sexually transmitted infections.

It is OK to take birth control pills during radiation treatment. However, it is possible that chemotherapy could make birth control pills less effective.

Your platelets should be at least “50” and your neuts should be at least “1” to use birth control methods that are inserted into the vagina, such as:

Diaphragm
Female condom
Contraceptive sponge

An intrauterine device (IUD) is put inside your uterus. This method of birth control is not safe for you.

Why? Because putting something in your vagina or uterus can rub, scratch or tear the delicate lining inside. During treatment, this may put you at greater risk for serious bleeding or infection. If you have any questions about birth control, talk with your oncologist.

Do I need to protect my partner or myself (girls)?

Yes. If you are sexually active you need to take some precautions.

During chemotherapy, a small amount of medication could pass into the fluid inside your vagina. Your oncologist can tell you if your chemotherapy medication will do this. It is best to wait at least 72 hours before having sex to protect your partner from exposure to chemotherapy.

You can get pregnant during chemotherapy, even if your periods have stopped. Each month, your ovaries may continue to release an egg. If your partner’s sperm fertilizes one of these eggs, you can get pregnant. Because chemotherapy may damage your eggs, a pregnancy during chemotherapy treatment could result in serious birth defects. For this reason, it is important to prevent pregnancy with birth control while you are undergoing treatment.

Decide on a method of birth control and have it ready, before having sex. Talk with your oncologist if you need help choosing a method of birth control.

If you have had many blood transfusions, you may worry about getting an infection and passing it to your partner. This is extremely unlikely to happen as all blood donors and donated blood are carefully tested.

One thing you don’t have to worry about is giving your partner cancer. Cancer cannot be passed from one person to another.

What is fertility? (guys)

The word “fertility” is used to describe the ability to have children biologically. Some cancer treatments can affect fertility. You may not yet be thinking about whether or not you want to become a parent someday. However, knowing about possible fertility effects of treatment now may help you take steps now to plan for the future.

Cancer treatment and fertility

Some fertility effects may last for a little while; others may be permanent. Risk for future fertility problems include your age at the time of your treatment, and the type and length of your treatment.

Some possible effects of cancer treatment

• High doses of radiation to the brain (and some chemotherapies) can affect your body’s ability to make sperm.

• Alkylating agents—like cyclophosphamide or procarbazine—have the biggest effect on fertility. Other drugs are generally less harmful to sperm-forming cells, but can still cause fertility problems, especially when used as part of combination medicine therapies.

• Higher doses of radiation may cause your body to permanently stop making sperm.

• If radiation is used on or near your testicles, your ability to make sperm could be affected for a while. But it could potentially return to normal later on. The effects of chemotherapy on sperm production may also be temporary.

• Radiation can affect testosterone, the male hormone. This side effect can either delay or speed up puberty. It may also affect your ability to have an erection.

Talk with your doctor if you think you may be going through puberty early (before age 13) or late (after age 15). The doctor may want to give you medicine to assist with the hormone balance. You can also talk with your doctor about a test to see if your body is making sperm.

Planning for the future

Before treatment

• Sperm banking. You may be able to donate sperm cells, which can then be frozen and stored. This is called sperm cryopreservation (or sperm banking or donation) and has the highest likelihood of success for male cancer survivors.

It may seem like an embarrassing topic, but your doctor or nurse will work with you to explain the process for collection and delivery, with your privacy in mind. Our specialists are comfortable talking about this—and can help ease any fears or discomforts you may have about the process of sperm banking.

During treatment

• Radiation testicular shielding. If possible, the doctor can put a shield over your pelvic area to protect your reproductive organs from radiation.

Before or after treatment

• Testicular sperm extraction (TESE) Under general anesthesia (where you aren’t awake at all) a surgeon removes a small piece of tissue from your testicle. Any sperm cells found in the tissue can be removed and frozen for later use. TESE can be done before or after puberty. It is still considered an experimental procedure in boys that haven’t yet reached puberty.

After treatment

• Donor sperm. When you are eventually ready to start a family, you can use sperm from an anonymous donor to produce a pregnancy through in vitro fertilization.

An important conversation on a sensitive topic

We will keep your concerns and private information confidential.

It is important to remember that even if you have been told by your doctor that you may have long-term fertility issues, it does not mean that you cannot get someone pregnant or get a sexually transmitted disease. So, always practice safer sex.