Chemotherapy. Alkylating agents affect fertility more commonly than other types of chemotherapy.

Examples of these drugs:

• Cyclophosphamide (Neosar)
• Ifosfamide (Ifex)
• Procarbazine (Matulane)
• Busulfan (Busulfex, Myleran)
• Melphalan (Alkeran)

Other drugs may cause short-term effects on a girl's menstrual cycle. These include vincristine (Vincasar PFS) and methotrexate (multiple brand names). However, these drugs do not cause early menopause. Menopause is when menstrual periods stop.

In general, high doses of alkylating agents will cause permanent damage. But doctors typically use the lowest possible doses for children. This lowers the risk of permanent damage to reproductive organs. Doctors treat many pediatric cancers without alkylating agents. Ask your doctor about possible fertility risks with any anti-cancer drug prescribed for your child.

Radiation therapy can damage the ovaries or testes.

The risk is greatest when the radiation is focused in these areas:

• Pelvis
• Abdomen
• Spine
• Whole body

In girls, radiation therapy may damage eggs and affect hormone production. This is called ovarian insufficiency. Girls who have not yet begun menstruation may have delayed puberty. Girls who have begun menstruation may have irregular menstruation. Or their menstrual periods may stop.

Scarring from radiation therapy to the uterus slows blood flow. This stops the uterus from enlarging during a pregnancy and can make pregnancy difficult later in life. It could also increase the risk of miscarriage and premature or low-birth-weight babies.

In boys, radiation therapy may damage sperm and affect their hormone production.

Children who have radiation therapy to the brain may also have fertility side effects. In these cases, treatment damages the brain’s communication with the reproductive organs. But if reproductive organs are not damaged, hormone treatment helps fix this problem.

Sometimes cancer is found in a child's reproductive organs. In these cases, the doctor might suggest surgery to remove part or all of these organs. These surgeries may affect fertility.

Fertility is a complex idea, especially for children. Still, children who understand it should be involved in the discussion about how cancer treatment may affect their fertility. Find age-appropriate ways to discuss the topic with your child. The healthcare team can help you with this.

Ask your child if he or she wants procedures intended to preserve fertility. Children and teens cannot give full legal consent because of their age. assent. Parents also must give consent before the procedure. Only give consent after learning about: the procedure’s risks, potential complications, success and failure rates, and fertility options for children.

Families have options to help preserve a child’s fertility. The American Society of Clinical Oncology (ASCO) recommends that parents and guardians discuss the risk of infertility and fertility preservation options with their child’s doctors. They should do this before cancer treatment begins. Options are limited for children diagnosed with cancer before puberty. Also, the costs of these options can be high.

Fertility options for girls:

Certain methods may help prevent or lower the risk of damage for girls. For example, doctors may use a treatment plan that avoids or reduces doses of chemotherapy that are linked to infertility. For some girls who need radiation therapy, an oophoropexy may be an option. This is when a surgeon moves one or both ovaries where radiation will not reach them. The surgeon may put them back in place after treatment. However, it is not always possible to prevent damage to the ovaries.

Oocyte (unfertilized egg) freezing

A girl who has gone or is going through puberty can freeze her eggs. Puberty usually occurs between ages 9 and 15. This method requires about 2 weeks of fertility drug treatment. Then, the healthcare team collects the eggs from the ovaries.

Sometimes, girls need to begin cancer treatment right away. This does not allow time for the 2-week fertility treatment. Instead, egg collection may occur after only brief fertility treatment or even without it. However, these eggs will not have fully matured in the ovaries. The eggs must then undergo in vitro maturation. This means that the eggs mature in a laboratory.

Ovarian tissue freezing followed by transplantation

Freezing eggs is not an option for girls who have not gone through puberty. Freezing ovarian tissue for later transplantation may be an option for these girls. This method is sometimes called ovarian cryopreservation. It was previously considered experimental. But now this procedure is improving and becoming a more standard option.

It is done as an outpatient laparoscopic surgery. Laparoscopy uses a thin, lighted tube called a laparoscope to remove ovarian tissue. A surgeon inserts the laparoscope through a small cut made in the abdominal wall. The surgery lasts about an hour.

Later, ovarian tissue can be transplanted back to the patient during an outpatient procedure. It can be transplanted to the pelvis or under the skin.

Fertility options for boys

Certain methods prevent or lower the risk of damage in boys. For example, the healthcare team can shield a boy’s testicles during radiation therapy. They may also use a treatment plan that avoids or reduces doses of chemotherapy that are linked to infertility.

Sperm banking

This is also called cryopreservation. It is a common, noninvasive option. However, it is only possible with boys who have gone through puberty. Most boys have some sperm in their semen by about age 13. This method involves collecting and freezing sperm. The sperm are then stored at a special center.

 hospitals have sperm bank programs. And some clinics specialize in sperm banking.

Testicular tissue freezing

For boys who have not gone through puberty, freezing testicle tissue may help preserve fertility. This is still an experimental approach This method involves collecting and freezing testicular tissue. Hopefully, the tissue contains stem cells that would later produce mature sperm. The healthcare team would then transplant thawed tissue back into the testicle at a later time. Or they would inject stem cells taken from the frozen tissue.