more than 5 Gy of radiation to the ovaries or uterus are more likely to experience difficulty becoming pregnant or maintaining a pregnancy. CHEMOTHERAPY EFFECTS The type and dose of chemotherapy will determine which fertility problems may occur in children treated for cancer. The pediatric oncologist will discuss the types of chemotherapy your child may receive. The medicines that are most likely to cause fertility problems are called alkylating agents. Chemotherapy drugs most likely to result in fertility problems in any child with cancer include:
Alkylating Agents Cyclophosphamide Ifosfamide Nitrogen Mustard Procarbazine BCNU (Carmustine) CCNU (Lomustine) Melphalan
Heavy Metals Carboplatin* Cisplatin*
Nonclassical Alkylating Agents
DTIC (Dacarbazine)* Temozolomide (Temodar)*
Thiotepa Busulfan
*Less likely to result in infertility in both females and males if given without alkylating agents or heavy metals. The combination of chemotherapy and radiation may increase the risk for future fertility problems in females. Other factors that may influence how future fertility is affected includes • total dose(s) of chemotherapy drugs • patient’s pubertal status at the time treatment begins
• patient’s fertility status prior to therapy • location and total dose of radiation.
Many females who receive chemotherapy may not develop fertility problems imme- diately. In fact, many females do not experience infertility, even after high doses of chemotherapy. However, the age in which females are diagnosed with cancer and treated may affect future fertility. Every survivor will respond to therapy differently, so your child will need regular check-ups during and after therapy to watch for problems. Females who are diagnosed with cancer and require a hematopoietic stem cell transplantation (HSCT) may develop infertility from high doses of alkylating agents like cyclophosphamide.
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