癌症治疗对生育的影响

当你的孩子正在抗癌时，它可能很难超越未来几天或几个月。然而，由于今天的治疗越来越有效 - 由于医学突破，儿童癌症的存活率近80％ - 了解如何影响孩子的生育。

While some treatments have little to no effect on reproductive health, others are likely to damage the testes or ovaries, resulting in temporary or permanent infertility. Your doctor can tell you if there’s a chance that treatment might affect the reproductive system.

Once armed with this knowledge, you and your child can consider what preventive measures (like sperm banking or egg preservation) to take before or after cancer treatment to help improve your child’s ability to start a family later in life.

Risks of Treatment

Chemotherapy, radiation, and surgery all can have lasting effects on reproductive health. Your child’s risk depends on the diagnosis, the type of treatment, and the dose (higher doses are more likely to lead to infertility) — but even your doctor can’t predict with 100% certainty what the lasting effects will be.

In general:

Somechemotherapydrugs are more likely to lead to infertility than others. The high-risk drugs most likely to affect reproductive organs are Cytoxan (known generically as cyclophosphamide), Ifosfamide, Procarbazine, Busulfan, and Melphalan. Others, like vincristine and methotrexate, are typically less likely to harm fertility. Some of these drugs also may interrupt menstruation in girls and/or cause early menopause.

辐射治疗可能会损坏睾丸或卵巢。如果辐射聚焦在盆腔区域，腹部，脊柱和/或全身附近，则可能对精子或鸡蛋造成损害。此外，对腹部，盆腔区域或整个身体的辐射可能会影响女孩的子宫功能，并导致携带婴儿的困难。它还可以中断女孩中的月经或减少男孩的精子数量和运动 - 这些条件可能是永久性的或在治疗后可能会逆转。对大脑某些地区的辐射的孩子也可能影响他们的生育。

如果癌症涉及生殖器官，手术可能会推荐，医生可能需要去除生殖器官的一部分以去除癌症。

精子和鸡蛋保存选择

如果您孩子的治疗承受着高不孕症的风险，这里有一些需要考虑的选择。

Boys

For boys who have gone through puberty, sperm banking or “cryopreservation” is a common, non-invasive option to consider. Sperm are collected and frozen for storage in a specialized facility. Some hospitals have sperm bank programs, but you may have to go to a clinic that specializes in sperm banking.

对于尚未达到青春期的年轻青少年和男孩，可能是一种更具名为“精子展示”的实验程序。该过程去除未成熟的精子细胞以供以后使用in vitrofertilization (sperm are used to fertilize an egg outside of the uterus, then the fertilized embryo is transferred to the uterus).

It also may be possible to preserve sperm by freezing testicular tissue. This is still experimental and its effectiveness hasn’t been determined. Your doctor may advise against it because of the risk that cancer cells could be reintroduced when the tissue is grafted back into your son’s body.

Girls

根据女孩病症的细节，可以冻结未受精卵（青春期后）或卵巢组织（在青春期之前或之后）。然而，这些是实验过程 - 并非所有医院或诊所都可以获得技术和成功率不同。在某些情况下，您的医生可能建议反对保存卵巢组织，因为它可能会在以后再发挥癌细胞的风险。

胚胎冻结 - 其中从卵巢中收获卵，在实验室中受精，然后冷冻和储存 - 更广泛的可用性，成功率较高。然而，由于它需要成熟的鸡蛋，这种方法仅适用于经历青春期的女孩。它比成年女性更少常用于青春期女性（因为它需要来自伴侣的精子），但是可以使用供体的精子来施肥卵。由于这种方法需要一段时间的卵巢刺激，因此对于需要尽快进行治疗的女孩并不理想。因此，这可以防止许多女孩能够收获鸡蛋。

Depending on the type and target area of treatment, it may be possible to shield the ovaries from damage or even move them out of the path of radiation (called transposition).

What to Ask the Doctor

When thinking through the options above, be sure to get all the facts from your care team. It might be helpful to see a fertility specialist about which option (if any) would be best for your child.

Some questions to ask:

• 这种治疗可能会损害我孩子的生殖器官吗？如果是这样，可能会受到哪些方面的影响，这种影响将如何生育？
• What are the chances this treatment will cause my daughter to experience an early menopause? Can the treatment affect some organs (like the lungs or heart) in a way that will make it hard for her to carry a pregnancy to term?
• 这种治疗是否会对我儿子的男性气质产生任何影响？如果对精子计数的损害很可能，损害会暂时或永久吗？
• Will this treatment have any affect on development through puberty?
• 在我们开始治疗之前是否有防止不孕症的方法？这些中的任何一个干扰治疗的疗效？
• What proactive measures, like sperm banking or egg preservation, are viable for my child? Are any experimental options available?
• 治疗后，我们如何知道我的孩子的生育是受影响的吗？

If infertility is a possibility, it’s important to know about other options for the future, including adoption or surrogacy. A surrogate mother carries a child to full term for a woman who is not able to do so herself, for health reasons or due to infertility. The surrogate mother may carry a child who is her genetic offspring or may be implanted with an infertile couple’s embryo viain vitro施肥。

Emotional Effects

在探索选项时，重要的是与您的孩子一起分享。

这可能不会很容易 - 性行为和繁殖通常是父母和孩子们讨论的困难的主题，并且不孕症的风险携带复杂的情绪，这对孩子来说可能很难处理。即使在很小的时候，不孕症的概念也可能是强大而激烈的。

如果面对生育问题 - 特别是青少年，孩子们尤其是青少年，孩子们可能会产生深刻的损失感

以下是帮助您的孩子应对这些潜在变化的方法：

Keep talking.一个开放的讨论with your son or daughter will help you plan for treatment and know what to expect afterward. It’s also important to let your child know that he or she is not alone, and that many teens who were told that their treatments would likely lead to infertility go on to have children; others go on to become parents through adoption, surrogacy, or other methods. Planning for the future can help your son or daughter stay positive and concentrate on getting well.

Seek support.The hospital or clinic may have a support group or counselor who can help work through the complex feelings your child is bound to experience.

保持希望现实。开放，诚实地对不孕症的风险，生育保存选择的成功率以及任何可能的风险或并发症。确保您和您的孩子明白，没有任何保证。提供您孩子仍然是同一个人的保证，无论发生什么事。并记住，即使无法对身体构想，您的孩子仍然可以成为一天的父母。

Reviewed by:Jonathan L. Powell, MD
Date reviewed: October 2012