Lymphoma

Treatment-induced infertility

Some chemotherapy drugs (not all) used for lymphoma can cause temporary or permanent infertility. High dose chemotherapy given as preparation for a stem cell transplant can cause permanent infertility. Radiotherapy to an area that includes the testes or ovaries will also cause infertility unless these are protected with lead shielding. For women who have not yet been through the menopause, periods usually stop or become irregular during treatment. The nearer the woman is to her natural menopause the more likely it is that chemotherapy will stop her periods permanently.

Many people had been told before starting certain treatments that it might make them infertile. A woman in her forties said she read this in a leaflet but was not 'told'. A 51-year-old man said that infertility wasn't mentioned before he had radiotherapy for his spinal lymphoma and it took him nine months to ask whether his fertility would have been affected. A 25-year-old woman wanted to know the likelihood of her becoming infertile as a result of treatment and could not find any statistics.

Before treatment starts men whose fertility is at risk are usually invited to store some sperm for possible future use. Some men who were not planning a family had turned this invitation down. Others had stored their sperm for many years. A man who was aged 14 at diagnosis said his doctor wasn't very good at talking to him about sperm banking and seemed embarrassed. He later had a good discussion about it with a young female nurse. A 16-year-old was told he was already so ill that he was unlikely to have any viable sperm to collect, and he knew he would die if he refused chemotherapy. The process may involve having an HIV test, but does not necessarily involve the degree of counselling that would usually accompany the test.

Women in a relationship are sometimes invited to preserve their fertility by harvesting eggs from their ovaries which are then fertilised using their partner's sperm and stored. This means delaying treatment for several weeks while eggs are harvested, so may be risky for women whose lymphoma needs immediate treatment. Storing unfertilised eggs is also now possible and is being used more commonly than in the past. Whether ovarian tissue can be successfully removed and re-implanted after treatment is also being investigated. A woman who was aged 16 at diagnosis in 1992 said egg harvesting was never mentioned, and a woman diagnosed in 1993 aged 20 said her mother asked about fertility preservation but the consultant suggested they already had enough to deal with and infertility wasn't an inevitable outcome of ABVD chemotherapy. Some young women were offered egg harvesting but decided against it.

A woman who was diagnosed with Hodgkin lymphoma in the 1980s at age 19 was told she needed radiotherapy to her groin and abdomen, which would make her infertile. She asked what could be done to prevent this and persuaded her doctors to perform an operation to move her ovaries out of the treatment field by stapling them to her uterus. Although this did preserve her fertility it caused painful pregnancies. Nowadays chemotherapy is preferred to radiotherapy as first line treatment for Hodgkin lymphoma and this type of surgery is rare.

Some young people had not begun to think about having children and had not put their fertility to the test since completing treatment. They knew that they would have to face this issue sometime in the future. One man was glad he had his stored sperm to fall back on if he turned out to be infertile. Other people had completed their families so weren't that concerned that treatment might make them infertile; one woman said she had already been infertile before her treatment so it wasn't an issue. 

While treatment made some people permanently infertile, others went on to have children. A woman diagnosed at age 11 had never been told by her doctors or her family that her fertility was at risk and later had three children. People are usually advised to use contraception during treatment and for at least a year afterwards. Two women we spoke to became pregnant accidentally within months of completing treatment. 

See more experiences of women who have been through premature menopause (some after treatment for cancer).

Last reviewed February 2016.

Last updated February 2016.

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