Treatment-induced infertility

Some leukaemia treatments can impair the production of sex hormones, eggs and sperm. In particular, high dose chemotherapy or total body irradiation (TBI) given as preparation for a stem cell transplant, will do this, resulting in temporary or permanent infertility and other symptoms including hot flushes, impaired libido, weakness and tiredness. Women may have a premature menopause with the risk of osteoporosis. Hormone replacement therapy (HRT) may be offered to relieve menopausal symptoms but it is not suitable for all women.

Several people told us that infertility was not a problem for them as they didn’t want children or had already completed their family; some had already been sterilised. Most people were warned about possible infertility before starting any treatment that might cause it. However, Ian, aged 35, was in intensive care when his acute leukaemia was diagnosed, and high dose chemotherapy was started immediately, so he wasn’t told about infertility until afterwards.

Ians doctor found it difficult to broach the subject of infertility after having started him on…

Age at interview 43

Gender Male

Age at diagnosis 35

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Frances and her lesbian partner had already decided that they didnt want children, so…

Age at interview 45

Gender Female

Age at diagnosis 42

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Dianne, who was childless and aged 50 at diagnosis, had not been warned about infertility before starting treatment and was shocked when her consultant explained it when she started having hot flushes (see clip below). Some women said that although they had been warned about possible infertility, it had not been made clear that they might experience an early menopause.

Men whose treatment may make them infertile are usually invited to ‘bank’ some sperm samples before it starts. This is often done in a different part of the hospital but men who are already in their own isolation room may be invited to do it there. The samples are frozen and stored for possible use in the future. Treatment for acute leukaemia usually starts as soon as possible after diagnosis, so men who wish to bank their sperm have to do so quickly at a time when they are still in shock from learning the diagnosis. Aley said his treatment was delayed by two days so he could bank his sperm.

Having just been told he had leukaemia and no immune system, Jim was stressed by having to leave…

Age at interview 24

Gender Male

Age at diagnosis 23

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It is less easy for women being treated for leukaemia to preserve their fertility. It may be possible to store some fertilized eggs (embryos) using sperm from a partner, so they can be re-implanted into the womb later. It may also be possible to freeze unfertilized eggs but the success rate with these is lower than for embryos. However, collecting the eggs takes a few weeks so this is possible only where it is safe to delay the start of treatment. Research is being done into the storage of pieces of ovarian tissue for later use, however, this procedure is still experimental and reimplantation of the thawed tissue may not be available at all UK hospitals. So far, only a few babies have been born using this method but the number is rising all the time.

Julie had a slice of ovarian tissue frozen but has not used it, in the 11 years since, as she does not want to go through hormone treatment that might be needed without a guarantee of success. Other women were given the option of freezing embryos, or were told about it, but didn’t do it.

She regrets that she didnt freeze some embryos when she had the chance. She would have liked to…

Age at interview 40

Gender Female

Age at diagnosis 28

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Ann was told about options for preserving fertility but was not encouraged to pursue them and was…

Age at interview 40

Gender Female

Age at diagnosis 33

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Coming to terms with the risk of infertility can be difficult and people react in different ways. Some felt it was better to concentrate on treating the leukaemia first and to consider the possible infertility later. For men who had banked their sperm, knowing that they might be able to father a child later was comforting. Jim, aged 24, said it was strange not knowing whether he was fertile or not and that he would like to have children one day but would be happy to adopt if necessary.

Aleys treatment would definitely cause infertility but he was more concerned about curing the…

Age at interview 33

Gender Male

Age at diagnosis 31

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Young women who had not yet started a family, and for whom egg or tissue banking was not an option, were more likely to weigh up the benefits and risks of having treatment because of a strong desire to have children later. Many said that after their treatment was over they wanted to have the same life choices as everyone else. Ann, aged 33 at diagnosis, had just got married and debated with her husband and a nurse whether she should have a stem cell transplant that would definitely make her infertile. She eventually decided there was no point in having a child if she might not survive to bring it up.

Julie, aged 27 and single, was devastated by the prospect of being made infertile by a stem cell…

Age at interview 38

Gender Female

Age at diagnosis 27

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Some women experienced a profound sense of sadness or loss when they became infertile during treatment, even if they had not been planning (more) children. Other people didn’t always understand why losing their fertility was so important to them when they were facing life-saving treatment choices.

Elaine wasnt bothered initially by becoming infertile as she already had 2 children, but when it…

Age at interview 39

Gender Female

Age at diagnosis 35

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Although Dianne was unlikely to have children at age 50 she still felt a sense of loss when her…

Age at interview 53

Gender Female

Age at diagnosis 50

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Several women started the menopause during or after their treatment. Elizabeth’s periods stopped during interferon treatment but she has never had menopausal symptoms. Julie had terrible hot flushes and, after having a blood test to confirm she was menopausal, she was put on Hormone replacement therapy (HRT). Elaine was put on HRT before developing any menopausal symptoms. Elsa has hot flushes despite taking HRT and doesn’t know whether they are caused by her illness or the menopause.

After treatment Frances had hot flushes with nausea, restlessness at night and felt moody when…

Age at interview 45

Gender Female

Age at diagnosis 42

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Infertility has varying effects on people’s lives and relationships. Women who would have liked children often envied friends and family who had them. Some developed close relationships with other people’s children and became an ‘auntie’ or godparent to them. Ann said that her inability to have children might have been a factor in her subsequent marital breakdown. She and her husband had never considered adoption but she has no regrets as she has nine godchildren who she spoils more than she could her own. Julie went on to marry a man who didn’t mind her infertility. They considered adoption but decided against it. (See more on experiences of infertility).

Julie envies friends and relatives who have children. She loves all her nieces and nephews as if…

Age at interview 38

Gender Female

Age at diagnosis 27

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The biological therapy imatinib (Glivec) may affect fertility and there is some evidence that it can damage a developing fetus (Macmillan Cancer Support August 2015). Therefore people were advised not to get pregnant or father a child while taking it. Some women would have liked to get pregnant but were reluctant to take a break from imatinib in case it caused their leukaemia to recur. A 40-year-old woman who had been taking the drug for 8 years envies her friends who have children and regrets not having pursued the possibility of getting pregnant. A woman in her 30s considered the risks to the fetus were small so didn’t try to avoid pregnancy while in a relationship, but it didn’t happen.

Aged 28 and with a partner, Chanelle wants to start a family but would have to stop taking…

Age at interview 28

Gender Female

Age at diagnosis 20

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Similarly, Glyn was warned that he should not conceive a child while taking lenalidomide (Revlimid) because birth defects were possible.

Remission and recovery from treatment

Treatment for leukaemia aims to achieve remission. Remission means that no leukaemic cells can be found in the blood or bone marrow and the bone...