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Reproductive organ damage and chemotherapy
The sexual or reproductive organs (also called gonadsgonadsThe organ that produces germ cells.) include the ovaries in women and the testicles in men. Some chemotherapy drugs can affect the reproductive organs, which can lead to infertility (the inability to conceive or produce children). Damage to the reproductive organs is also called gonadal toxicity or gonadal dysfunction.
Damage to the reproductive organs is often related to the type and dose of chemotherapy drugs given and the length of treatment. Drugs that seem to produce the most severe side effects include:
- busulfan (Busulfex)
- chlorambucil (Leukeran)
- cisplatin (Platinol AQ)
- cyclophosphamide (Cytoxan, Procytox)
- mechlorethamine (nitrogen mustard, Mustargen)
Factors that put a person at risk for developing reproductive organ damage include:
- the combination of drugs given, such as those used to treat Hodgkin lymphoma or leukemia
- chemotherapy given in combination with radiation therapy to the pelvis
- a person’s age
- For example, women who are within several years of natural menopausemenopauseThe time in a woman’s life when her ovaries stop producing estrogen and she has not had a menstrual period for 12 months. Most women start menopause between 45 and 55 years of age. are more vulnerable to chemotherapy damage, and ovarian failure is more likely to be permanent.
Changes to the reproductive organs can lead to:
- fertility problems in men and women (can be temporary or permanent)
- a lower number or poorer quality of sperm produced, which affects sperm’s ability to reach and fertilize a woman’s egg
- menstrual changes (such as irregular menstrual cycles or lack of menstruation)
- premature menopause (caused by ovarian failure)
Damage to the reproductive organs may not show up until after chemotherapy is finished.
A detailed interview can help identify a problem with sexual function. People with cancer may be interviewed alone or with their partners. The doctor may do a physical examination to check the genitals. Sometimes tests are done to find out the cause of sexual problems or to check sexual function.
Infertility is sometimes permanent. People concerned about having children in the future should discuss how chemotherapy treatment may affect their fertility with their doctor. They should also discuss fertility options before treatment starts.
Many chemotherapy drugs are passed from the body within 72 hours. People receiving chemotherapy should talk to their doctor or healthcare team about any precautions they need to take while having sex (including oral sex), when to avoid having sex and when it is safe to start having sex again.
People receiving chemotherapy need to use birth control measures. This is because chemotherapy drugs can be mutagenic (causing genetic mutations) or teratogenic (causing defects to a developing fetus). A woman may still be fertile while she is receiving chemotherapy, even if her menstrual cycles become irregular or stop.
Men should use a condom during sexual intercourse for the first few days after treatment because some of the drugs may end up in the sperm.
Some chemotherapy drugs can affect the ovaries so they stop producing eggs or do not produce the normal amount of hormones.
- A woman cannot get pregnant if the ovaries stop producing eggs. Some women’s ovaries start producing eggs once treatment ends and periods return to normal. For other women, this effect can be permanent and they will be infertile.
- During chemotherapy, a woman’s menstrual periods may become irregular or stop completely. This is due to hormone changes. Hormone changes may bring on menopausal symptoms, such as hot flashes and vaginal dryness. Vaginal dryness can make intercourse uncomfortable and can make a woman more prone to bladder or vaginal infections. Steps can be taken to help deal with menopausal symptoms. For some women, periods will not return and menopause will be permanent (treatment-induced menopause).
Having children after chemotherapy
Talk to your doctor if you and your partner are considering pregnancy after chemotherapy treatments are over.
It is recommended that a person wait at least 6 months or more after cancer treatment before trying to conceive or have a child. Some doctors may suggest delaying pregnancy for about 2 years after treatment. How long someone has to wait depends on many factors, including the:
- type and stage of cancer
- chances of the cancer recurring
- person’s age and personal wishes
The healthcare team considers all these factors when advising people about the best time to conceive after cancer treatment.
A delay is also recommended to allow the ovaries or sperm to recover after cancer therapy.
There has not been any conclusive evidence that shows children born to parents who have received chemotherapy drugs have an increased potential for birth defects or other diseases.
For more detailed information on specific drugs, go to sources of drug information.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.