Fertility is your ability to make a baby, that is, to become pregnant or get someone else pregnant. Some treatments for lymphoma can affect your fertility. These can include chemotherapy, immune checkpoint inhibitors, and radiation treatment if is to your abdomen or genitals.
Fertility changes can happen when you have treatment for lymphoma as a child or as an adult. However, there are some things that can be done to try to protect your fertility. It is important that these be done BEFORE YOU START TREATMENT.
Will my treatment affect my fertility? And, what can be done to protect it?
Definitions
We recognise that some people identify differently to the gender they were assigned at birth. For the purposes of discussing fertility in this webpage, when we say male, we refer to those assigned male at birth. When we say female, we refer to those assigned female at birth.
Can I get (or get someone else) pregnant during treatment?
In most cases, the answer is no. You should not get pregnant or get someone else pregnant during treatment for lymphoma. Many treatments for lymphoma can affect sperm and eggs (ova). This puts the baby at higher risk of deformities (not developing properly). It may also cause delays to your treatment.
Other treatments can harm an unborn baby. The biggest risk to the baby is in the first 12 weeks of pregnancy when all the cells that make up the baby are being developed.
Talk to you doctor about when the best time to plan a pregnancy will be. In some cases, you may need to wait up to 2 years after you finish treatment before becoming pregnant.
If an unexpected pregnancy happens while you are having treatment, let you doctor know immediately.
What if I am already pregnant when I am diagnosed with lymphoma?
Being diagnosed with lymphoma while you are already pregnant is challenging. And it is not fair! But, unfortunately it does happen.
Can I keep my baby?
Often the answer is YES! There may be some cases when your doctor will suggest a medical termination (abortion). But, in many cases, pregnancy can continue and result in a healthy baby. The decision is yours. Make sure you get all the information you need before making a decision.
Can I still have treatment for the lymphoma?
Yes. However, your doctor will need to consider several things before making a plan for treatment.
Your doctor will consider:
- Whether your pregnancy is in the 1st trimester (weeks 0-12), 2nd trimester (weeks 13-28), or 3rd trimester (weeks 29 until birth).
- The subtype of lymphoma you have.
- The stage and grade of your lymphoma.
- Any symptoms you have, and how your body is coping with the lymphoma and the pregnancy.
- How urgent is it to have treatment and what treatment you will need.
- Any other illnesses or treatments you may be having.
Why does treatment affect my fertility?
Different treatments can affect your fertility in different ways.
Lymphoma in the testes
Lymphoma can develop in testes of biological males. Some treatments aimed to destroy the lymphoma can affect the way the testes function. In some cases, surgery may be needed to remove the lymphoma and surrounding testicular tissue.
Chemotherapy
Chemotherapy attacks fast growing cells, so as sperm is produced, or eggs mature in the ovaries they can be affected by chemotherapy.
Effect on ovaries
Chemotherapy can affect the way your ovaries work, and prevent them from maturing and releasing healthy eggs. It can also damage maturing eggs. The effect on your ovaries may differ depending on your age, whether you have reached puberty or are close to menopause age, and the type of chemotherapy you have.
Effect on testes
The effect chemotherapy has on your testes can be temporary or permanent. The chemotherapy can affect your sperm, but can also damage cells in your testes responsible for the functioning of your testes and sperm production.
If the cells in your testes are damaged, the effect chemo has on your fertility could be permanent.
Monoclonal antibodies
Some monoclonal antibodies, especially immune checkpoint inhibitors such as pembrolizumab or nivolumab can affect your abililty to produce hormones. Hormones are needed to tell your body to make sperm or mature eggs.
When your hormone levels are affected, your fertility is affected. This can be a permanent change, but does not happen to everyone. There is no way to tell if your hormones will be permanently affected by these medicines.
Radiation therapy
Radiation to your abdomen or genital area can cause scar tissue, and affect your ovaries or testes from producing hormones needed for fertility.
Menopause versus Ovarian Insufficiency
Treatments can result in menopause or ovarian insufficiency in biological females. Menopause is a permanent condition that will stop periods and prevent you from falling pregnant.
Ovarian insufficiency is different, though will still have similar symptoms to menopause.
- missed periods for 4-6 months in ovarian insufficiency and 12 months for menopause.
- decreased follicle stimulating hormone (FSH) levels
- inability to get pregnant
- hot flushes
- changes to your mood and sleep patterns
- low libido (low desire for sex)
- vaginal dryness.
Ask your doctor how your treatment will affect your fertility, and whether the change will be permanent or temporary.
What can be done to protect my fertility?
There are several options that may be available to you, or your child having treatment that can help protect fertility.
The right option for your situation will depend on several factors including:
- how old you are
- if you have reached, or gone through puberty
- your gender
- the urgency of your treatment
- ability to get fertility appointments before treatment needs to start.
Freezing eggs, sperm, embryo’s or other ovarian and testicular tissue
The Sony foundation has a program called You Can Fertility. This service is free for people 13-30 years of age to store eggs, sperm, embryos (fertilised eggs) or other ovarian or testicular tissue to help with pregnancy later in life. Their contact details are at the bottom of this page under Other resources.
Eggs and sperm may be stored if you have already reached puberty or are an adult. An embryo may be stored if you have a partner that you would like to have children with later.
Other ovarian or testicular tissue is usually stored for younger children who have not yet reached puberty, or if you need to start treatment before your eggs of sperm can be collected and stored.
You may have a slice of your ovary (biological females) or testicle (biological males) removed and frozen to help with pregnancy after treatments. The procedure may be done as a keyhole surgery. When we say “Other ovarian or testicular tissue” we are referring to this slice of ovary or testicle.
Other options to store or preserve eggs/sperm, embryos and other tissue
If you do not meet the criteria for the Sony Foundations program, you can still store your eggs, sperm, embryos or other ovarian or testicular tissue. There is usually a yearly fee which will differ depending on where it is stored. Talk to your doctor about the options and costs involved in storing your eggs, sperm or other tissue.
Medicine to protect your fertility
You may be able to have medicine that help protect your ovaries or testicles during treatment. This medicine is a hormone that temporarily shuts your ovaries or testes down, so the treatment has less effect on them. After treatment ends, you will stop the hormone treatments and your testes or ovaries should start working again after a few months.
Hormone treatments for fertility preservation are not effective for young children.
Ask your doctor about the options you have to protect your fertility before you start treatment.
Can I get pregnant after treatment if I haven't had fertility preservation?
Most lymphoma treatments can make it harder to get pregnant later in life. However, pregnancy can sometimes still happen naturally for some people. This may happen whether you have had fertility preservation or not.
If you do not want to get pregnant, you should still take precautions to prevent pregnancy after treatment.
Are there tests to check my fertility?
To check if you may be able to get pregnant naturally, talk to your general practitioner (GP or local doctor). They can arrange tests to check your hormone levels, ovaries or testes and the quality of your eggs or sperm. However, the results of these tests can change over time.
For some people, fertility improves soon after treatment, and for others it may improve years after treatment. But for some, pregnancy will only be possible through other means, such as using your stored sperm, eggs or embryos, or other testicular or ovarian tissue.
What happens if I still cant get (or get someone else) pregnant?
More and more people are choosing to have a child free life. This may be an option for you.
However, if a child free life is not for you, there are other options to have a family even if you or your partner cannot get pregnant. Families are changing and many families have unique circumstances. Some options can include:
- Adoption
- Foster care
- Using donor eggs or sperm
- Surrogacy (the laws around surrogacy are different in different states and territories)
- Big brothers, big sisters program
- Volunteer to work with children.
Emotional and psychological support
Having lymphoma and treatment can be a very stressful time. But when the treatment that will save your life, prevents you from having the life you were planning, it can be very difficult to cope emotionally and psychologically.
It is normal to struggle with emotions during or after treatment. However, you also may not feel the effects of the emotional and psychological stress until years later, or when you are ready to start a family.
Talk to your local doctor (GP) about how you are feeling and the impact the changes in your fertility are having for you or your partner. They can organise a *mental health plan which will allow you to access up to 10 sessions with psychologist each year. You may also like to ask to speak with a counsellor or psychologist at your nearest family planning centre.
*You will need a Medicare card to access the Mental Health Plan.
Other resources
Sony Foundation – You Can Fertility program
Cancer Council – Fertility and Cancer booklet
Summary
- Many lymphoma treatments can affect your fertility later in life.
- Do not get pregnant or get someone else pregnant while you’re having treatment for lymphoma. Tell your doctor immediately if you (or your partner) get pregnant while having treatment.
- There are several approaches to protect your fertility.
- Fertility preservation should be done before you start treatment.
- You may need to wait for up to 2 years after you finish treatment to get pregnant.
- You may still get pregnant naturally after lymphoma treatment. If you do not want a pregnancy, use precautions to prevent pregnancy.
- In some cases, you may not be able to get pregnant. There are other options available.
- Call the Lymphoma Care Nurses for more information. Click the contact us button at the bottom of the screen for contact details.
