Issues relating to haematological disease in adolescents - principles of sexual and reproductive health, particularly in the context of chemotherapy

Overview

Chemotherapy and other haematological malignancy treatments carry significant implications for fertility, contraception, and sexual health - these should be discussed proactively before treatment starts, given many effects are difficult or impossible to reverse once treatment has begun
Gonadotoxicity varies substantially by specific drug/regimen (alkylating agents carrying particularly high risk) and by patient age/sex, but fertility discussion is relevant to essentially every patient of reproductive age starting significant chemotherapy

Alkylating agents and total body irradiation (used in some conditioning regimens) are particularly gonadotoxic, causing premature ovarian insufficiency in women and impaired spermatogenesis (sometimes permanent) in men - the degree of risk varies by specific drug, cumulative dose, and patient age at treatment

Fertility risk discussion should occur before treatment starts, ideally with referral to fertility preservation services (sperm banking for men, oocyte/embryo cryopreservation for women, though the latter requires more time and is not always feasible before urgent treatment must begin) when time and disease urgency allow
Contraception during and after treatment is essential given the teratogenic potential of chemotherapy - effective contraception should be discussed and arranged proactively, not assumed to be unnecessary because of reduced fertility, since some fertility can persist despite treatment

Fertility preservation options should be offered and facilitated wherever feasible before treatment, balanced against the urgency of starting cancer treatment - a multidisciplinary discussion involving the patient, haematologist, and fertility specialist optimises this balance
Ongoing sexual health/function issues during and after treatment (from treatment effects, fatigue, or psychological impact) should be actively asked about, since patients frequently do not volunteer these concerns unprompted

Premature ovarian insufficiency, chemotherapy-induced infertility, teratogenicity of chemotherapy, fertility preservation (sperm/oocyte/embryo cryopreservation)

Fertility preservation options become progressively more limited once treatment has started - proactive discussion and referral before treatment initiation is essential given the frequently narrow window available, particularly when urgent treatment cannot be meaningfully delayed

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