Understanding the Unique Fertility Challenges for AYAs
A brain tumor diagnosis is a life-altering event, especially for adolescents and young adults (AYAs)—those between the ages of 15 and 39. This age group is in a stage of life where planning for the future, relationships, career growth, and family-building are top priorities. However, a diagnosis often puts these dreams on hold as immediate treatment takes precedence.
Among the many concerns that come with brain tumor treatment, fertility preservation is one that is often overlooked or not discussed early enough. Many AYAs are not aware that certain treatments—such as chemotherapy, radiation, and surgery—may affect their reproductive health. Without proper counseling, they may lose the opportunity to preserve their fertility before beginning treatment.
This article explores the importance of fertility preservation, the available options for AYAs, and how young patients can advocate for their future family-building possibilities.
Why Fertility Preservation Matters for AYAs
Fertility concerns may not be the first thing on a patient’s mind when receiving a brain tumor diagnosis, but for many, it becomes a significant issue later in life. That’s why discussing fertility before treatment begins is so important.
1. AYA Patients Are in a Critical Life Stage
The AYA years are a time of transition. Some patients may already be parents, while others are just starting to consider family-building. A brain tumor diagnosis often interrupts life milestones, forcing AYAs to shift their priorities.
For those who have not yet had children, losing the ability to conceive naturally can feel like a loss of identity and future possibilities. Having the option to preserve fertility before treatment can allow patients to maintain hope for a family later on.
2. Increased Fertility Risks Due to Treatment
Certain brain tumor treatments can damage reproductive health, sometimes permanently. These include:
- Chemotherapy: Many chemotherapy drugs are gonadotoxic, meaning they can harm sperm and egg cells, leading to temporary or permanent infertility.
- Radiation Therapy: Whole-brain or cranial radiation can affect the hypothalamus and pituitary gland, disrupting hormone production necessary for fertility. Pelvic or spinal radiation can also damage reproductive organs.
- Surgery: Tumors near the pituitary gland may require surgery that affects hormone levels, impacting ovulation and sperm production.
- Hormone Therapy or Steroids: Some treatments suppress hormone production, which can lead to long-term reproductive challenges.
Understanding these risks is essential to making informed decisions about fertility preservation before undergoing treatment.
Fertility Preservation Options for AYAs
While a brain tumor diagnosis can feel overwhelming, many fertility preservation options are available. The right choice will depend on factors such as age, medical history, and treatment timeline.
For Women
Women with brain tumors have several options for preserving their reproductive health before treatment:
1️⃣ Egg Freezing (Oocyte Cryopreservation) – This involves stimulating the ovaries with hormones to produce multiple eggs, which are then retrieved and frozen for future use.
2️⃣ Embryo Freezing – Similar to egg freezing, but instead of freezing unfertilized eggs, the eggs are fertilized with sperm before freezing. This is a preferred option for patients in committed relationships or those comfortable using a sperm donor.
3️⃣ Ovarian Tissue Freezing – A newer method where small pieces of ovarian tissue are surgically removed and frozen. This tissue can be reimplanted after treatment, restoring fertility. This is an option for prepubescent girls or those who don’t have time for traditional egg retrieval.
4️⃣ Ovarian Suppression with Hormone Therapy – Some doctors recommend using medications like Lupron to put the ovaries into a temporary “resting” state during treatment. This may reduce fertility damage, though research is still ongoing.
For Men
Men with brain tumors also have fertility preservation options:
1️⃣ Sperm Banking (Sperm Cryopreservation) – This is the most common and effective fertility preservation method for men. A sperm sample is collected and frozen for future use.
2️⃣ Testicular Tissue Freezing – For prepubescent boys who cannot produce sperm yet, doctors may remove and freeze testicular tissue, which may be used in the future when medical advancements allow sperm maturation from tissue samples.
3️⃣ Testicular Sperm Extraction (TESE) – A procedure in which sperm is directly extracted from testicular tissue for use in fertility treatments like IVF.
The Importance of Advocacy
Not All AYA Patients Are Given Fertility Counseling—Advocate for Yourself
Unfortunately, fertility preservation is not always discussed as part of the treatment plan for brain tumor patients. Studies show that less than 50% of young cancer patients receive fertility preservation counseling before treatment begins.
If your doctor has not brought up fertility risks or preservation options, don’t be afraid to ask. Here are key questions to start the conversation:
✔️ What is my risk for infertility based on my treatment plan?
✔️ What fertility preservation options are available for me?
✔️ How much time do I have before starting treatment to pursue preservation?
✔️ Can I be referred to an oncofertility specialist?
✔️ What are the costs, and are there financial assistance programs available?
By advocating for yourself and getting informed, you can make empowered decisions about your future.
Hope for the Future
While a brain tumor diagnosis can feel like it takes control of your life, fertility preservation gives AYA patients a chance to reclaim their future. Thanks to advancements in oncofertility research, many survivors go on to have biological children through fertility treatments, surrogacy, or adoption.
If you or a loved one are facing a brain tumor diagnosis, know that you have options. The earlier you explore fertility preservation, the more choices you will have for building a family down the road.
