Fertility and lymphoma treatment Freephone helpline 0808 808 5555 www.lymphomas.org.uk

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Freephone helpline 0808 808 5555
information@lymphomas.org.uk
www.lymphomas.org.uk
Fertility and lymphoma treatment
If you have been diagnosed with lymphoma, you might be recommended to have
treatment with chemotherapy, radiotherapy or antibody therapy. Some of these treatments
can affect your fertility (your ability to have children). There are several techniques available
to help preserve your fertility and it is important to discuss these with your medical team
before your treatment starts, even if you are not currently in a relationship or planning to
have a family.
In this information sheet we will discuss:
• Sex during treatment (see below)
• Contraception during and after treatment (page 2)
• How lymphoma treatments affect fertility (page 3)
• Preserving your fertility (page 5)
• Planning a family after treatment (page 8)
• Ways of helping you conceive if you have fertility problems (page 9)
• Accessing advice and support (page 10)
Sex during treatment
There is no reason why you should not have sex during your treatment if you feel like
it and don’t find it uncomfortable, but ask your medical team if there are any precautions
you should take. If you have low blood counts, for example, you will be more at risk of
catching an infection, bleeding or bruising. It will be important to use contraception if
you have sex during your treatment and for up to 2 years after your treatment has
finished if you need to avoid pregnancy (see page 2).
It is also possible you will not feel like having penetrative sex during your treatment or
for a while afterwards. Going through the process of diagnosis, tests and treatment
is physically and emotionally demanding and it is common to be affected sexually.
Don’t feel that sex is not important enough to bring up with your medical team. They
won’t be embarrassed and won’t consider this a trivial subject.
We have separate information on how lymphoma and lymphoma treatments can
affect you sexually. You can phone us free on 0808 808 5555 if you would like to
talk to someone about sexual problems you may have or if you would like to be
sent this information. Alternatively, email us at information@lymphomas.org.uk or
download the information from our website (www.lymphomas.org.uk).
LYM0069/Fertility/2013v2
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Contraception during and after treatment
Traces of chemotherapy usually remain in the body for a few days following treatment.
It is hard to be precise about how long this lasts, but some experts suggest that
chemotherapy can remain in body fluids for up to 5 days. You should avoid exposing
your partner to your body fluids during this time. It is advisable to use a condom and
avoid oral sex during this time.
There is little evidence that cancer treatments (chemotherapy, antibody therapy
or radiotherapy) increase the risk of birth defects or cancer in babies conceived
after treatment has finished but conceiving a baby during your treatment is not
recommended. Doctors generally recommend that pregnancy is delayed for a period
of time after the treatment has ended. This applies to both men and women who are
planning a family. Everybody's circumstances will be different, so it is important to
discuss your individual situation with your medical team so that they can recommend
what they feel would be best for you.
Contraception in women
Women with lymphoma are strongly advised not to become pregnant while they
are being treated and for about 2 years afterwards. Exactly how long you will be
recommended to wait before becoming pregnant will depend on your individual
circumstances and on what your medical team believe is best for you.
This waiting period is advised because being pregnant can make it more difficult to
treat lymphoma and the first 2 years is the time when lymphoma is most likely to come
back and need further treatment. The treatments can also be harmful to the developing
baby. You should therefore continue to use contraception during this time, even if your
periods have stopped.
It is not known what effects antibody therapies have on an unborn baby. It is
recommended that women do not become pregnant during treatment or for 12 months
after finishing treatment with rituximab because rituximab takes several months to be
fully cleared from the body. This advice applies to women on maintenance rituximab
treatment as well to women who are being given rituximab together with chemotherapy.
Discuss the best form of contraception with your specialist, GP or nurse. This is
especially important if you take oral contraceptives (the pill), which are sometimes not
as effective during treatment. If you have trouble with nausea, vomiting or diarrhoea, for
example, this will make it difficult for you to absorb oral contraceptives properly and you
might be advised to use another form of contraception.
Contraception in men
Men with lymphoma are usually advised that they should avoid making their partner
pregnant during their chemotherapy and for at least 3 months afterwards. This is to
make sure that there are no traces of drugs left in the body that can damage the sperm
that are forming. Some doctors advise men to wait for as long as 1 year before making
a partner pregnant.
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Men who are on antibody therapy (eg rituximab) are advised to avoid making their partner
pregnant while they are on this form of treatment. It is important to continue to use
effective contraception for 12 months after rituximab treatment has finished because
rituximab remains detectable in the blood for several months after the last dose.
If you want to avoid pregnancy it is important to use contraception, even if your fertility
has been reduced by your treatment. This is because fertility can start to come back
over the months after the treatment ends.
How lymphoma treatments affect fertility
Chemotherapy and fertility
Chemotherapy drugs work by stopping lymphoma cells from multiplying or by
damaging these cancerous cells. The drugs also affect some normal cells, which is why
these treatments have side effects. Many of these drugs reduce the numbers of sperm
that men produce or make the sperm less able to fertilise an egg. They can reduce the
number of eggs that mature in a woman’s ovaries.
The risk to your fertility depends on:
•
which drugs you have – some drugs are more likely to cause infertility, for
example cyclophosphamide, chlorambucil and procarbazine. Other drugs that can
affect fertility (but do so less commonly) are doxorubicin, vinblastine and cisplatin.
Some drugs are less likely to affect fertility, such as vincristine, methotrexate and
bleomycin. Less is known about the effects of newer chemotherapy drugs such
as bendamustine. You should ask your medical team for specific advice about
contraception and fertility if you are on one of these drugs.
•
the total dosage of drugs you have – the higher the dosage, the more likely
infertility becomes. The dosage you have depends partly on whether you have the
drug by itself or in combination with other drugs and partly on how many cycles of
treatment you have. Having a stem cell transplant usually involves having particularly
high doses of chemotherapy drugs, so this kind of treatment is more likely to lead to
fertility problems.
•
(for men) your sperm count before you start treatment. Your general health can
influence how many sperm you are able to produce. A serious illness like lymphoma
might mean that you have a low sperm count, even before you start treatment.
•(for women) your age – older women are more likely to experience reduced fertility
following treatment than women who are younger when they are treated.
The effects of chemotherapy in men
Most chemotherapy regimens for lymphoma pose some risk to a man’s fertility, but
fertility will usually return after standard-dose chemotherapy regimens. It can take 2
years or more for the numbers of sperm to recover after your chemotherapy is finished.
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Your sexual function, including arousal, erections and ejaculation are less likely to be
affected by chemotherapy. This is because most chemotherapy regimens do not affect
production of testosterone (the male hormone) in the testes. A few chemotherapy drugs
such as vincristine can affect the nerves in the genital area (this is called ‘neuropathy’)
and this can cause temporary problems with having or maintaining erections for some
men. This usually improves after the treatment is finished. Speak to your doctor or nurse
if your sexual function is concerning you at any stage.
The effects of chemotherapy in women
Many women are able to have babies normally after treatment, but some women
experience reduced fertility and some women become infertile.
Your periods may become irregular or stop for a while during chemotherapy, though
some women might still be producing eggs during this time – this is why it is
important to continue with contraception (see page 2). It can take anything from a
few months to 2 years for your periods to come back after the end of treatment. Even
if your periods come back, eggs might not be produced for several months or even
years after treatment. In addition, your menopause may come some years earlier
than it would have done if you had not had chemotherapy (the average age for the
menopause in women in the UK is 51).
If you are near to the natural menopause when you have treatment, your periods
might not return and you will experience an early or ‘premature’ menopause.
Please contact our helpline team if you would like to talk to someone about
premature menopause by telephoning our Freephone number, 0808 808 5555.
Radiotherapy and fertility
Radiotherapy uses high-energy particles or waves to kill lymphoma cells. If it is given
to the pelvic area, this radiation can also reduce the numbers and the function of
sperm and the numbers of eggs maturing in the ovary. This can lead to temporary or
permanent infertility.
The effects of radiotherapy in men
Radiation to the pelvis, close to the testes, can cause temporary or permanent
infertility, though the radiation dose to the testes may be minimised by shielding of
that area during the treatments. Because there might only be a temporary reduction
in sperm numbers you should continue to use contraception during your treatment.
The final outcome for your fertility will depend on the dose of radiation you are given,
with higher doses more likely to lead to permanent infertility. If some fertility is going
to return, it can take up to 5 years for this to happen.
If the testes themselves are treated with radiotherapy the infertility will be permanent.
Total body irradiation (TBI), which is sometimes used before a stem cell transplant,
usually causes permanent infertility.
Radiotherapy can also reduce the amount of testosterone produced by the testes.
This can decrease your desire to have sex (your libido) and ability to get an erection,
but you can be treated with testosterone replacement therapy to help with this.
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The effects of radiotherapy in women
Radiotherapy to an area that includes the pelvis in women can lead to temporary or
permanent infertility. This is because the radiation can destroy the eggs in the ovaries.
To reduce the likelihood of this happening your ovaries may be specifically shielded
from the radiation. It is also possible to move your ovaries so they are no longer
included in the radiation field, but this is considered an experimental approach.
Your periods can stop for a while and you may have some menopausal symptoms
or even a premature menopause. As with chemotherapy, infertility is more likely if
you are older when you have the radiotherapy. Infertility is also more likely if you are
being treated with chemotherapy in addition to the radiotherapy. TBI usually causes
premature menopause and permanent infertility. Radiation, especially TBI, can also
affect the uterus (womb) making it less able to carry a pregnancy. This can make
miscarriage or premature birth more likely.
Biological therapies and fertility
It is not known whether antibody therapies such as rituximab affect fertility. It is
recommended that both men and women use contraception during treatment with
antibodies and for 12 months after the end of the treatment (see pages 2 and 3). This is
because it is not known how these treatments might affect an unborn baby.
Little is known about the effects on fertility of the newer biological therapies
(sometimes called 'targeted therapies' or 'novel agents'). Again, you should ask your
medical team for advice about contraception and fertility if treatment with one of these
therapies is planned.
Preserving your fertility
It is difficult for your doctors to predict exactly what will happen to your fertility but you
should have an opportunity to discuss this before you start treatment. There are ways
of preserving your fertility before you start treatment. Some of these techniques are
well established; others are still at an experimental stage.
Preserving fertility in men
For men, the main options are sperm banking and sperm extraction. Testicular tissue
freezing is a third option, but this is still experimental.
Sperm banking
You should ask about the possibility of sperm banking before starting treatment, even
if the drugs you are going to have do not commonly cause infertility. Sperm banking
is a good option for men who want to have children after completing their lymphoma
treatment. It is also a good option for teenage boys who have gone through puberty
and for men who might want to have children one day but who either haven’t currently
got a partner or aren’t sure about how they will feel in the future.
Before men provide sperm for banking, the hospital does routine blood tests for
infections such as human immunodeficiency virus (HIV) and hepatitis. These tests
are done in all men who provide sperm, whether the sperm is being stored for their
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own future use or whether it is being given as a donation. You should also have an
opportunity to discuss the procedure and future options with a specialist counsellor.
Sperm banking is not recommended once you have started chemotherapy in case the
drugs have damaged the sperm.
In sperm banking, a man provides a sample of his semen. This is usually done in a
private collection room at a sperm bank facility or in a hospital. The man ejaculates
(has a climax) through masturbation or with the help of a partner. If normal ejaculation
is not possible, it might still be possible to collect sperm after electrical stimulation.
The semen is collected in a sterile container and is tested to see how many sperm it
contains (the sperm count), what proportion of them are able to swim strongly (the
sperm ‘motility’) and how many are normal in shape.
You will usually be advised not to ejaculate for up to 3 days before giving a sample, so
that the sperm count is as high as possible. You will probably be asked to provide up
to three samples over the 1–2 weeks before your treatment starts. If your team wants
to start your treatment more quickly than this, even storing one sample is a good idea
because some assisted reproductive techniques (see page 9) only need a few sperm.
Because lymphoma can make you ill at the time of diagnosis, your sperm count may
be lower than it normally would be or you may not be able to ejaculate properly. In this
case there are techniques available to obtain a sample (see below).
Once the sperm have been collected they are frozen and stored. You will need to
sign a consent form about how the sperm can be stored and used in the future. The
rules and regulations on sperm banking change from time to time and you should
check the latest guidance on the Human Fertilisation & Embryology Authority website
(www.hfea.gov.uk). Currently, the Authority states that: ‘The standard storage
period for sperm is normally 10 years. This period can be exceeded only in certain
circumstances, up to a maximum of 55 years [of age].’
Some NHS hospitals will store sperm free of charge, but some health authorities
charge for storing sperm or will charge after a certain period has elapsed (after 2 years
for example), so it is a good idea to ask about this. If there is a cost, this might
depend on whether or not you already have a child or children.
Once you have sperm in storage it is your responsibility to keep the storage facility
informed of any change of address because the hospital doesn’t update this on your
behalf. Fertility units are now obliged to contact you regularly to ask if the sperm
should be kept. If they cannot contact you the sperm will be destroyed.
When a man needs to use the frozen sperm, they can be thawed and used to
fertilise a partner’s eggs via intrauterine insemination, in-vitro fertilisation (IVF) or
intracytoplasmic sperm injection plus IVF (ICSI-IVF, see page 9).
Sperm extraction
There are other ways of collecting sperm from men who cannot produce it as we
have described above, or from men who didn’t store any sperm before they started
their treatment. Fluid or tissue can be taken from the testis or the epididymis
(a long, coiled tube that sits behind each testis in the scrotum) and sperm obtained
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this way can be stored for future use. These procedures entail having a minor
surgical procedure and you might hear them called ‘testicular sperm retrieval’ (TSR),
‘microsurgical epididymal sperm aspiration’ (MESA) or ‘percutaneous epididymal sperm
aspiration’ (PESA). These procedures are not available in all hospitals and are not always
funded by the NHS, but your specialist will know what is available in your area.
Testicular tissue freezing
Researchers are trying to find out if removing some testicular tissue and freezing it
for later re-implantation might work. This is called ‘testicular cryopreservation’. It is
not known what the risks of this procedure are and it hasn’t yet led to the birth of
any babies, so it is still very much at an experimental stage. This is the only option for
young boys who have not yet reached puberty, so it is hoped that it will be developed
further over the next few years.
Preserving fertility in women
It is less usual for women to be able to take precautions to preserve their fertility
before treatment starts. This is because women’s fertility is less affected than men’s
and the methods used can take up to 6 weeks. This might be too long to wait before
starting treatment if you are very unwell or if the lymphoma is a faster growing type.
If there is time, the options are to freeze and store embryos, mature eggs or ovarian
tissue. The last two options are still regarded as experimental.
Your specialist will be able to advise the best course of action for you, depending on
your personal and family circumstances, what kind of lymphoma you have and the
type and timing of any treatment being proposed.
Embryo freezing
This is the most common and most successful method for preserving fertility for women
of reproductive age (including older teenagers) and has been used successfully for
nearly 30 years. This procedure starts with stimulation of your ovaries to produce
a larger number of mature eggs than usual – the more eggs that are collected, the
greater your chances of becoming pregnant. This is done by giving you a series of
hormone injections over 2–3 weeks.
The mature eggs are collected from your ovaries in an outpatient procedure. A needle
is guided through the upper vagina and an ultrasound scan helps the medical team
locate fluid-filled sacs in the ovary (follicles) that contain mature eggs. The eggs are
collected and can then be fertilised in the laboratory by sperm from your partner or
from a donor. Any embryos that form can then be frozen and stored, to be used to
start a pregnancy later on. This technique is called in-vitro fertilisation or IVF
(see page 10).
You need to have access to a specialist IVF unit for this. Some hospitals offer this
routinely but provision varies considerably throughout the country. Storage of
embryos also depends on what local health authorities are prepared to pay for. It is
not considered to be a routine part of any cancer treatment, but most areas will pay
for this if it is considered appropriate.
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Egg freezing
This is an option if you don’t currently have a partner and don’t want to use donor sperm
for the creation of embryos. It involves freezing mature eggs that have been collected
(as described on page 7) before lymphoma treatment starts. The eggs are frozen
without first being fertilised by sperm. Later on, the eggs can be thawed and fertilised
by ICSI (see page 9). This is still regarded as experimental and is not widely available on
the NHS, though it might be possible to have eggs frozen privately. Research shows that
only around five babies are born per 100 frozen eggs using this method, but techniques
are improving all the time and success rates will hopefully improve over the next few years.
Ovarian tissue freezing
This is also called ‘ovarian cryopreservation’. In this technique, all or part of one ovary is
removed in a minor surgical procedure. The tissue is usually divided into strips before
being frozen and stored. Ovarian strips can then be transplanted back into your body at a
later stage if you want to become pregnant. To date, these procedures have resulted in
very few successful pregnancies (by natural conception and by IVF) and the technique is
still considered to be experimental.
Ovarian tissue freezing has the advantage of being a possible way of preserving
fertility in young girls who have not reached puberty. This is because their ovarian
tissue contains immature eggs that have the potential to mature later on, either in the
laboratory or in the body after the tissue has been put back.
Storage of ovarian tissue is not widely available in NHS hospitals. Some specialist units
may offer the service but you might only be able to access it through a clinical trial (or
through a very small number of private facilities – but you would then be asked to pay
for it).
Planning a family after treatment
It is not routine for people to have their fertility tested after having treatment. Most
people who want to start a family following treatment will be advised to see whether
or not pregnancy happens naturally after waiting for the recommended time after the
end of their treatment (see page 2). Further investigations, such as measurement of
hormone levels, will usually only be done if you have not conceived after about 1 year
of trying.
Many people find it difficult to decide when to have a baby following treatment for
lymphoma. Most people with lymphoma are advised to wait for up to 2 years after their
treatment for lymphoma has finished before trying to start a family. This is partly to give
your body time to recover from treatment. It is also important to consider the possibility
that your lymphoma might relapse (come back) and need further treatment. You would
need to consider the implications of being pregnant, having a pregnant partner or having
a new baby if this happens.
Something else that women need to keep in mind is that a few chemotherapy drugs
can damage the heart or lungs in the long term. If this has happened, a pregnancy could
place an extra, possibly dangerous, strain on your system. Check with your specialist
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whether it would be advisable for you to have your heart function and lung function
tested before trying to conceive.
Many people go on to have a family after having treatment for lymphoma and in fact
women are often advised not to wait too long after their advisory 2-year wait is over,
in case their menopause starts early (see page 4). Being pregnant won’t make the
lymphoma more likely to relapse once this period is over.
For both men and women, there is strong evidence that there is no increased risk
of their baby having birth defects if they conceive after treatment is finished. There
is also lots of evidence that babies born to survivors of cancer are not at increased
risk of developing cancer themselves (except for some rare inherited conditions
such as retinoblastoma, an eye cancer). These are things that many people who are
considering having a child after their lymphoma treatment are worried about and so
this research evidence is reassuring.
Ways of helping you conceive if you have fertility
problems
For some people, fertility will not be affected or will return after lymphoma treatment,
but some people will need to have help to get pregnant. This may involve receiving
hormone treatments. It may involve using your own sperm, eggs or embryos that
were stored before treatment or donor sperm or eggs.
A detailed description of all the methods that are available to help with conception
(sometimes called ‘assisted reproductive techniques’ or ARTs) is beyond the scope of
this information sheet but we will summarise the main ways that can help if you have
fertility problems after lymphoma treatment.
Help for men
For men with infertility following lymphoma treatment, stored sperm that have
been thawed can be inserted directly into a partner’s uterus (womb). This is called
intrauterine insemination or IUI. If no sperm are available, donor sperm may be
used instead. This is known as artificial insemination by donor or AID. More usually,
thawed sperm are mixed with a partner’s eggs (collected as described on page 7)
in the laboratory. If eggs are successfully fertilised by the sperm, one or two of the
embryos that develop are inserted into the woman’s uterus. This technique is called
in-vitro fertilisation or IVF (see pages 7 and 10).
A way of increasing the likelihood of starting a pregnancy for men with fertility
problems is intracytoplasmic sperm injection or ICSI. In this technique a single
thawed sperm is injected into a single mature egg in the laboratory. About 6 out of 10 of
these fertilised eggs will form an embryo. An embryo is then inserted into the uterus,
as in IVF (so this is often called ICSI-IVF). This is particularly useful when there are
few sperm or eggs available. The results of this technique are quite good, with just
over 1 in 4 women aged under 35 eventually getting pregnant.
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Help for women
For women who experience infertility after lymphoma treatment, the most successful
option is to use embryos that were created by IVF and frozen before treatment began.
One or sometimes two embryos can be placed directly into the uterus. Another
option is to use a partner’s fresh sperm to fertilise a frozen/thawed egg and then
insert the embryo into the uterus, though few women will have frozen eggs available
as this service is still not widely available in the UK. The option of using frozen ovarian
tissue is also still an experimental method: if ovarian tissue that is put back into the
body starts to work again, eggs might be produced that can be fertilised naturally
by a partner. There have been reports of a few babies being born after this kind of
treatment.
For women who have had an early menopause as a result of lymphoma treatment,
donor eggs will be required. These can be fertilised in the laboratory by a partner’s
sperm or by donor sperm.
Other options for couples
If your own embryos or eggs are available but you are unable to go through a
pregnancy, there is still the option of surrogacy (where another woman carries your
baby). There is information on surrogacy on the Human Fertilisation & Embryology
Authority website (contact details on page 11). Some couples choose to adopt, and
some couples feel that they don’t want to go through fertility treatment at all and that
they want to go on and enjoy life without children.
Accessing advice and support
Whether you have been able to take steps to preserve your fertility or not, infertility
and potential infertility are difficult to cope with for many people who are having or
have had lymphoma treatment. It is important to seek advice and ask for support
if you are worried about possible infertility. It can be helpful to talk to other people,
either on your own or as a couple. Your GP, your clinical nurse specialist or fertility
clinic staff will be good sources of information and support. They might also be able to
put you in touch with other people who are in a similar position so that you can share
your feelings and feel less isolated.
Please contact our helpline if you want to talk about any concerns you have
about your fertility (Freephone 0808 808 5555).
Conclusion
For many people who have had lymphoma the prospect of potential infertility after
treatment can cause much anguish. In the long term, infertility can have a huge
impact on your life, on your partner’s life and on your family. The uncertainty of not
knowing if your fertility will return and for how long can also be difficult to live with.
It is important to ask your medical team about what to expect and about ways of
preserving your fertility before treatment begins. On page 11 you will find a list of
questions that might help you start such a discussion.
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There is much that can be done to help you if you do experience problems and
techniques to help both men and women to have children are advancing all the time.
There is also increasing awareness of how important it is to consider future fertility
when lymphoma treatments are being planned. Researchers are striving to develop
new drugs and design treatment regimens that are effective against the lymphoma
but which have as little impact on fertility as possible.
Acknowledgements
The Lymphoma Association is grateful to Professor Mark Vickers, Honorary Consultant
Haematologist, Aberdeen Royal Infirmary and to Jeff Horn, Macmillan Haematology
Clinical Nurse Specialist, Aberdeen Royal Infirmary for reviewing this information sheet.
Questions to ask about fertility
• Can I continue to have sex during treatment?
• What contraception should I use?
• Will the treatment affect my fertility? If so, could it be permanent?
•Can I delay the treatment or can I have a different drug regimen in order to
preserve my fertility?
• Can I bank my sperm before treatment?
• Can I bank embryos, eggs or ovarian tissue before my treatment starts?
• Will my periods be affected?
•Could I have menopausal symptoms and is there any help available to cope
with these?
• If I wish to start a family, how long will I need to wait following treatment?
• Is there someone I can talk to about fertility problems or infertility?
Useful organisations
British Infertility Counselling Association
Offers information on all aspects of infertility and assisted conception and contact
details for accredited fertility counsellors based throughout the UK.
www.bica.net
CancerHelp UK (part of Cancer Research UK)
0808 800 4040 (cancer information nurses)
www.cancerresearchuk.org/cancer-help/
Human Fertilisation & Embryology Authority (HFEA)
020 7291 8200
enquiriesteam@hfea.gov.uk
www.hfea.gov.uk
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Infertility Network UK
0800 008 7464 (Helpline) and 0121 323 5025 (Supportline)
admin@infertilitynetworkuk.com
www.infertilitynetworkuk.com
Macmillan Cancer Support
0808 808 0000
www.macmillan.org.uk
Selected references
The full list of references is available on request. Please contact us via email
(publications@lymphomas.org.uk) or telephone 01296 619409 if you would like a copy.
Royal College of Physicians, Royal College of Radiologists and Royal College of
Obstetricians and Gynaecologists. The effects of cancer treatment on reproductive
functions: guidance on management. 2007. London: RCOG. Available at: http://www.
rcog.org.uk/files/rcog-corp/uploaded-files/WPREffectCancerReproduction2007.pdf
(accessed 27 August 2013).
National Institute for Health and Clinical Excellence (NICE). Fertility: assessment and
treatment for people with fertility problems. Clinical guideline 11. February 2004.
Available at: http://www.nice.org.uk/nicemedia/pdf/CG011niceguideline.pdf (accessed
27 August 2013).
Schover L. Sexuality and fertility after cancer. 1997. New York: John Wiley and Sons Inc.
Matthews ML, et al. Cancer, fertility preservation, and future pregnancy: a
comprehensive review. Obstetrics and Gynecology International, 2012. Published online
18 March 2012. DOI: 10.1155/2012/953937.
Peddie VL, et al. Factors affecting decision making about fertility preservation after
cancer diagnosis: a qualitative study. BJOG, 2012. 119: 1049–1057.
Wallace WH, et al. Optimizing reproductive outcome in children and young people with
cancer. Journal of Clinical Oncology, 2012. 30: 3–5.
Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. New England
Journal of Medicine, 2009. 360: 902–911.
12/13
How we can help you
We provide:
a Freephone helpline providing information and emotional support  0808 808 5555
(9am–6pm Mondays–Thursdays; 9am–5pm Fridays) or  information@lymphomas.org.uk
●
●
information sheets and booklets about lymphoma (free of charge)
●
a website with forums – www.lymphomas.org.uk
●
●
the opportunity to be put in touch with others affected by lymphoma through our
buddy scheme
a nationwide network of lymphoma support groups.
How you can help us
We continually strive to improve our information resources for people affected by lymphoma
and we would be interested in any feedback you might have on this article. Please visit
www.lymphomas.org.uk/feedback or email publications@lymphomas.org.uk if you have
any comments. Alternatively please phone our helpline on 0808 808 5555.
We make every effort to ensure that the information we provide is accurate but it
should not be relied upon to reflect the current state of medical research, which is
constantly changing. If you are concerned about your health, you should consult
your doctor.
The Lymphoma Association cannot accept liability for any loss or damage resulting
from any inaccuracy in this information or third party information such as
information on websites which we link to. Please see
our website (www.lymphomas.org.uk) for more
information about how we produce our information.
© Lymphoma Association
PO Box 386, Aylesbury, Bucks, HP20 2GA
Registered charity no. 1068395
Updated: September 2013
Next planned review: 2015
13/13

Fertility and lymphoma treatment Freephone helpline 0808 808 5555 www.lymphomas.org.uk

Transcription

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Saturday 16th November 2013