Sex, fertility and acute myeloid leukaemia (AML)

Having acute myeloid leukaemia (AML) and its treatment might affect your sex life and can make it harder for you to get pregnant or father a child in the future. Find out more.

Your sex life and AML

There's no physical reason why having AML or its treatment should affect your sex life. But you'll probably go through times when you don’t feel like sex. This might be because you're too tired, or have other side effects of treatment like feeling sick.

It's important to use contraception during treatment and for a period of time after. Getting pregnant while you (or your partner) are having treatment is not a good idea. This is because some of the drugs might harm the developing baby.

Even if you’re using other forms of contraception, you should also use barrier contraception. It is not known whether small amounts of cancer drugs such as chemotherapy is passed on through semen or secretions from the vagina.

Generally, doctors advise using the barrier method such as condoms, femidoms and dental dams. This applies to vaginal, anal or oral sex. 

Advice like this can be worrying, but this does not mean that you have to avoid being intimate with your partner. You can still have close contact and continue to enjoy sex. 

Fertility after AML treatment

Treatment for leukaemia can make it harder for you to get pregnant or get someone pregnant in the future. But there are many people who have leukaemia treatment that do keep their fertility. Before treatment, your doctor will talk to you about your risk of infertility. They can also refer you to a fertility specialist who can give you more information and support.

At the end of treatment, you usually have checks to see how treatment has affected your fertility. They check:

• the quality and number of sperm if you are male

• your hormone levels

• your ovaries, womb (uterus) and fallopian tubes if you are female – you have an ultrasound scan to check this

You are at a higher risk of permanent infertility if you have had a stem cell transplant . This is because you may have high dose chemotherapy and total body irradiation (TBI) before a stem cell transplant.

If you have a partner, you may want to see your doctor together so that you can both discuss any fears or worries. Don’t be afraid to ask questions. Being well informed can help you cope.

Men and infertility

Treatment might affect a man’s fertility by:

• reducing the number of sperm you make, or stopping you making any at all

• affecting the ability of the sperm to fertilise an egg

This might be temporary or might mean you can no longer get someone pregnant.

Women, infertility and early menopause

Chemotherapy and radiotherapy are treatments you might have for acute leukaemia that can affect your fertility. These treatments can stop ovaries from making eggs. If this happens, you won’t be able to become pregnant. It can also cause you to have an early menopause.

The menopause is normally the period of time between the early 40s and late 50s. This is when women stop producing sex hormones,  causing their periods to become irregular and eventually stop. Women can then no longer become pregnant. If you go through menopause before the age of 40, your doctor may call this premature ovarian insufficiency, or POI.

Some of these symptoms of menopause include:

• hot flushes and sweating

• missing periods or periods stopping completely

• vaginal dryness

• feeling sad or depressed

• loss of confidence and self esteem

• joint pains and muscle aches and you may have thinning and weakening of the bones (osteoporosis) over time

• loss of interest in sex (libido)

Talk to your doctor or nurse if you have any of these symptoms. There are treatments and things you can do to help cope with the effects of menopause. Your doctor might recommend you have hormone replacement therapy (HRT).

Preserving fertility

There are ways for both women and men to try to preserve their fertility, such as freezing eggs and embryos, or storing sperm. However, these methods are not always successful or suitable for everyone.

If you have acute leukaemia, you often need to start treatment right away. For women, freezing eggs can take several weeks because you need to take medications to help your ovaries make eggs. After that, a doctor collects and stores the eggs. Because this takes time, many women can’t freeze their eggs before treatment begins. You may be able to have ovarian tissue freezing (cryopreservation), but this is not suitable for everyone and is not available everywhere.

For men, it may be possible to collect and store sperm. This is called sperm banking. Whether this is an option depends on how well you feel and how quickly treatment needs to start.

Talk to your doctor or nurse about any concerns you may have about your fertility.

Contraception

It is still important to use contraception during treatment and for some time after. Your doctor, nurse or pharmacist can tell you how long this should be. Becoming pregnant or getting someone pregnant during and shortly after treatment may affect the developing baby.

If you don’t want to have a baby, you should continue to use contraception after treatment until you know for certain if you are infertile or not.

Coping with infertility

It can be extremely distressing to find out that your leukaemia treatment could stop you being able to have children. It can seem very unfair to have to cope with this as well as your diagnosis. Even if you hadn’t thought about having children before, losing your fertility can be very difficult to cope with. It can also affect how you feel about yourself.

It takes time to adjust. You need to give yourself time to feel sad and come to terms with it.

Talking to other people

Talking to someone close to you is usually helpful, although you might not be able to do this for a while. Help your family and friends by letting them know if you would like to talk about what’s happening and how you feel.

You might want to talk to someone other than your partner, friends or family members. You might find it helps to speak to a counsellor or a therapist. Your doctor or nurse can put you in touch with professional help if you would like it. Don’t be afraid to ask, as it really can help.