Having Children After Transplant

Most, but not all, patients who undergo a blood stem cell transplant will become infertile. If you had a reduced intensity transplantTransplant using lower dosages of chemotherapy and/or radiation than standard transplants. (also called a mini or nonmyeloablativeDoes not suppress the immune system. transplant) you are less likely to become infertile.

Fortunately, there are options available to couples that wish to have children after a transplant. 

Medically Assisted Reproduction

Sperm that was banked by men prior to their transplant may be used afterward to conceive a child. Although the procedure, called artificial insemination, is not always successful, many men have had children after transplant by this method.

If you did not bank your sperm prior to transplant, a procedure called sperm extraction or sperm retrieval may be an option. Even if you currently have no sperm in your ejaculate, there may still be sperm in your testicular tissue that can be used to fertilize a woman's egg in the laboratory. The resulting embryo is then implanted in the woman's uterus in a procedure called in-vitro fertilizationA procedure in which eggs are removed from a woman’s ovary and combined with sperm outside the body to form embryos. The embryos are grown in the laboratory for several days and then either placed in a woman’s uterus or cryopreserved (frozen) for future use..

In-vitro fertilization can also be used by women who created and stored embryos prior to transplant. If the woman has no eggs or embryos stored, many fertility clinics have lists of women who will donate eggs for this purpose. The egg is then fertilized with sperm in the laboratory and implanted in the woman's uterus. While not always successful, many transplant survivors have used this technique to have children after transplant.

Artificial insemination, sperm retrieval and in-vitro fertilization may not be covered by medical insurance and it may take several attempts before a child is successfully conceived by these methods.

Fertile Hope offers a wealth of information about parenthood options after transplant,  referrals to fertility clinics in the US, and questions to ask fertility and adoption agencies. The Fertile Hope web site also has links to organizations that provide couples with financial aid to help pay for the cost of IVF treatments. 

The Society for Assisted Reproductive Technology offers data on success rates at fertility clincis, as well as patient fact sheets that may be helpful as you consider your options for having children after transplant.

To learn more, view BMT InfoNet's webcast on fertility options after transplant.

Adoption

Many transplant survivors choose adoption as the way to create or expand their family after transplant. There are many agencies that facilitate domestic or international adoptions. Although some may be reluctant to work with a transplant survivor because of his or her medical history, private adoption using an attorney who specializes in this service is also an option. 

The Child Welfare Information Gateway is a federal agency that lists organizations in the United States that facilitate adoptions.

A Note of Caution

Although most people will be infertile after transplant, there have been a number of cases where children have been conceived without any sort of medical intervention after transplant. If you don't want to have children after transplant, using protection when having sex is recommended.