Gender words are used here to talk about anatomy and health risk. Please use this information in a way that works best for you and your doctor as you talk about your care.

Your teen years are full of changes and challenges. When you're also going through cancer treatment, things get even more complicated. You likely have many questions about what's happening.

One question on your mind might be how cancer treatment will affect being able to have children later. You may not want to talk about it or know how to bring it up. But remember: This is your body. Don't be afraid to ask your health care team about fertility issues. Fertility is the ability to have children. When someone can't have children, it's called infertility. You may not be ready to have children now. But these topics are an important part of your future.

Several cancer treatments can impact your ability to have children in the future.

• Surgery. Depending on your type of cancer, some surgeries remove organs you need to have a child.
• Radiation therapy. Radiation that is aimed close to your reproductive organs or brain can affect your ability to have a child.
• Medicines. Cancer treatment medicines like chemotherapy, targeted therapy, hormone therapy, and immunotherapy can affect your fertility.
• Bone marrow or stem cell transplant. These treatment choices involve high-dose chemotherapy or full body radiation. Both of these can impact your fertility.

Different treatments may cause you to be infertile for a short time (temporarily) or long-term (permanently). Before you start treatment, ask your doctor what you can expect and what choices you have.

Take the time now to learn as much as you can about your choices to have a baby later. Talk with your doctor about the best choices for you. Choices depend on your age, if you've started puberty, your type of cancer, and your treatment. The choices also have different success rates, ease of access, and costs.

• Egg banking. Mature eggs are removed from your ovary and frozen for later use. It may also be called egg freezing. This choice gives you the chance to conceive later no matter what happens during treatment.
• Ovarian tissue freezing. This choice may be available for girls who haven't gone through puberty yet. Part or all of an ovary is removed with surgery. The ovarian tissue, which contains eggs, is frozen for later use. In some cases, this may be a choice for girls after puberty.
• Ovarian shielding. If your treatment plan includes radiation in your belly area, your doctor may be able to shield your ovaries to protect them. You can ask your doctor about this choice. A protective cover is placed over your body to shield your ovaries from radiation.
• Ovarian transposition. Your doctor may be able to surgically move your ovaries away from the radiation treatment area.

• Sperm banking. Sperm is collected and frozen for later use. To freeze your sperm, you'll need to masturbate to collect the sperm sample in a private setting. You might not feel comfortable talking about this with your health care team. But don't be shy. They're here to help explain the process, answer your questions, and be honest with you.
• Testicular tissue freezing. This may be a choice for boys who have not gone through puberty yet and are at high risk for infertility. Testicular tissue that contains the cells that make sperm is frozen and used at a later time.
• Testicular shielding. If you need to have radiation, your doctor may be able to shield your testicles. A protective cover is placed on the outside of your body. But this choice may not be possible depending on your type of cancer.

Your health care team should talk with you about any possible fertility issues before treatment begins. If they don't bring it up, ask! When you know what to expect from treatment, it can help you weigh your choices. Have specific concerns? Ask to speak with a fertility specialist. You might also want to talk with a counselor.

While your parents are the ones who legally decide on your treatment, you have a voice in the decision. Here are questions to ask your care team:

• Will my treatment cause infertility?
• How long will I be infertile after treatment?
• Will this treatment stop my period? If so, for how long?
• Are there alternative treatments available that won't affect my fertility?
• Can I preserve my eggs or sperm if my treatment will affect them?
• What fertility treatment choices are available?
• How are my hormones affected during treatment?
• Is there a fertility specialist or counselor I can talk to?
• What are the costs related to each fertility-preserving choice?

If you're sexually active, it's important not to get pregnant or make someone pregnant during your treatment. Cancer treatment for boys or girls can harm the fetus. Ask your health care team about what contraception works best for you and your situation.

It may feel awkward to talk about sex, but it's important. Don't take chances.

Once you've made it through cancer treatment, you can get tested to learn if you are fertile and can have children. If you don't want to be tested right away, that's okay. Talk with someone you're close to about your feelings.