Will Leukemia treatment make me infertile

Leukemia Treatment and Fertility: What You Need to Know

This is an important question, and the answer depends on several factors including your type of leukemia, the specific treatments you receive, and your age and gender.

The General Picture

According to the NCCN Guidelines for Patients, treatment with targeted therapy and other systemic therapies can affect your fertility (your ability to have children). However, this doesn't automatically mean you will become infertile—it means fertility is a real concern that deserves discussion with your care team.

For Different Leukemia Types:

Chronic Myeloid Leukemia (CML):

• Tyrosine kinase inhibitors (TKIs) — the main CML treatments — appear to have different effects depending on your biological sex
• For people assigned male at birth: TKI therapy does NOT appear to harm male fertility. Studies show that miscarriage or fetal abnormality rates are not elevated in female partners of men on TKI therapy
• For people assigned female at birth: TKI therapy during pregnancy has been associated with higher rates of miscarriage and fetal abnormalities, so these medications should be stopped before attempting pregnancy

Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL):

• Chemotherapy and other systemic therapies can affect fertility in both sexes
• The specific impact depends on the drugs used and doses given

What You Can Do NOW

Before starting treatment, ask your care team these specific questions:

1. "How might my specific treatment plan affect my fertility?"
2. "Should I see a fertility specialist before starting treatment?"
3. "What fertility preservation options are available to me?"
4. "How long should I wait after treatment before trying to conceive?"
5. "Are there any restrictions on pregnancy during or after my treatment?"

Fertility Preservation Options

According to NCCN Guidelines, fertility preservation should be discussed with all patients of childbearing age before starting treatment. Options may include:

• Sperm banking (for people assigned male at birth) — can be done before starting therapy
• Egg/oocyte retrieval and freezing (for people assigned female at birth) — typically requires stopping TKI therapy for at least 1 month before the procedure, coordinated with your obstetrician
• Embryo freezing — fertilized eggs can be preserved for future use

A referral to an in vitro fertilization (IVF) center is recommended if you're interested in fertility preservation.

Special Considerations for CML

If you have CML and want to pursue pregnancy:

• Stop TKI therapy before attempting conception — continuing these drugs during pregnancy carries teratogenic risk (risk of birth defects)
• Achieve deep molecular response first — ideally, you should reach what's called "durable deep molecular response" (DMR) before stopping treatment, though there are no published guidelines on the "safest" depth
• Work with specialists — referral to a CML specialty center AND consultation with a high-risk obstetrician is strongly recommended
• Close monitoring during pregnancy — if you do become pregnant, frequent molecular monitoring (every 1-3 months) helps guide when to restart treatment if needed

The Bottom Line

Fertility concerns are real but manageable. The key is having this conversation early—ideally before you start treatment. Many people with leukemia do go on to have successful pregnancies and healthy children, but it requires planning and coordination with your care team.

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Questions to Ask Your Care Team

1. What is my specific leukemia type and treatment plan?
2. How might THIS treatment affect MY fertility specifically?
3. Should I be referred to a fertility specialist?
4. What are my fertility preservation options, and how much time do I have to decide?
5. If I want children in the future, what should I know about pregnancy during or after treatment?
6. Are there any clinical trials that might be relevant to my situation?

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Sources:

• NCCN Guidelines for Patients: Chronic Myeloid Leukemia (2025) — Fertility and pregnancy management sections
• NCCN Guidelines for Patients: Acute Myeloid Leukemia (2025) — Fertility testing and considerations
• NCCN Guidelines for Patients: Acute Lymphoblastic Leukemia (2025) — Fertility preservation recommendations

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.