Impact on fertility

People living with myeloma may be faced with additional concerns that anti-myeloma treatment could affect their fertility. It is important they are fully informed about such potential side-effects as early as possible, preferably around the time of diagnosis and certainly before the start of treatment. These discussions should be documented and advice given in patients’ medical notes.

For patients who do have concerns their fertility may be affected, nurses should explain which treatments (systemic anti-cancer treatments (SACT), radiotherapy, those used to treat side effects) have the greatest potential to cause damage to the gonads and what techniques are available to preserve fertility. Written information should be provided and where necessary, a referral to specialist psychological support and counselling.

Treatment in some patients who are male can affect their ability to make new sperm or semen. This is usually temporary although it may be some years before sperm production returns to normal. For some, however, infertility is permanent. The option of sperm banking should be discussed with patients and those wishing to explore this further should be referred to the fertility clinic before they start their treatment.

For patients who are female of reproductive age, treatment can directly damage the eggs or ovarian function. The latter can lead to hormonal imbalances and precipitate early menopause. It is possible to store unfertilised or fertilised eggs and an immediate referral to the fertility clinic is necessary. Nurses should however, prepare patients in the event that it is not possible to do this if treatment needs to be started urgently: the process of egg/embryo collection can take 3 – 6 weeks depending on where they are at in their menstrual cycle.

Going through the menopause during myeloma treatment, or coping with early menopause as a result of treatment (in particular HDT-SCT) can be very difficult. Many symptoms of the menopause overlap and/or exacerbate symptoms and complications of myeloma disease and treatment, such as fatigue, hot flushes and low mood. Nurses are well placed to support patients by helping them explore various approaches such as complementary therapies, talking to other women in similar situations and counselling. For patients with severe symptoms, it may be necessary to explore pharmaceutical options, such hormone replacement therapy (HRT).

These issues can be very sensitive, even for those who have not considered starting a family or those who have children already. The most important factor is to be open and honest, and allow space for patients to voice their feelings and worries.