Fact sheet–BMT long-term follow up fact sheets

Published: November 2020.

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Fertility and reproductive health

This fact sheet is for people who have had a blood and marrow transplant (BMT).

BMT patients may experience health complications in the months or years following the transplant. Long-term follow up has an important role in the early detection of any health issues.

This fact sheet has general information about ways to look after your health. If you have specific concerns, speak to your BMT team or your doctor for further information and advice.

What are the issues that could affect my fertility and reproductive health?

The majority of people who have had a BMT will experience changes to their fertility and reproductive health. For some, these changes will be temporary while others will experience permanent infertility or ongoing difficulty becoming pregnant and having children. While this is not a major concern for people who have completed their family, for those who haven’t or haven’t started a family, this can be a source of anxiety and deep sadness.

There are a number of reasons why fertility and reproductive health are affected by BMT including the cumulative effects of chemotherapy and radiotherapy received before or as part of BMT, reduction on hormone levels following transplant, graft versus host disease (GvHD), infection and medications used during and following BMT.

As a result, women may experience premature ovarian failure (menopause), infertility or reduced fertility and a range of difficulties associated with pregnancy, while men may experience testicular failure (with reduction in sperm production or quality) or sexual difficulties. Reassuringly, if women or men who have had a BMT do become parents, their children are generally normal with no increase in rates of cancer or hereditary (genetic) disorders.

For all of these reasons, the risks of infertility and reproductive problems are generally discussed prior to BMT, including what can be done to assist people who wish to have a baby after a BMT.

What are the symptoms?

Symptoms vary and will depend on your situation. Some people may have few symptoms while for others the symptoms may be very vague and hard to put into words. This is only a general list. Speak to your BMT team about your own situation.

Women

Symptoms of ovarian failure or premature menopause – including irregular or absent periods, joint pain, urinary urgency, a dry or tight vagina, pain during sex, low sex drive, cold or hot flushes or flashes and night sweats, emotional changes, and/or difficulty falling or maintaining sleep.

Difficulties becoming pregnant.

Difficulties during pregnancy and birth – although most women who do become pregnant after a BMT will successfully carry their baby to term, women who have had a BMT often experience more difficulties with pregnancy, including a higher risk of miscarriage, premature (early) labour, high blood pressure, elevated blood sugar, low birth-weight (small) babies and more often need to have a caesarean section.

Men

Symptoms of testicular failure – including low energy, mood changes, muscle aches or weakness, erection or ejaculation problems and a low sex drive.

How are fertility and reproductive health issues diagnosed?

If you have symptoms or if you notice changes that concern you, you should talk to your BMT team or general practitioner (GP). After transplant your reproductive and hormonal (endocrine) health will be routinely assessed in the BMT clinic. You may also be referred to an endocrinologist and (for women) a gynaecologist as required. If you are trying to have a baby, you will need to have additional specific tests and will be referred to a fertility specialist.

  • Blood tests – As part of your post-BMT assessments you will have blood tests to check:
    • prolactin and thyroid function
    • hormone levels (testosterone, prolactin, oestrogen, progesterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH))
  • Fertility assessments – If you are trying to have a baby, or hope to in the future, you will have additional tests done (generally with the assistance of a fertility specialist). These may include:
    • anti-mullerian hormone (AMH), as a marker of ovarian reserve
    • pelvic ultrasound
    • sperm sample tests

If you are taking high risk medications, you may be advised to avoid conception and pregnancy for a while. It is important to let your BMT team know about your family plans.

How are fertility and reproductive health issues treated?

Whatever symptoms or concerns you have, it is always important to speak with your BMT team, GP and your partner as treatment and support are always available. The type of treatment that is offered depends on your situation, including what symptoms you have and whether you plan to try and have a baby.

If you have symptoms that may be related to low levels of hormones you may be prescribed forms of hormone replacement including tablet, gel or ointment oestrogens and testosterone. Symptoms may also be treated with common anti-depressant medications. If you are wanting to start a family, it is important to let your BMT team know about your family plans, as you may be advised to use contraception and avoid becoming pregnant for a period of time if you are taking medications that are a risk for your baby. You will then be referred to a fertility specialist, who will guide your further treatment and arrange review with other specialists including endocrinologists, psychologists and genetic counsellors.

Irrespective of whether you are trying to start a family or not, it is important to make lifestyle changes such as maintaining a healthy weight, exercising, eating a healthy diet, not smoking and getting adequate sleep.

Where can I find further information?

Who do I talk to about fertility and reproductive health issues?

Speak to your BMT team and GP. You may also need to discuss specific issues with other specialists, including a fertility specialist, endocrinologist, fertility counsellor or genetic counsellor.

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