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Growth, puberty and fertility after childhood leukaemia | CION Cancer Clinics
Many children treated for leukaemia with chemotherapy alone grow normally, go through puberty on time and later have children. The risk to fertility is highest after a stem cell transplant, radiation to the whole body or head, or high doses of certain drugs. This guide explains what can be affected, when each check happens, what fertility options exist, and why your child's treatment summary matters for life. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Can a child treated for leukaemia grow up and have children?
- What can treatment affect as your child grows?
- When are growth, puberty and fertility checked?
- What do the words on a hormone or fertility report mean?
- Can fertility be protected before or after treatment?
- What do families often believe that is not true?
- Common questions about growth and fertility after childhood leukaemia
The short answer
Can a child treated for leukaemia grow up and have children?
Many can. Most children treated with chemotherapy alone for leukaemia go through puberty on time and grow to a normal height. The risk to growth, puberty and fertility is highest after a stem cell transplant, radiation to the whole body or the head, or high doses of certain drugs.
Why the treatment matters more than the leukaemia
The leukaemia itself rarely harms the ovaries, the testes or the glands that control growth. The treatment can. Some chemotherapy drugs, called alkylating agents, can damage the cells that later make eggs or sperm. Radiation to the brain can affect the pituitary, the small gland that sends growth and puberty signals. Radiation to the whole body before a transplant can affect all of these at once.
Why you will not know straight away
In a young child, the effect often stays hidden for years. A girl may start her periods normally and still have fewer eggs in reserve. A boy may grow and develop normally and still make little sperm. That is why follow-up carries on long after the last treatment, and why the answer for your own child comes from tests at the right age, not from a guess made today.
Ask your child's team for a written treatment summary listing every drug and any radiation. Every later check starts from that document.Three areas to watch
What can treatment affect as your child grows?
Each area has its own signs and its own tests. Not every child needs every check. The treatment summary decides which ones.
Growth and height
Steroids and illness can slow growth during treatment. Most children catch up afterwards. Radiation to the head can lower growth hormone, so a child may keep falling behind classmates.
Signs to notice
- Clothes and shoe size not changing for a long time
- Dropping lower on the growth chart at each visit
Puberty
Puberty can come too early after radiation to the head, or late or not at all if the ovaries or testes were damaged. Both can be treated once they are picked up.
Signs to notice
- Body changes starting much earlier than friends
- No breast growth, periods or voice change by the mid-teens
Fertility
This is the effect families think about least during treatment and worry about most later. In girls, the egg reserve may be smaller and periods may stop earlier than usual. In boys, sperm production may be low even when hormones are normal.
A child with normal puberty can still have reduced fertility. Only testing shows it.Not sure whether this applies to you?
Ask an oncologistThrough the years
When are growth, puberty and fertility checked?
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At diagnosis, before treatment starts
If your child has reached puberty and the planned treatment carries a high risk to fertility, this is the time to ask about storing sperm or eggs. For younger children, ask whether any option applies at all.
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During treatment and maintenance
Height and weight are measured at routine visits. Slowed growth now is expected.
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The years after treatment ends
Growth is plotted on a chart at each follow-up. The doctor watches whether your child catches up, and when puberty begins, and refers to a children's hormone specialist if something looks off.
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Teenage years
Puberty stages are checked. Blood tests for hormones may be done, especially after radiation or a transplant. This is also when the teenager should start hearing the plan directly, not only through parents.
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Young adulthood
A young woman may be offered tests of egg reserve. A young man may be offered a semen test. These are best done before the person is planning a family, so there is time to act on the result.
On the report
What do the words on a hormone or fertility report mean?
- AMH (anti-Müllerian hormone)
- A blood test that gives a rough idea of how many eggs remain. A low result suggests a smaller reserve. It does not say whether a pregnancy can happen this year.
- FSH and LH
- Signals from the pituitary gland to the ovaries or testes. High levels can mean those organs are not responding well.
- Semen analysis
- A lab test counting sperm and checking how they move. One low result is usually repeated before anything is concluded.
- Growth hormone deficiency
- The pituitary is not making enough growth hormone. It is confirmed with special tests, not a single blood sample.
- Premature ovarian insufficiency
- The ovaries stop working normally before the usual age. Periods become irregular or stop, and hormone support is often needed.
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Options to ask about
Can fertility be protected before or after treatment?
Sometimes. The options depend on your child's age, sex and how urgently treatment has to start. Leukaemia often needs treatment within days, so there may be little time, and the leukaemia always comes first.
For teenage boys
Sperm banking is the most established option. It is simple and does not delay treatment much. A boy who has reached puberty can usually provide a sample, and it can be stored for many years for use later.
For teenage girls and young women
Egg freezing needs hormone injections over a couple of weeks. With leukaemia, that delay and the risk of bleeding or infection often make it unsafe. Freezing a piece of ovary is done in some centres, but with blood cancers there is concern that leukaemia cells could be stored in the tissue, so it is handled with great caution.
For younger children
Options before puberty are experimental and offered in only a few research centres. For most young children the realistic plan is careful follow-up and testing later.
CION's haematology team does not freeze sperm, eggs or tissue. The team can tell you whether it is worth asking, and coordinate with a qualified fertility centre if time allows.Commonly believed
What do families often believe that is not true?
"Chemotherapy always makes a child infertile."
Not always. Many children treated with standard chemotherapy for leukaemia go on to have children. The risk depends on which drugs were used, how much, and whether there was radiation or a transplant. Your child's treatment summary tells you which group they are in.
"She has periods, so her fertility must be fine."
Regular periods are a good sign, but the egg reserve can still be smaller than usual. That can mean a shorter window to plan a family. A test of egg reserve in young adulthood gives a clearer picture.
"If we talk about this, it will ruin a marriage proposal."
Silence helps nobody when a young adult later needs help to conceive. Specialists can do far more when they know the history early.
"A pregnancy after leukaemia will harm the baby."
Children born to survivors of childhood leukaemia do not generally have a higher rate of birth defects. Some survivors need extra heart or pregnancy monitoring because of past treatment, which is why the obstetrician should know the history.
Did you know
This page cannot tell you your own child's fertility. That depends on the exact drugs, any radiation, and tests done at the right age. Keep the treatment summary safe for life.
Questions we are asked
Common questions about growth and fertility after childhood leukaemia
My son had leukaemia at four. Can he become a father?
Many boys treated with chemotherapy alone can. The chance is lower after high doses of certain drugs, radiation to the testes, or a transplant. Nobody can tell you for certain today. A semen test once he is a young adult gives the real answer, and the treatment summary tells his doctor how likely a problem is.
My daughter is shorter than her classmates. Should I worry?
Mention it at the next follow-up rather than waiting. Children often catch up after treatment, but a child who keeps falling behind on the growth chart, especially after radiation to the head, should be seen by a children's hormone specialist. Growth hormone problems can be treated, but only while the bones are still growing.
Can we store sperm or eggs now, before treatment starts?
Ask on the day the plan is discussed. For a teenage boy, sperm banking is often possible without much delay. For a girl, egg freezing usually takes too long for leukaemia. Treatment of the leukaemia cannot be put off for it. Your haematologist will tell you what is realistic in the time available.
Will my child need hormone treatment?
Most children treated with chemotherapy alone do not. Some need help to start or complete puberty, or hormone replacement later, usually after radiation or a transplant. When it is needed, it protects bones, growth and wellbeing. Only the specialist starts, changes or stops it, based on tests.
Can a girl treated for leukaemia have a normal pregnancy?
Many do. Some survivors reach menopause earlier, so waiting a long time to plan a family can matter more for them. Some need heart checks before or during pregnancy because of certain past drugs. She should tell her obstetrician about the leukaemia and bring the treatment summary.
When should we tell our child about fertility risks?
Gradually, in words that fit their age. By the teenage years, they should know what treatment they had and why follow-up matters. A young adult has a right to their own medical history. Your child's doctor or a counsellor can help you have this conversation if it feels hard.
Which doctor checks growth, puberty and fertility?
Usually the haematology follow-up team watches for problems and refers on. A children's hormone specialist handles growth and puberty. A gynaecologist or fertility specialist handles egg reserve, and an andrology or fertility clinic handles sperm tests. Keep one folder with every report so each doctor sees the whole picture.
Are these tests covered by Aarogyasri or insurance?
Coverage for follow-up hormone and fertility tests varies. Treatment of the leukaemia is more often covered than storage of sperm or eggs, which is frequently paid privately. Check the current rules of Aarogyasri, CGHS, ECHS, EHS, PM-JAY or your insurer, because entitlements change.
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Sources
- Cancer Research UK — Fertility and children's cancer treatment
- National Cancer Institute — Late Effects of Treatment for Childhood Cancer (PDQ)
- American Cancer Society — Late Effects of Childhood Cancer Treatment
- Cancer.Net — Fertility Concerns and Preservation for Children and Teens
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Late Effects After Childhood Blood CancerHeart, bones, learning and other checks after treatmentTransition From Paediatric to Adult HaematologyHow follow-up continues when your child grows upThe Long Maintenance Phase: Two Years at HomeWhat the final phase of treatment involvesPaediatric Blood CancersThe full guide for parents
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Worried about your child's growth or fertility after leukaemia?
Share the treatment summary and recent reports. CION's haematology team will tell you which checks matter and coordinate with the right specialist. One helpline serves every CION centre.