Sex, fertility and non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) and its treatment does not always affect your sex life. But you will probably go through times when you don't feel like sex, because you are too tired or have side effects.

Some chemotherapy drugs for NHL can cause infertility . This does not happen with all chemotherapy drugs for NHL. Your doctor will talk to you about this before you start your treatment.

Contraception during treatment

Reliable contraception is important while you or your partner are having chemotherapy. It is important you avoid getting pregnant, or getting someone else pregnant while you are having chemotherapy. This is because the drugs may harm the baby. 

Women on treatment can still get pregnant, even if your periods have stopped. So you should still take precautions.

It is not known for sure if chemotherapy drugs can be passed on through semen or secretions from the vagina. So some doctors advise you to use a barrier method if you have sex during treatment. Barrier methods mean condoms, femidoms or dental dams. This applies to vaginal, anal or oral sex.

Doctors generally only advise a barrier method for when you are actually having treatment. And for about a week after your treatment.

Advice like this can be worrying, but this does not mean that you have to avoid being intimate with your partner. You can still have close contact with your partner and continue to enjoy sex.

Low platelet count 

A very low platelet count increases your risk of bleeding. Your doctor might advise avoiding sex for a short time, if you have a very low platelet count. Discuss this with your doctor or nurse if you are not sure.

Early menopause

Sometimes chemotherapy can cause an early menopause in women. If your periods stop permanently after chemotherapy, you have had an early menopause. This can cause other symptoms apart from not having periods. You might have:

• hot flushes and sweats
• dryness of the vagina
• less interest in sex
• dry skin
• loss of energy
• mood swings, loss of concentration or just feeling low

Your doctor might offer you hormone replacement therapy (HRT) for an early menopause. HRT is treatment with the female sex hormones that you would normally produce naturally. The hormones are called oestrogen and progesterone. 

HRT can help to relieve the symptoms of early menopause. It can also help to prevent long term problems like bone thinning (osteoporosis). But there are some risks with HRT. Ask your doctor to explain the pros and cons of this therapy.

You can have HRT by taking tablets or by using skin patches that are like sticking plasters. The dose of hormones is lower than the dose you would normally produce if you had not had an early menopause. So you are very unlikely to have any side effects.

How chemotherapy can affect fertility

Some chemotherapy drugs for NHL can cause infertility . 

This does not happen with all chemotherapy drugs for NHL. Your doctor will try to use drugs that do not cause infertility. But the first priority is to treat your lymphoma effectively. 

If you become infertile you will not be able to have children naturally after your treatment. Having a stem cell transplant will almost certainly mean you will be infertile.

Some drugs are likely to cause infertility but do not always do so. Some people may be made infertile at a lower dose of a particular drug than other people. Some drugs cause temporary infertility. So your fertility may come back from six months to a year after your treatment has finished.

With some chemotherapy treatment, your doctor can't be certain whether you will be infertile or not. This will depend on:

• the drugs you have
• the total dose of each drug
• your age if you are a woman

Your doctor or nurse will tell you whether your chemotherapy is likely to make you infertile. And they can answer your questions before you start your treatment. If you have a partner, you may want to see the doctor together. You can then both ask questions and discuss any fears or worries.

Sperm banking for men

It may be possible for you to have sperm frozen and stored before you start your treatment. This is called sperm banking. Sperm banking means you might be able to have children in the future. You can use the frozen sperm to make your partner pregnant.

Teenage boys can also have sperm frozen. Their sperm can be stored for use in later years.

Sometimes men who have lymphoma have fewer sperm in their semen. It is not then possible to store the sperm. But there are newer techniques to help men with low sperm counts.  It's important to discuss sperm banking with your doctor before you start treatment.

Freezing embryos or eggs for women

The closer you are to menopause, the more likely it is that chemotherapy will make you infertile. Your periods might stop or become irregular during your chemotherapy. This does not necessarily mean you will be infertile. Your periods might go back to normal six months to a year after treatment has finished.

You might be able to have children in the future if you have embryos or eggs frozen. This is more complicated than sperm banking is for men. You have to take hormones to stimulate your ovaries to make many more eggs than usual. This takes a couple of weeks at least, depending on where you are in your menstrual cycle.

Depending on your situation, you can have the eggs fertilised and stored as embryos. It is now also possible to have just your eggs frozen (if they cannot be fertilised first). The embryos or eggs are kept in storage until the time when you want to try to have children. 

Talk to your lymphoma specialist as early as possible if you think you would like to do this. You have to do it before you start this treatment. It takes a few weeks, so it could delay your chemotherapy.

With some types of faster growing lymphoma, this might not be possible. Your doctor might feel you need to start treatment straight away.

Coping with infertility

It can be very upsetting to find out that your lymphoma treatment means you will not be able to have children. It can seem very unfair to have to cope with this as well as your lymphoma. You might not have really thought much about having children before. But even so, losing your fertility can be very difficult to come to terms with. It can affect the way you feel about yourself.

It takes time to come to terms with this. Give yourself time to adjust and feel sad. Talking to someone close will almost certainly help. But you might not be able to do this for a while.

You may want to talk to someone other than your partner, family or friends. Some people find it helpful to talk to a therapist or counsellor. Ask your doctor or nurse if you can be put in touch with some professional help if you think it would be helpful for you.

That Cancer Conversation is Cancer Research UK's podcast. There is an episode exploring infertility and cancer,. During this we chat with people whose cancer journey has had an impact on their fertility.

It also features Professor Richard Anderson. He is the  Deputy Director of the University of Edinburgh’s Centre for Reproductive Health. During the episode we explore options that are available. And what the future of fertility medicine could look like.