Ask the Nurse: Myeloma and fertility

A diagnosis of myeloma at a younger age can cause anxiety about your future fertility. This could be because you are still hoping to start or grow your family, or perhaps you are unsure if you want to have children but would like to know what to expect following diagnosis.

It can be difficult to discuss hopes or concerns around fertility but starting that conversation early can help you to understand and put processes in place to preserve your options. This month, we answer some of the questions we are asked on our Myeloma Infoline about fertility and having children.

How can I access emotional support as a myeloma patient struggling with fertility or early menopause?

Thinking about fertility options, coming to terms with infertility, managing a pregnancy with myeloma and coping with early menopause are all challenging experiences. Remember that support is available if you want it, and you don’t have to go through it alone.

Some people find talking helpful. This could mean reaching out to a loved one or connecting with others going through similar experiences. You may find it useful to contact a fertility support group, like Fertility Friends or Fertility Network UK.

If you’d like to talk to a specialist counsellor, your healthcare team can connect you with a professional who can support you. Some hospitals employ fertility/sexual health nurses to guide you through your available options.

You can also get in touch with our Myeloma Information Specialists by calling the Myeloma Infoline on 0800 980 3332 (UK) or 1800 937 773 (Ireland) or by using the Ask the Nurse email service.

Will I still be able to have children after myeloma treatment?

Unfortunately, many of the most effective treatments for bringing your myeloma under control can impact fertility, either temporarily or permanently.

For example, high doses of melphalan, a chemotherapy drug used in high-dose therapy and stem cell transplant (HDT-SCT), can sometimes affect sperm counts or induce early menopause.

If this is something you are worried about, do speak to your healthcare team as soon as possible. Remember that your team are there to support you and can explain your options to you before you begin treatment.

If you have already started treatment, you can still talk to your doctor to help you understand what options might be available to you in future.

Is there any way to preserve fertility?

Freezing your eggs, sperm, or embryos (eggs fertilised by sperm) may be a way of preserving your fertility until after your myeloma treatment.

Making decisions about preserving fertility can feel overwhelming, especially if it is the first time you have needed to consider this. You should be offered the opportunity of counselling before making any decisions, as well as during and/or after any fertility treatment or procedures.

Freezing sperm is relatively straight forward and typically, conception is just as successful as when using fresh sperm.

Freezing eggs is a more complicated process, as a period of hormone treatment is needed to encourage several eggs to mature at once, ready for collection. Unfortunately, there can be less success in producing viable embryos following freezing.

Embryos can also be frozen. This process is often more successful than freezing unfertilised eggs.

It may not be possible to delay myeloma treatment long enough to mature and collect eggs for freezing. Many patients need to start myeloma treatment as soon as possible, to get the myeloma under control and manage any complications it may have caused.

The Human Fertilisation and Embryology Authority (HFEA) offer further information about preserving eggs, sperm or embryos.

A general overview of the processes involved in in vitro fertilisation (IVF), including the support available, can be found on the NHS website.

Are myeloma treatments dangerous to an unborn baby?

Some myeloma treatments can be dangerous to an unborn baby. For example, immunomodulatory drugs (IMiDs) like thalidomide, lenalidomide (Revlimid®) and pomalidomide (Imnovid®), are known to cause defects in unborn babies.

For this reason, for some treatments you will need to follow a Pregnancy Prevention Programme if you or your partner could become pregnant. This involves confirming you’re not pregnant before starting treatment and ensuring you and/or your partner are using suitable contraception.

Sometimes you may be asked to take steps to avoid pregnancy because there is not enough evidence to know that it is safe.

Don’t worry about feeling awkward discussing this topic with your doctor – remember they are used to having these conversations.

Is pregnancy safe if I have myeloma?

If you have myeloma and are considering pregnancy, or have found out that you are pregnant, it’s essential that you tell your doctor as soon as possible.

Typically, you will have more regular appointments to monitor you and your baby, and you may be offered counselling to support you throughout the experience.

People with myeloma can be at higher risk of certain complications during pregnancy, including conditions like anaemia, blood clots and hypercalcaemia (high levels of calcium in the blood). If you experience any increase in myeloma symptoms, or signs of pregnancy complications, your healthcare team will discuss treatment options with you.

If your myeloma becomes more active during your pregnancy, this can be difficult to manage because many myeloma treatments may be harmful to you and your baby during pregnancy.

Your healthcare team will discuss your options with you – if you choose to continue with the pregnancy, they will advise the most suitable treatments available.

In some circumstances, when the baby is well-developed, they may advise early delivery. This allows you to safely begin more intensive treatment without danger to the baby.

Can I breastfeed whilst having myeloma treatment?

Some treatments can pass to the baby through breastmilk. It is not recommended to breastfeed whilst having these treatments due to possible risk to the baby, so always check with your healthcare team if you are unsure.

Often, there is not enough evidence to know whether a treatment can affect a baby via breastmilk and so it may still be recommended to avoid breastfeeding as a precaution.

Your healthcare team will be able to advise on whether there are suitable treatment options that would allow you to breastfeed safely.

Does my diagnosis mean I will experience an early menopause?

Menopause occurs naturally with age, and experiencing menopause whilst living with myeloma can be particularly challenging. Certain myeloma treatments, such as HDT-SCT, can cause early menopause.

Early loss of your fertility may have further impact if you were hoping to have (more) children in the future.

Your doctor can help you access practical or emotional support to cope with the emotional and physical side effects of early menopause.

Typically, menopause causes a variety of symptoms such as:

  • Fatigue
  • Hot flushes
  • Mood swings
  • Depression
  • Increased anxiety

Coping with these symptoms can heighten the emotional impact and physical side effects of myeloma and its treatments.

Hormone replacement therapy (HRT) is a treatment that replaces some of the hormones reduced during menopause. If you and your doctor feel that HRT is suitable for you, it is important to tell your haematologist and/or clinical nurse specialist before you start treatment.

Read more about fertility in Section 5 of our Infopack for living well with myeloma or watch our video about Issues for younger myeloma patients. You can find more information about coping with side effects of myeloma in our Psychological wellbeing and myeloma Digital Infoday Session.

Get in touch with us through the Myeloma Infoline on 0800 980 3332 (UK) or 1800 937 773 (Ireland) or by using the Ask the Nurse email service.

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