When you or a loved one is diagnosed with cancer, the main things on your mind are treatment options and how to cope.

However, another facet of the harsh reality of cancer is the potential infertility  that can result–an issue that can affect children as well as adults with cancer.

While childhood cancer is highly treatable, some treatments, like chemotherapy and radiation, can render young boys and girls infertile before they even hit puberty. Chemotherapy can harm eggs, sperm and the cells that generate sex hormones. Radiation has similar effects when targeted at the pelvis, stomach, brain or pituitary gland.

Cancer treatment has varying impacts on children, and the effect on fertility depends on many factors. These factors include the amount and location of radiation, the type and amount of chemotherapy, the site of surgery and the child’s puberty status. Some cancer drugs are also more likely to cause infertility than others.

Since different treatment options have such diverse effects, ask your doctor about the impact they could have on you or your child’s fertility before making such decisions. Fertility-saving options are available if patients consult with their doctors before treatment begins. This conversation is critical to your child’s ability to have his or her own family in the future. To help start the conversation, visit SaveMyFertility.org.

Fertility-saving procedures depend on a child’s puberty status. Children who have experienced puberty have more choices to preserve their fertility. Pubescent boys can undergo sperm banking, testicular sperm extraction, testicular tissue freezing (an experimental method) or shielding testicles during radiation therapy. Pubescent girls have the options of ovarian transposition (surgically moving the ovaries out of the radiation field), egg banking, ovarian tissue banking (also experimental) or shielding pelvic regions during radiation. Younger children can undergo radiation shielding, tissue banking or, for girls, ovarian transposition.

Cancer treatments might also induce early or delayed puberty in prepubescent children. Early puberty is considered before age nine in boys and age eight in girls. If 14-year-old boys and 13-year-old girls have not reached puberty, it may be delayed due to treatment. Medicines can help your child have a normal puberty.