Fertility and Cancer
Cancer and cancer treatment may cause fertility challenges for some people. These changes are caused by a variety of factors and it’s important that you talk to your healthcare team about whether your medication will affect fertility and what your options are before beginning cancer treatment.
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How does cancer treatment affect fertility?
Fertility is a person’s ability to have a child. This ability depends on a few factors like whether someone’s reproductive organs are functioning as they should, whether the person is having sex and how often, and whether their partner has any reproductive problems.
Cancer can affect fertility in different ways. Whether or not your fertility will be affected depends on a few factors like age, type of cancer treatment, the amount and length of time of that treatment, and other individual factors like baseline fertility. For both women and men, cancer treatments like chemotherapy, radiotherapy, surgery, or hormonal therapy can all affect fertility.
In females:
- Chemotherapy can slow down or even stop the production of eggs. This can be temporary or permanent depending on the treatment and the treatment dose
- Radiation therapy may reduce hormone levels, affect egg production, and possibly damage the reproductive organs, like the ovaries or uterus
- Surgery for cancer of the reproductive system and in the pelvis region, can affect surrounding tissues or the reproductive organs themselves
- Hormone therapy, or endocrine therapy, may disrupt the menstrual cycle, depending on the type of hormones used
In males:
- Chemotherapy can slow down or even stop the production of sperm. This can be temporary or permanent depending on the treatment and the treatment dose
- Radiation therapy to the pelvic area and/or testicles can affect sperm production, and possibly reduce testosterone. Radiation therapy to the brain can also reduce testosterone
- Surgery for cancers affecting the reproductive organs or pelvic region may result in damage to these organs, nearby nerves, or pelvic lymph nodes, leading to infertility
- Hormone therapy may also reduce the levels of testosterone, which can cause issues with erections and a lower sex drive used
- Targeted therapy and immunotherapy drugs work differently than other cancer treatments and their effects on fertility for both males and females are not as well known
What are my options to preserve fertility?
The possibility of infertility or any risks to having a baby after treatment are difficult and upsetting side effects of cancer treatment. The best thing to do is to talk to your healthcare team about the risks and options first. This conversation should happen as early as possible, either before treatment or surgery. In addition to discussing the fertility risks of cancer treatment, these conversations should also include your goals for a family, personal beliefs, and available options for you. You may even consider seeing a fertility or reproductive specialist as part of your cancer care team. If you have a partner, it is important that they are a part of these conversations as well. Talking to a counselor or therapist about what you are going through may also be beneficial for your mental health.
Studies have shown that some doctors or nurses may not ask about sexual orientation or gender identity. As part of the conversation, it may be helpful for you to let your healthcare team know your sexual orientation and gender identity. With this information, your conversation about fertility will be focused on your specific needs.
Here are some general questions that you can ask your healthcare team to start the conversation about fertility.
- Does cancer treatment have an impact on my fertility?
- Does this treatment have a risk of causing infertility?
- What are the long-term fertility risks with this treatment?
- Could treatment make it difficult to become pregnant, get someone pregnant, or carry a pregnancy in the future?
- Do you have other recommended cancer treatments that might not cause, or cause fewer, fertility problems?
- What fertility preservation options are available for me?
- Would you recommend I see a fertility specialist?
- After treatment, what are the chances that my fertility will return? How long might it take for this to happen?
- Is birth control recommended?
Depending on your age, family situation, and stage of life, having a child may be important to you, so it is vital you talk to your healthcare team to understand the risks you face and what you can do to preserve fertility. There are multiple options available for patients. Some, but not all, are included below.
Fertility preservation for females
- Egg freezing - a procedure where mature eggs are removed from the ovaries and frozen. In the future, these eggs can be thawed, fertilized with sperm, and placed in the uterus
- Embryo freezing - eggs are collected and fertilized with sperm. If the fertilized eggs develop into embryos, the embryos are frozen and stored for the future
- Surgical protective measures - there are various surgical methods to protect your reproductive organs that your healthcare team can discuss with you depending on the type of cancer and cancer treatment
Fertility preservation for males
- Donors – if infertility happens after cancer treatment, there is the option of using carefully selected donor eggs, sperm, or embryos to become pregnant. This may be an option for women who have a healthy uterus and are cleared by their doctors to carry a pregnancy but cannot conceive with their own eggs
- Surrogacy – this is when another woman carries the baby to term, if there is infertility or an inability to carry a pregnancy after cancer treatment
- Adoption – if there is not a possibility of pregnancy, but there is still a desire to be a parent, adoption may be an option
This is not a complete list of options, and each one has different costs and effort associated with it. Talking through fertility preservation with your partner, family, and healthcare team can help you determine what is best for you. There are also support groups that have more information on the different options and may be able to help you find resources for your fertility journey. For children going through cancer treatment, there are additional options for children that your healthcare team can advise you on.
For caregivers and partners
If you share fertility concerns with your partner or loved one going through treatment for cancer, it is important to work together to find options for preserving fertility or for having a child once treatment is over. Help support your loved one by going to appointments together and make sure you both understand the risks and the available options. This can help both of you cope with the changes that are happening and the challenges that lie ahead.
Looking ahead
Changes to fertility can be permanent for some people, but temporary for others. Talking to your healthcare team is the best way to understand possible fertility risks and options to preserve fertility. It is also important to talk to them about types of birth control or contraception to use during cancer treatment since some treatments could harm a developing baby.
Remember, it may be helpful to talk about what you are going through with your partner, family, friends or a trained therapist during this time. Fertility issues can be upsetting, so it is important you feel supported throughout this process and know what your options are.
Managing your cancer care throughout treatment can take a lot of effort. Learn more about how you can best manage your cancer care throughout your journey.
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