Cancer treatment: how does it affect fertility?

Does cancer cause infertility?

The treatments you may need for your cancer can cause problems with your fertility. This is often only temporary. But in some cases, loss of fertility can be permanent. If this is a possibility, your healthcare team will discuss it with you before any treatment.

Going ahead with treatment that may affect your fertility can be hard. But your healthcare team is there to support you. If having children is important to you, they’ll do as much as they can to preserve your fertility.

How do cancer treatments affect fertility?

Different cancer treatments affect fertility in different ways.

• Chemotherapy uses drugs that destroys cancer cells. But it may damage your ovaries so that you produce fewer eggs. Chemotherapy also affects sperm production. It might be temporary or permanent, depending on which drugs you have, and the dose.
• Radiotherapy uses radiation to destroy cancer cells. Radiotherapy targeted to your pelvis can damage the womb, cervix and, ovaries. It can also affect sperm production and sperm count. Radiotherapy on the pituitary gland in your brain can also affect the production of eggs or sperm.
• Hormonal therapy can stop periods. It may also affect sex drive and erections. These problems are usually temporary. Surgery to your pituitary gland in your brain will affect your fertility. If you have surgery to remove both of your ovaries and your womb, this will lead to infertility.
• Stem cell transplant can affect your fertility as you will have chemotherapy or radiotherapy before the procedure.
• CAR T-cell therapy is an advanced therapy that may affect fertility, but this is still being studied.

The effect of other treatments such as targeted therapies and immunotherapies on fertility is not clear to doctors yet.

Your risk of fertility problems depends on the type of cancer you have and the exact treatment you’re having. Other factors such as your age and how near to menopause you are, are also important.

How can I preserve my fertility?

If having children matters to you, there are ways to reduce the risk of infertility.

• If you need to have surgery to remove your ovaries, it might be possible to remove only one ovary. This will mean you still produce eggs so that you might still be able to get pregnant.
• If you’re having chemotherapy, in some cases, your doctor may be able to give you hormone medicine to protect your ovaries. This makes your ovaries stop working, and you might go into menopause for a time.
• In radiotherapy, shields can be used to reduce radiation to your testicles and ovaries. You can also have surgery to move your ovaries before radiotherapy. This helps reduce the risk of radiation exposure. But radiation may still reach your ovaries.

If there’s time before starting treatment, your doctor may refer you to a fertility clinic. They’ll talk to you about the options for fertility preservation before cancer treatment. You may be able to have your eggs, embryos (fertilised eggs), ovarian tissue, or sperm frozen. After your cancer treatment you can then use your frozen eggs, embryos, or sperm. You’ll need to have fertility treatments such as in vitro fertilisation (IVF).

Other options include using eggs, sperm, or embryos from a donor. You may also want to consider adoption or surrogacy.

Can you get pregnant while having cancer treatment?

You should not try to get pregnant or get someone pregnant when you are on treatment for cancer. This is because cancer treatment can damage your eggs or sperm. Cancer treatments can harm an unborn baby or cause miscarriage. If you have sex, you’ll need to use contraception to prevent pregnancy even if your fertility has been lowered. You’ll need to carry on using contraception for some time after your treatment too. Speak to your healthcare team about what contraception you should use during and after cancer treatment.

Can you have children after cancer treatment?

Your doctor can talk to you about the possibility of your fertility recovering after cancer treatment. They can also advise how long you need to wait before trying for a baby after finishing treatment. You might need to wait one to two years before trying.

You’ll have follow-up appointments with your doctor or nurse after treatment. You can talk to them about your fertility. Or book an appointment with your GP, who can provide support and talk to you about next steps.