Cancer and Fertility
Each year, over 100,000 individuals under the age of 45 are diagnosed with cancer in the United States. Many of these individuals receive treatments that will affect their fertility. According to the National Cancer Institute, the estimated number of reproductive-aged cancer survivors is approaching half a million.
Being told you have cancer and you may lose your fertility from treatment can be devastating. Fortunately, there are a variety of options to preserve fertility for individuals affected by cancer who wish to have children.
How Does Cancer Treatment Affect Fertility?
The likelihood of reproductive damage from cancer treatment depends on several factors, including your age and fertility status at diagnosis, gender, cancer type and stage, and treatment regime (including treatment type, length and dosage).
For men, cancer treatment can affect the normal quantity, speed and shape of sperm. For women, cancer treatment can damage eggs in the ovaries, affect the body’s hormonal balance, or injure the reproductive organs.
The following are some ways cancer can affect fertility:
- Cancer itself: Some men with cancers like testicular cancer and Hodgkin lymphoma become infertile from direct effects of the tumor.
- Surgery: Surgery to parts of the reproductive system (e.g., removal of all or part of a woman’s ovaries, uterus or cervix; surgery to a man’s testicles or prostate) can cause infertility. Sometimes surgery can cause scarring in the fallopian tubes, which can prevent eggs from traveling to meet sperm. Some other types of surgery for men (e.g., removal of lymph nodes in the pelvis) can damage nerves, causing problems with ejaculation.
- Chemotherapy: Depending on the type and dosage of drugs used, chemotherapy can damage or destroy a woman’s eggs or a man’s sperm, reduce sperm production or limit sperm mobility. It can also affect a woman’s menstrual cycle, causing a stop in ovulation or early menopause.
- Radiation therapy: Depending on the dosage and location, radiation therapy to the pelvic region can damage or destroy a woman’s eggs and cause early menopause, or damage the uterus and make it difficult to maintain a pregnancy. For men, radiation to or near the testicles can harm sperm production. Radiation to the brain (e.g., pituitary gland) can affect fertility in women and men by interfering with normal hormone production, affecting egg supply or sperm count.
- Other treatments: A stem cell transplant can affect fertility because the procedure generally involves high doses of chemotherapy and sometimes radiation therapy. Hormone therapies can sometimes affect fertility, but it is usually temporary.
Fertility Questions to Ask Your Doctor During Cancer Care
- How will my cancer treatments affect my fertility?
- Can anything be done to preserve my fertility before treatment begins?
- What are my fertility preservation options?
- Will any of these options interfere with my treatment?
- Will any of these options increase the risk of cancer recurrence?
- What is the likelihood that I could become infertile after treatment?
- Is my infertility likely to be short-term or permanent?
- Are there other treatments that won’t affect my fertility but are equally effective?
- Is it safe for me to get pregnant during treatment?
- How long should I wait after treatment ends to start a pregnancy?
- If I become infertile after treatment, what are my options for having children?
- Where can I find support for coping with fertility issues?
If you want to have a baby in the future, there are a range of fertility-preserving options. Some options can be time consuming and expensive, and can pose other challenges for people with cancer, such as delaying cancer treatment or risking tumor growth. It’s important to discuss all of these issues with your doctor.
Keep in mind the following options may not be appropriate for everyone, and there may be other options available that are not listed below:
- Sperm banks
- Embryo freezing
- Egg freezing
- Ovarian tissue freezing
- Donor eggs/embryos or insemination
- GnRH analog treatment
- Modified cancer treatments
- Fertility-sparing surgery
- Chemoprotective drugs
- Techniques to protect the reproductive organs during radiation
Starting a Family After Cancer Treatment
Once cancer treatment is complete, the excitement over surviving cancer can be overshadowed by fertility concerns. While many cancer survivors are able to conceive naturally after treatment, many require assisted reproductive technology. Many men who lose sperm function as a result of cancer treatment will eventually regain fertility. However, it can be more difficult for women.
Women are often advised to wait for six months or longer after treatment ends before trying to conceive, as eggs can become damaged from exposure to radiation and/or chemotherapy. Some doctors recommend waiting two years before trying to get pregnant to make sure the cancer doesn’t recur. Also, women often need to be closely monitored during pregnancy.
NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING FERTILITY AND CANCER.
Tips for Addressing Fertility Concerns During Cancer Care
- Know you're not alone. Being told you have cancer and the treatment you need may affect your ability to have a child can be devastating. It can also be very isolating. It’s important to understand you are not alone. There are other people out there who can support you if you let them.
- Ask yourself questions. If you’re at risk for infertility, ask yourself questions to better understand your feelings about parenthood. Have you always wanted to have children? Are you unsure if you will want a child, but at least want the option? How would you feel about having a child that isn’t biologically related to you? Are you open to using donor sperm or donor embryos?
- Be upfront with your doctor. If possible, talk with your doctor about fertility concerns before treatment begins. Ask how treatment is likely to affect your fertility. Find out about options to protect your fertility before and during treatment. Ask about whether anything can be done to lessen the effects of treatment on your fertility. An open discussion with your doctor will help you better anticipate what to expect.
- Communicate with your partner. If you’re in a relationship, you and your partner may or may not be ready to have a family yet. Regardless of which stage of family planning you’re in, open communication is important. Let your partner know how you feel about having children and ask how your partner feels.
- Explore your fertility-preserving options. Learn about your fertility-preserving options before treatment, if possible. To evaluate your options, consider the risks and successes of each. Currently, the most established options are sperm banking for men and embryo freezing for women. Learning about all the options available to you can help you feel better about your choices.
- Protect what's important to you. If you have always wanted to have children, don’t let others minimize this desire, including your health care team. Sometimes cancer-related infertility is not discussed as often as it should be. The disease takes priority, which is understandable and necessary. However, you still have a right to protect your ability to have children in the future.
- Consider the challenges. When researching your options, keep in mind that many are costly and may not be covered by your health insurance. Also, some options are time-consuming, and you may not be able to postpone treatment as long as you need to. Don’t be afraid to get a second opinion before making important decisions.
- Seek out resources. Ask your doctor about available fertility resources and referrals, such as reproductive endocrinologists, sperm banks, financial assistance, and adoption agencies. Talk to a fertility counselor or join a support group. Fertile Hope, a LIVESTRONG initiative, provides helpful information about cancer and fertility.
- Learn about pregnancy risks. Talk with your doctor about when is a safe time to begin a pregnancy. Your doctor may advise you to avoid pregnancy during cancer treatment, as some treatments may cause birth defects or harm to the developing fetus. Also, you may need to wait for a period of time after treatment to avoid miscarriage or premature birth.
- Don't give up. If you’ve always dreamed of having a child and you’ve already finished treatment without undergoing fertility preservation procedures, it doesn’t mean you still can’t have children. If you can’t conceive naturally, you may decide to pursue surrogacy or adoption. Many people choose adoption regardless of whether or not they can have biological children.
NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING FERTILITY CONCERNS DURING CANCER CARE.
About Cancer Treatment Centers of America
Cancer Treatment Centers of America (CTCA) is a network of cancer hospitals unlike any other.
CTCA doctors focus on the treatment of patients with many forms of cancer, including complex and advanced cases. They work as a team, alongside cancer treatment experts across multiple disciplines, to keep patients strong in body, mind and spirit.
CTCA care team members listen to patients and provide clear, well-defined choices. They work together to develop a comprehensive treatment plan based on each patient’s unique diagnosis and needs.
Using the latest technologies and advanced tools to fight cancer, our cancer experts provide a powerful combination of treatments. While our oncologists help patients fight cancer, other clinicians provide supportive therapies to help patients tolerate treatment, manage side effects, and enjoy a better quality of life.
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