Fertility and cancer

Cancer and its treatment may affect a person’s ability to conceive a child or maintain a pregnancy (fertility). The information on these pages helps you understand how cancer treatment can affect fertility.

Whether or not you want to become a parent or add to your family, you may be wondering how cancer will affect your fertility. We hope this information will help you understand how you may be able to try to keep (preserve) your fertility before and during cancer treatment, and your options after cancer treatment. We cannot give advice about the best ways to preserve fertility. You need to discuss this with your doctors.

When talking about the body, we use the terms “female” and “male”. Some people may identify with a different sex or gender.

Reproduction is the way we produce babies. Knowing how your body works may help you understand how fertility problems happen.

How reproduction works

The female and male reproductive systems work together to make a baby. The process involves combining an egg (ovum) from a female and a sperm from a male. This is called fertilisation.

Role of hormones – These substances are produced naturally in the body. Hormones control many body functions, including how you grow, develop and reproduce. The pituitary gland in the brain releases hormones that tell the ovary and adrenal gland to make sex hormones.

Oestrogen and progesterone, often called female sex hormones, are produced in the ovaries. These hormones control the growth and release of eggs, and the timing of periods (menstruation).

Androgens are often called male sex hormones. The major androgen is testosterone, which is produced mainly in the testicles, but also in the male and female adrenal glands and the ovary. Most people produce some testosterone, although generally men make more. It helps the body make sperm.

Ovulation – Each month, from puberty (sexual maturation) to menopause (when periods stop), one of the ovaries releases an egg. This is called ovulation.

Pregnancy – The egg travels from the ovary into the fallopian tube. Here it can be fertilised by a sperm. Once the egg is fertilised, it implants itself into the lining of the uterus and grows into a baby. After the egg is fertilised by the sperm, it’s called an embryo.

Menopause – As females get older, hormone levels fall to a level where the ovaries stop releasing eggs and periods stop. This is known as menopause. This is the natural end of the female reproductive years and it usually happens between the ages of 45 and 55.

Factors that affect fertility

Some of the common factors that affect fertility include:

• age – fertility starts to naturally decrease with age
• weight – being very underweight or overweight
• smoking – both active and second-hand smoking can harm reproductive health
• alcohol – drinking too much alcohol may make it harder to conceive
• other health concerns – endometriosis, fibroids, pelvic disease, certain hormonal conditions or cancer.

Female sex organs and reproduction

ovaries

• two small, walnut-shaped organs in the lower part of the abdomen
• contain follicles that hold immature eggs (ova), which eventually become mature eggs
• make hormones including oestrogen and progesterone fallopian tubes

fallopian tubes

• two long, thin tubes that extend from the uterus and open near the ovaries
• carry sperm to the eggs, and eggs from the ovaries to the uterus

uterus (womb)

• a hollow muscular organ where a fertilised egg (ovum) is nourished to develop into a baby
• the inner lining of the uterus is known as the endometrium; each month if an egg is not fertilised, some of the lining is shed and flows out of the body  (menstruation or monthly period)
• joined to the vagina by the cervix

cervix (neck of the uterus)

• the lower, cylinder-shaped entrance to the uterus
• produces moisture to lubricate the vagina
• holds a developing baby in the uterus during pregnancy and widens during childbirth vagina (birth canal)

Vagina (birth canal)

• a muscular sheath or canal that extends from the opening of the uterus (the cervix) to the vulva
• the passageway through which menstrual blood flows out of the body, penetrative sex (such as intercourse) occurs and a baby is born

vulva

• the external sex organs; includes the labia

testicles (testes)

• two small, egg-shaped glands
• make and store sperm
• also make the hormone testosterone, which is responsible for the development of male characteristics, sexual drive (libido) and the ability to have an erection

scrotum

• the loose pouch of skin at the base of the penis that holds the testicles

epididymis

• a tightly coiled tube attached to the outer surface of each testicle
• sperm travel from the testicles through the epididymis to the spermatic cord

spermatic cord and vas deferens

• tube running from each testicle to the penis
• contains blood vessels, nerves and lymph vessels
• carries sperm towards the penis

seminal vesicles

• a pair of glands that lie close to the prostate
• produce fluids that make up part of semen

prostate

• a small gland about the size of a walnut
• produces fluids that form part of semen
• located near the nerves, blood vessels and muscles that control bladder function and erections

penis

• the main external sex organ
• urine and semen pass out of the body through the penis
• semen is made up of sperm and other fluids, and is ejaculated from the penis

This information has been developed based on evidence in people born female or male.

If you are non-binary or a trans person or person with an intersex variation, this information may still be relevant to you if you have ovaries, a cervix and a uterus, or testicles and a penis. For information specific to you, talk to your doctor.

Call Cancer Council on 13 11 20 to ask for information about the specific cancer needs of LGBTQI+ people.

Answers to some common questions about fertility, following a cancer diagnosis, are below.

It’s best to talk about ways to preserve or protect your fertility before cancer treatment begins.

Get expert advice – Most people find it helpful to talk to a fertility specialist about their fertility options. Ask your cancer specialist whether you should see a fertility specialist or oncofertility specialist. You can also get a referral from your general practitioner (GP). As well as explaining your fertility options, these specialists can help with contraception and hormone management to prevent ovulation during cancer treatment. It’s best to see a fertility specialist as soon as possible after diagnosis to prevent any delays to treatment

Ask questions – It’s important that you feel comfortable enough to ask about the possible impact of different cancer treatments on your fertility, the possible risks of having treatment to preserve your fertility and the risk of delaying treatment to have fertility treatment. You may find it helpful to plan some questions in advance and to take notes during the discussion.

It’s your decision – After a cancer diagnosis, you may feel too overwhelmed by decisions about treatment to think about fertility. Or you may be asked to make fertility decisions before you’ve given much thought to whether you want to have a child in the future. Even if you think, “But I don’t want kids anyway” or “My family is complete”, you may be encouraged to consider as many fertility options as possible to keep your choices open for the future. These decisions are  personal, and you need to feel comfortable with your choices.

What to consider when making decisions

After a cancer diagnosis, you may need to make decisions about your fertility. These decisions can be difficult, particularly if you have several options to consider and you feel that everything is happening too fast 

Learn more about the options – Generally, people make decisions they are comfortable with – and have fewer regrets later – if they gather information and think about the possible outcomes. Ask your health professionals to explain each fertility option, including risks, benefits, side effects, costs and success rates.

Expect to experience doubts – It’s common to feel unsure when making tough decisions. Keeping a journal or blog about your experience may help you come to a decision and reflect on your feelings.

Talk it over – Discuss the options with people close to you (such as your partner, a friend or family member) or with a fertility counsellor or psychologist. Research shows that couples who make fertility decisions together are happier with the outcome, whatever it is.

Use a decision aid – A decision aid outlines the available options and helps you focus on what matters most to you. They are available online or in booklets. Breast Cancer Network Australia has developed a resource called Fertility-related choices to help younger women with breast cancer make fertility-related decisions.

The main costs of fertility treatment

Fertility preservation can be expensive, and this may influence your decision-making. The cost of specialists and private clinics vary across Australia. You may also be able to have treatment at a fertility unit in a public hospital or a clinic that provides discounted fertility treatment for cancer patients. Ask your fertility clinic about costs.

Depending on the treatment you have, costs may include:

• fertility specialist consultations – ask if they offer a discount for people diagnosed with cancer
• medicines and blood tests
• fees for procedures (e.g. the different steps in the IVF cycle for egg or sperm collection, preimplanation genetic testing and implantation of embryos after treatment)
• day surgery, operating theatre and anaesthetist fees
• egg, sperm and embryo storage (cryopreservation) – ask your clinic about up-front payments, instalment payments and ongoing fees.

How much you have to pay will depend on whether you are a public or private patient. If you are a private patient, there may be Medicare rebates for some of these costs. Ask your fertility specialist for a written estimate of their fees and any Medicare rebates. Ask your private health fund (if you belong to one) what costs they will cover and what you’ll have to pay – some funds only pay benefits for services at certain hospitals.

Medicare will cover the cost to see a specialist only if you have a referral. The referral should list both you and your partner so you can claim the maximum benefit.

This section provides an overview of how cancer treatments may affect fertility. The most common treatments for cancer are chemotherapy, radiation therapy, surgery and hormone therapy. Other treatments include immunotherapy and targeted therapy. Learning that cancer treatment may affect your fertility can be distressing. If you need support at this time, call Cancer Council 13 11 20.

Avoiding pregnancy during treatment

Some cancer treatments, such as chemotherapy, radiation therapy, immunotherapy or targeted therapy, can harm an unborn baby or cause birth defects.

During treatment – Even if your periods stop during cancer treatment, you might still be fertile. You will need to use some form of contraception to avoid  pregnancy while having treatment.

After treatment – Your treatment team and fertility specialists may also advise you to wait between 6 months and 2 years before starting fertility treatment or trying to conceive naturally. How long you have to wait will depend on the type of cancer treatment you’ve had.

Using contraception – Your team may also advise you to use barrier contraception (such as a condom, female condom, dental dam or diaphragm), “the pill” or hormone implants, or non-hormone-based contraception (IUD) for a short time after each treatment, even if there is no risk of pregnancy.

Barrier contraception will also protect your partner from any chemotherapy drugs that may be present in your body fluids.

Managing fertility and treatment

Talk to your doctor –If you think you may want to have children in the future or if you’re not sure, discuss ways to preserve or protect your fertility with a fertility specialist before starting treatment.

Talk to your partner – Share your feelings about any fertility concerns with your partner, who may also be worried or grieving.

Use contraception – Ask your doctor what precautions to use during treatment. You may need to use barrier contraception, such as condoms or female condoms, to reduce any potential risk of the treatments harming a developing baby or being toxic to your partner.

Avoid pregnancy – Tell your cancer specialist immediately if you or your partner becomes pregnant during treatment.

Check fertility status – Consider having tests to check if your fertility has been affected.

Specific challenges after treatment

If you still have your reproductive organs, you may be able to conceive without medical assistance after cancer treatment. However, many people experience one of the following physical issues.

Acute ovarian failure

While you’re having chemotherapy and radiation therapy, and for some time afterwards, the ovaries often stop producing hormones because of the damage caused by the treatment. This is known as acute ovarian failure. You will have occasional or no periods, and symptoms similar to menopause, before regular periods return. If ovarian failure continues for several years, it is less likely that your ovaries will work normally again.

Premature menopause

Menopause is the end of menstruation (having periods). It usually happens between the ages of 45 and 55. Menopause before the age of 40 is known as premature menopause or premature ovarian insufficiency (POI), and before the age of 45 it is called early menopause.

Premature menopause could occur immediately or many years after treatment depending on your age, type of treatment and the dose of any drugs you received. If the ovaries are surgically removed or too many eggs are damaged during treatment, menopause is permanent.

While premature menopause means you won’t ovulate, it may be possible to carry a baby if you have a uterus and have not had radiation therapy and use stored eggs or donor eggs. After spontaneous POI there is a small chance (5–10%) of becoming pregnant naturally because a remaining egg may mature and be fertilised by a sperm. The likelihood of getting pregnant after POI caused by cancer treatment is not known.

Your feelings about early menopause – How menopause affects you can vary. For some, going through menopause earlier than expected may be upsetting. It may make you feel older than your age and affect your sense of identity.

For others, not having to worry about regular periods is a positive.

It may take time to adjust to the changes you’re experiencing. Talk about how you’re feeling with a family member, friend or counsellor or sexual therapist. Some studies show that mindfulness exercises can also help.

Menopause symptoms – Most menopause symptoms are related to a drop in your body’s oestrogen levels and might be more severe when menopause starts suddenly. Common symptoms may include a dry vagina, hot flushes and night sweats, aching joints, changes in mood and difficulty sleeping.

Menopause hormone therapy (MHT) – previously known as hormone replacement therapy or HRT – may help treat menopause symptoms. MHT replaces the hormones that the ovaries stop making, and can be taken as tablets, creams or skin patches. Taking MHT may increase the risk of some diseases. If you were diagnosed with hormone-sensitive cancers such as breast cancer, you are advised not to take MHT, but there are other non-hormonal drugs available that can help.

Vaginal moisturisers and lubricants can help with vaginal discomfort and dryness. They are available over the counter from a pharmacy. For more information, talk to your doctor or ask for a referral to a specialist menopause clinic.

Retrograde ejaculation

If treatment causes retrograde ejaculation, you may be given medicine to help the semen move out of the penis as normal. This may make it possible for you to conceive naturally. Your fertility specialist can also collect some ejaculated sperm from the urine, which can be used to fertilise eggs during IVF.

Erection problems

Sometimes surgery damages the nerves that help control erections and causes erectile dysfunction. This is often a temporary problem. The ability to have erections firm enough for penetration can continue to improve for up to 3 years after treatment has finished. Some people may not get strong erections again. There are several medical options you can try. These include prescription medicine and erectile aids, which may make it possible for you to conceive naturally.

Sometimes, erection problems can be permanent. If you are not able to have penetrative sex, you may be able to have testicular sperm extraction to help you conceive.

This section has information about ways you can preserve your fertility before starting cancer treatment. It’s ideal to discuss the options with your cancer or fertility specialist or oncofertility specialist at this time. Keep in mind that these methods don’t work all of the time.

If you didn’t have an opportunity to discuss your options before starting cancer treatment, you can still consider your fertility later, but there may not be as many options available.

Learn more about the options below.

1. Ovarian stimulation – Hormone injections daily for 10–14 days help stimulate your body to produce more eggs.
2. Egg collection – Mature egg/s are collected from the follicle using a needle guided by ultrasound.
3. Egg and sperm combined – The eggs are combined with sperm from a partner or donor, or frozen (cryopreservation) for later use.
4. Embryo freezing – Fertilised eggs may divide and form embryos. Embryos can also be frozen (cryopreservation) for later use. One full cycle of IVF takes about 2–3 weeks.
5. Embryo transfer – A syringe and tube is used to implant embryos into your body (or a surrogate). This will usually happen after cancer treatment.

Fertility options after cancer treatment may be limited. Your ability to become pregnant depends on the effects of cancer treatment on fertility, your age and whether you have been affected by premature ovarian insufficiency or early menopause. Options to consider include:

• conceiving naturally
• using eggs or embryos you harvested and stored before treatment, implanted into either your body or a surrogate
• freezing eggs or embryos after treatment ends for later use (if your ovaries are still working)
• using donor eggs or embryos.

Checking fertility after treatment

Before trying to conceive, you may want to do some tests to see how your fertility has been affected. While there is no reliable way of checking how treatment has affected your fertility, these tests provide your fertility specialist or reproductive endocrinologist with some information. You can ask them how much the tests  will cost.

Natural conception

You may be able to conceive naturally after finishing cancer treatment if your ovaries are still releasing eggs and you have a uterus. If fertility tests suggest it may be possible for you to get pregnant, your medical team will encourage you to try for a baby naturally.

Even if your periods return after chemotherapy or pelvic radiation therapy, there is a high risk of early menopause. If menopause is permanent, you will no longer be able to conceive naturally.

Uterus transplant is being studied in clinical trials. Talk to your doctor about the latest research and whether there are any suitable clinical trials for you.

Donor eggs and embryos

If after cancer treatment you have early menopause but a healthy uterus, you could try for a pregnancy using eggs or embryos donated by another person. You may be able to use eggs or embryos from overseas, but there are strict rules about importing them into Australia. Donors cannot be paid but you can cover (reimburse) their medical expenses.

Using donor eggs

In most cases, eggs are donated by a family member or friend. Your fertility clinic may have an egg bank, but there is usually a long waiting list. All donors are required to have blood tests, answer questions about their genetic and medical information, and have counselling.

After the eggs are collected from the donor, they are combined with sperm from your partner or a donor using IVF. The embryo is frozen until needed.

Using donor embryos

Donor embryos usually come from people who still have frozen embryos after they’ve had successful IVF treatment. Embryos may be donated for ethical reasons (instead of discarding the embryos) or compassionate reasons (to help someone with infertility).

If you use a donated embryo, you will take hormones to prepare your uterus for pregnancy. When your body is ready, the embryo will be thawed and implanted into your uterus using IVF. A child born from a donated embryo is deemed to be the child of the birth mother. Donors have no legal or financial obligation to the child. It is common to have counselling before beginning the IVF process.

Finding information about the donor

In Australia, fertility clinics can only use eggs and embryos from donors who agree (consent) that people born from their donation can find out who they are. This means that the donor’s name, address and date of birth are recorded.

Once donor-conceived people turn 18, they are entitled to access identifying information about the donor.

In some states, a central register is used to record details about donors and their donor-conceived offspring. Parents of donor-conceived children, and donor-conceived people who are over the age of 18, can apply for information about the donor through these registers. In other states and territories, people who want information about their donor can ask the clinic where they had treatment.

It is important to discuss possible issues for donor-conceived children with a fertility counsellor.

This section has information about ways you can preserve your fertility before starting cancer treatment. It’s ideal to discuss the options with your cancer or fertility specialist at this time.

Sperm banking (cryopreservation) and radiation shielding are well-established ways to preserve fertility. Surgically extracting sperm from the testicles is another way to store sperm for later use. The option that is right for you depends on the type of cancer you have and your personal preferences.

Keep in mind that no method works all of the time. Fertility treatments carry some risks and your doctor should discuss these before you go home.

If you didn’t have an opportunity to discuss your options before starting cancer treatment, you can still consider your fertility later. Your choices after treatment will depend on whether you are able to produce sperm.

Learn more about the options below.

After cancer treatment, your medical team will look at a sample of your semen to assess how many sperm you are making, how healthy they look and how well they move (motility).

Depending on the results of these tests, your options include:

• conceiving naturally
• intrauterine insemination or IUI
• artificial insemination or IVF using your own sperm frozen before treatment or fresh sperm collected after treatment
• testicular sperm extraction, if you can’t ejaculate normally or there is no sperm in the semen
• banking sperm after treatment ends, if you are still fertile
• using donor sperm.

Checking fertility after treatment

After treatment, you may be able to have an erection and ejaculate, but this doesn’t necessarily mean you are fertile. Before trying to conceive, you may want to do some tests to see how your fertility has been affected. These can be arranged by your fertility specialist or reproductive endocrinologist. The results will help the specialist recommend the best options for having a child after cancer treatment.

If you stored sperm in a sperm bank before cancer treatment, your doctor can compare this sample to your sperm sample after treatment.

Learn more about the tests you might have below.

Natural conception

You may be able to get your partner pregnant naturally after finishing cancer treatment. This will only be possible if your semen production returns to normal and you are making healthy, active sperm. As fertility declines with age, it will also depend on the age of you and your partner. If treatment has permanently affected your ability to produce sperm and have erections, you will no longer be able to conceive naturally.

Your medical team will do tests to assess your fertility and check your general health. Depending on the treatment you’ve had, they may advise you to wait 6 months to 2 years before trying to conceive. Discuss the timing and contraception options with your specialist.

The pituitary gland makes hormones that tell the testicles to make sperm. If cancer treatment has damaged the pituitary gland, you may be able to have medical treatment to trigger the production of sperm. This is called sperm induction.

Intrauterine insemination (IUI)

Also called artificial insemination, this technique places the sperm directly into the uterus. IUI increases the chance that the sperm will fertilise an egg. The sperm may be fresh or it may have been frozen. The sample is washed and faster-moving sperm are separated from slower sperm.

Insemination is usually done in a fertility clinic. Once your partner is ovulating, the sperm are inserted into their uterus using a small, soft tube (catheter). This takes only a few minutes and may cause some mild discomfort to your partner. You should know in a few weeks whether fertilisation took place.

In-vitro fertilisation (IVF)

IVF uses either sperm collected and frozen before treatment or fresh sperm to fertilise an egg outside of the body. Intracytoplasmic sperm injection (ICSI) is a specialised type of IVF in which a single, good quality sperm is injected into an egg.

Donor sperm

If you are infertile after cancer treatment, you could try for a pregnancy using sperm donated by another person.

Using donor sperm

In most cases, sperm are donated by a family member or friend. Your fertility clinic may have access to donor sperm, but there is usually a waiting list. You may be able to advertise for your own donor. It’s possible to use sperm from overseas, but there are strict rules about importing donor sperm into Australia.

Sperm donors have voluntarily contributed sperm to a fertility clinic. They are not paid for their donation, but you can cover (reimburse) their travel or medical expenses. The donors are usually aged 21–45. Some states and territories may have a limit on how many people can have children from the same sperm donor. The limit includes the donor’s partner. Ask your fertility clinic for more information.

All donors are required to complete health tests, answer questions about their genetic and medical information and have counselling.

Personal information is also collected, including details about ethnicity, education, hobbies, skills and occupation.

Samples are screened for genetic diseases or abnormalities, sexually transmitted infections (STIs) and overall quality, then quarantined for several months. Before the sperm is cleared for use, the donor is checked again for infectious diseases.

The sperm is frozen and stored in liquid nitrogen in individual containers. When the sperm is ready to be used, insemination is usually done in a fertility clinic. The sample is thawed to room temperature and inserted directly into the uterus using IUI or combined with an egg using IVF.

Finding information about the donor

In Australia, fertility clinics can only use sperm from donors who agree that people born from their donation can find out who they are. This means that the donor’s name, address and date of birth are recorded.

All donor-conceived people are entitled to get identifying information about the donor once they turn 18.

In some states, details about donors and their donor-conceived offspring are recorded on a central register. Parents of donor-conceived children, and donor-conceived people who are over the age of 18, can apply for information about the donor through these registers. In other states and territories, people who want information about their donor can ask the clinic where they had treatment.

It is important to discuss possible issues for donor-conceived children with a fertility counsellor.

When a child or adolescent is diagnosed with cancer, there are many issues to consider. Often the focus is on survival, so health professionals and families may not immediately think about fertility. Many young people say that fertility is important to them.

Some cancer treatments do not affect a child’s reproductive system. Others can damage the ovaries, which contain eggs, or the testicles, which make sperm. Sometimes this damage is temporary, but sometimes it’s permanent.

In many cases, decisions about fertility preservation are made before treatment begins. Often the decision involves specialists, the young person and their parents or carers. Parents of children under 18 will usually need to consent to any fertility preservation procedures.

The National Ovarian and Testicular Tissue Transport and Cryopreservation Service allows young people to have their ovarian or testicular tissue harvested by their own fertility specialist and then transported and stored at the national cryobank at The Royal Women’s Hospital (Melbourne).

Giving birth yourself or having your partner become pregnant aren’t the only ways to become a parent. This chapter talks about other paths to parenthood you may want to consider, including surrogacy, adoption and fostering.

Surrogacy

Surrogacy may be an option if you are unable or do not wish to carry a pregnancy. For example, you may choose a surrogate to carry your embryo if you do not have a uterus or you have been advised that it is medically too risky to carry a pregnancy.

In Australia, a surrogate is a healthy female who carries a donated embryo to term. The surrogate cannot use her own eggs. The intended parents or a donor provide the egg and sperm to create an embryo. This embryo is implanted into the uterus of the surrogate through IVF.

Advertising for someone to be a surrogate or to pay a surrogate for their services is illegal in Australia. Non-commercial or altruistic surrogacy is legal. It’s common for people to ask someone they know to be the surrogate. You can cover the surrogate’s medical costs and other reasonable expenses.

Surrogacy is a complex process. The fertility clinic organising it ensures that both the donor and surrogate go through counselling and psychiatric testing before the process begins. An ethics committee may also have to approve your case. This ensures that everyone involved makes a well-informed decision. For detailed information about surrogacy, including a helpful domestic surrogacy arrangement legal checklist, visit the Victorian Assisted Reproductive Treatment Authority.

Paid surrogacy is legal in some countries overseas. However, in some Australian states and territories it is a criminal offence for residents to enter into commercial surrogacy arrangements overseas – you will need to check that it is legal in your state or territory. It is also important to seek independent legal advice about parentage, citizenship and any conditions you and the surrogate have to meet. To find out more about international surrogacy, visit Smartraveller.

This is general information about surrogacy. Laws regulating surrogacy vary across Australia and may change. Check with your local fertility clinic or legal adviser for the current legislation in your state or territory. It’s best to consult a lawyer before making a surrogacy arrangement.

Adoption and fostering

Adoption involves becoming the legal parent of a child who is not biologically yours and looking after them permanently. Although the number of adoptions in Australia each year is low, you may be able to adopt a child within Australia or from an overseas country.

Fostering (foster care) means taking responsibility for a child without becoming the legal parent. Types of foster care include emergency, respite, short-term and long-term care. In Australia, there are more opportunities to foster than to adopt.

Most adoption and fostering agencies say they do not rule out adoption or fostering for cancer survivors based on their medical history. However, all applicants must declare their health status. The agency may also speak directly with your doctor and require you to have a medical examination. The intention is to  determine the risk of the cancer returning and your capacity to raise a child.

Applicants for adoption and fostering must also be willing to meet other criteria. The agency from your state or territory may send a representative to assess your home, and you will have a criminal record (background) check. The process depends on where you live and if the child is from Australia or overseas.

For more information about adoption and foster care, visit the family and community service government website in your state or territory. Intercountry Adoption Australia is an information and referral service to help guide people through the overseas adoption process. For details, visit their website or call them on 1800 197 760.

If you have not been able to preserve your fertility, or even if you have, you may come to accept that you won’t have a child. You might feel like you ran out of time, money or energy to keep trying to have a child. Not being able to have a child after cancer treatment may cause a range of emotions, including:

• sadness or emptiness
• a sense of grief or loss
• anger that cancer and its treatment caused changes to your body
• relief, contentment or happiness
• empowerment, if you chose not to have children.

You may feel a sense of loss for the life you thought you would have. It can take time to accept that you won’t have a child and learn to enjoy the benefits of being child-free – more time to follow other aspects of your life, focus on your relationships, advance your career or afford a different lifestyle. Many people have happy and fulfilling lives without children, or gain satisfaction from other types of nurturing.

How you feel about having a child may change over time. It may depend on if you have a partner and how they feel. If you want support, a counsellor, social worker or psychologist can talk to you about being child-free and help you deal with challenging situations (for example, if your partner feels differently to you).

How people respond to infertility varies. Common reactions include shock at the diagnosis and its impact on fertility, grief and loss of future plans, anger or depression from disruption of life plans, uncertainty about the future, loss of control over life direction, and worry about the potential effects of early menopause (such as reduced bone density).

The physical and emotional process of infertility treatment, and not knowing if it will work, can be exhausting. People who didn’t get a chance to think about their fertility until treatment was over say that the emotions can be especially strong.

While these feelings are a natural reaction to loss of fertility, see below for ways to manage these feelings before they overwhelm you. It may also help to consider other ways of becoming a parent, or you may decide to stop trying to have a child.

Coping strategies

Learning that cancer treatment has affected your ability to have children can be challenging. There is no right or wrong way of coping. The strategies described here may help you feel a greater sense of control and confidence.

Gather information – The impact of cancer on your fertility may change your plans or make them unpredictable. Knowing your options for building a family may help you deal with feelings of uncertainty.

Get support from others – Talking to people who have been in a similar situation or to family and friends can reduce feelings of isolation and help you cope.   Consider joining a support group for people with cancer or fertility-related issues

Consider professional counselling – You can talk to a counsellor about the impact of infertility. Most fertility units have a fertility counsellor or you can find a private fertility counsellor near you at Access Australia.

Get creative – If you don’t want to talk about how you are feeling, you could keep a journal or blog, or you could make music, draw, paint or craft. You can share your writing or artworks with those close to you or keep them private.

Try relaxation and meditation exercises – Both of these techniques can help reduce stress and anxiety. Exercise such as walking can also help with mood changes and energy levels.

A cancer diagnosis, treatment side effects and living with the uncertainty of infertility may affect how you feel about your relationships and your sense of who you are and how you see yourself (sexuality).

Whether or not you have a partner, it may be a good idea to find out your fertility status as soon as you feel ready. This way, you can think about what you want, and if you have a partner, start talking with them about what the future may hold.

Communicating with your partner

A cancer diagnosis, infertility and changes to your sexuality can cause tension in a relationship.

Your partner will also experience a range of emotions, which may include helplessness, frustration, fear, anger and sadness. How your relationship is affected may depend on how long you have been together, expectations about becoming a parent, the strength of your relationship before cancer and infertility, and how well you communicate.

Fertility issues may cause conflict between partners. Some partners are very supportive, while others avoid talking about it. If your partner is unwilling to talk about fertility, you might feel like you’re coping alone or making all the decisions. It can also be challenging if you and your partner disagree about what to do and focus on different outcomes. Seeing a fertility counsellor can help you talk about these issues and develop strategies to manage conflict.

Communicating with a new partner

If you are in a new relationship, you may be worried about their reaction to your diagnosis, or explaining any fertility concerns.

While the timing will be different for each person, it can be helpful to wait until you and your new partner have developed a mutual level of trust and caring. Start the conversation when you feel ready. It may be easier if you practise what you want to say – and how you would respond to questions your partner may ask – with a friend, family member or health professional.

Sexuality and intimacy

Sexuality is about who you are, how you see yourself, how you express yourself sexually and your sexual feelings for others. Being able to conceive a child may be part of your identity, and infertility may change how you feel about yourself. This can happen if you are in a heterosexual relationship, if you are LGBTQI+ or have a same-gender partner. You may feel that sex is linked with the stress of infertility, and you may lose interest in intimacy and sex (low libido).

Body image – Fertility concerns may affect how you feel about your body (body image). You may feel that your body has “let you down”. It will take time to accept any physical and emotional changes. It may be helpful to:

• look after your body with exercise, eating well and sleep
• spend time with a partner doing something you both enjoy.

Resuming sexual activity after cancer treatment – Some cancer treatments may cause physical problems, such as pain during penetrative sex or trouble getting and keeping an erection.

These problems may be difficult for you and your partner, if you have one, but can be managed in various ways:

• think about what used to get you sexually aroused and explore if it still does
• explore different erogenous zones; mutual masturbation; oral sex; personal lubricants; vibrators and other sex toys; erotic images and stories
• focus on getting in the mood and making foreplay enjoyable to take the pressure off getting pregnant
• talk to each other about how fertility concerns are affecting you and discuss ways you can keep enjoying sex (e.g. “I just want to cuddle now” or “That feels  good”).

If you feel you need further support, consider talking to a counsellor or sex therapist. To find a counsellor in your local area, speak to your doctor or call Cancer Council 13 11 20.

If you’re a young adult

During and after treatment for cancer, young people continue to develop and mature. This means living life as normally as possible, which may include going on dates and having a partner. You may feel confused about how much to share with others about having cancer and the impact on your fertility.

Canteen supports young people aged 12–25 who have been affected by cancer. They offer counselling in person or by phone, email or direct messaging (DM). Canteen also runs online forums and camps. To get in touch, call
1800 835 932 or visit Canteen.