Fertility after a cancer diagnosis

Infertility is defined as difficulty getting pregnant (conceiving). This may result from female or male factors, or a combination of both, or the reasons may be unknown. For females under 35, the term usually refers to trying unsuccessfully to conceive for 12 months; if a female is 35 or over, the term is used after 6 months of trying.

Cancer and its treatment may affect your fertility. This will depend on the type of cancer and treatment you have.

Fertility problems after treatment may be temporary – lasting months to years – or permanent.

Chemotherapy and radiation therapy can damage reproductive organs involved in creating or carrying an unborn baby, such as the ovaries, uterus or testicles. Sometimes these organs are damaged or removed during surgery, which can harm or destroy eggs or sperm.

Age is one of the most important factors in how cancer treatment affects fertility.

Female age and fertility – Females are born with all the eggs they will have in their lifetime. From the age of 30, fertility starts to decline and speeds up after 35. It then becomes harder to conceive and the risk of chromosomal conditions (e.g. Down syndrome) in the eggs increases. From your early 40s, although you may still have regular periods, it is difficult to conceive a child because of poor egg quality. After menopause, it is no longer possible to conceive a child naturally.

How cancer treatments affect fertility will vary with age. Before and after puberty, the effect of chemotherapy and radiation therapy on fertility can vary, depending on the drugs used or the dose.

Before puberty, high doses of drugs or radiation may sometimes cause enough damage to the ovaries that both the start of puberty and future fertility are affected. After puberty, treatment to the ovaries can cause periods to stop permanently. Even if periods return after treatment, some women may experience premature or early menopause.

Male age and fertility – The quality and quantity of sperm decreases with age. This means it may take longer for an older man’s female partner to get pregnant. Before and after puberty, chemotherapy and radiation therapy may affect sperm production and may cause infertility. The impact of radiation will depend on the dose and what organs are affected by the radiation.

This describes the procedures that can help preserve your fertility, for example, freezing eggs, embryos or sperm, or using injections. If a cancer treatment may affect your fertility, fertility preservation procedures are usually done before treatment begins. Your fertility may be also be protected during treatment, for example ovarian shielding or transposition.

This is a very personal decision. Having cancer may change the way you feel about having a child. If you have a partner, discuss your family plans  together. Worrying about cancer coming back may make it hard for you to make plans, including having a child. Fertility clinics often have counsellors who can talk through your situation.

This depends on many factors, including the type of cancer and type of treatment you’ve had. Some cancer specialists advise waiting between 6  months and 2 years after treatment ends. This may be to allow your sperm or eggs to recover, and to ensure you remain in good health during this time. It’s best to discuss the timing and what contraception to use with your doctor.

If you have a hormone-sensitive cancer and are taking antioestrogen drugs, you will need to wait for 9 months after you finish taking these drugs and before getting pregnant. Discuss the risks of anti-oestrogen drugs harming an unborn baby with your cancer or fertility specialist.

Research shows that for most types of cancers, pregnancy does not increase the chances of cancer coming back (recurring). Research is continuing, so it’s best to discuss this issue with your specialist.

Studies to date suggest that survival rates for people who have children after cancer treatment are no different from people who don’t have children after treatment.

Studies show that if one or both parents have a history of cancer, their child has the same risk of getting cancer as anyone else. Up to 10% of some cancers are caused by an inherited gene from either of the parents. This is known as familial cancer. The gene increases the risk of cancer, but not all children will inherit the gene. Even if they do, it does not mean they will develop cancer.

If your diagnosis is linked to a faulty gene, you may consider having preimplantation genetic testing (PGT) as part of IVF. This involves testing embryos for genetic conditions. Only unaffected embryos are selected and implanted into the uterus. This reduces the chance of the faulty gene being passed on to the child. Discuss PGT testing and the cost with your fertility specialist.

If you are concerned about your family history of cancer, ask for a referral to family cancer centre or genetic counselling service for advice. For a list of clinics, visit the Cancer Council Australia website.

Being diagnosed with cancer during pregnancy is uncommon – it is estimated that one in every 1000 pregnant females are diagnosed with cancer. Call Cancer Council 13 11 20 for more information about pregnancy and cancer.

Treatment during pregnancy – This may be possible, but you need to discuss the potential risks and benefits to you and the baby with your oncologist before treatment begins. In some cases, treatment can be delayed until after the baby’s birth. For some cancers, chemotherapy may be safely used after the first trimester (12 weeks), usually with a break of a few weeks before the birth.

Termination – Some people diagnosed with cancer in the early weeks of pregnancy decide to terminate the pregnancy so they can start treatment immediately.

Change in birth plan – If you are diagnosed later in the pregnancy, you may be able to have the baby before the due date.

Breastfeeding – You will be advised not to breastfeed while having chemotherapy, targeted therapy or immunotherapy as drugs can be passed to the baby through the breastmilk. If you are having radiation therapy, talk with your doctor about whether it is safe to continue breastfeeding during treatment.

Fertility is an important part of health for everyone. But your doctor may not discuss whether you want children in the future if they make assumptions based on your age, sexual orientation, gender and sex characteristics or focus on starting treatment immediately. If fertility matters to you, let your health professional know.

Ask your oncologist about the chances of your treatment causing fertility problems and what you can do now if you want to have a child later (e.g. freezing eggs, or ovarian, sperm or testicular tissue). Your doctor may be able to plan treatment in ways that protect or limit damage to reproductive organs to reduce the chances of infertility after treatment. Ask to be referred to a fertility clinic or oncofertility specialist.

Tell the fertility clinic or oncofertility specialist that you are having treatment for cancer so that they can arrange an appointment for you as soon as possible. Your cancer care team may also be able to help you get an appointment quickly. The fertility clinic can give you information about:

• how your age and cancer treatment might affect fertility
• the options available to you
• how likely it is that each option will lead to pregnancy
• the costs of the different options, including long-term storage fees for eggs, sperm or embryos
• using donor eggs or sperm in the future and your legal rights and those of the child and donor.

If you have a partner, try to attend appointments together and include them in the decision-making process. You may also wish to bring a family member or friend for support. 

There are several people who can help with fertility concerns.

Health professionals you may see

cancer specialist – might be a medical oncologist, radiation oncologist, gynaecological oncologist, surgeon, haematologist or cancer care coordinator

fertility specialist – diagnoses, treats and manages infertility and reproductive hormonal disorders; may be an obstetrician, reproductive  endocrinologist or urologist

oncofertility specialist – specialises in fertility care of adults or children with cancer

paediatric gynaecologist, endocrinologist, surgeon – may specialise in fertility care of children with cancer

fertility counsellor – provides support and advice for people with fertility concerns

genetic counsellor – provides advice for people with a strong family history of cancer or a genetic condition linked to cancer

gynaecological oncologist – diagnoses and treats cancers of the female reproductive system, e.g. ovarian, cervical

urologist/andrologist – diagnoses and treats diseases of the urinary system and the male reproductive system