Fertility and Cancer
Contents
- About fertility and cancer
- What are reproduction and fertility?
- Fertility after a cancer diagnosis
- Making decisions
- Treatment side effects and fertility
- Female options before cancer treatment
- Female options after cancer treatment
- Male options before cancer treatment
- Male options after cancer treatment
- Preserving fertility in children and adolescents
- Other ways to be a parent
- Not having a child
- Emotional impact
- Relationships and sexuality
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Fertility and Cancer
Preserving fertility in children and adolescents
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).
The options will depend on whether the young person has been through puberty. Most young females go through puberty between the ages of 8 and 13.
Before puberty
- Ovarian tissue that contains immature eggs can be removed and frozen for later use. This is called ovarian cryopreservation.
- When needed, the tissue is put back into the body. There have been several births worldwide from ovarian tissue removed before puberty and it is no longer considered experimental.
After puberty
- Mature eggs or ovarian tissue can be collected and frozen (cryopreservation) for later use.
- Taking a long-acting hormone called gonadotropin releasing hormone (GnRH) may reduce activity in the ovaries or ovarian tissue and protect eggs from damage during cancer treatment for breast cancer.
- Hormone levels can be checked to assess fertility. Having periods after treatment is not a sign of fertility.
Before or after puberty
- Shielding the abdominal area during radiation therapy to the pelvic area provides some level of protection to the ovaries but not the uterus.
- Surgically move the ovaries away from the field of radiation (ovarian transposition). If the ovaries aren’t protected, the risk of ovarian failure is higher (premature ovarian insufficiency).
The options will depend on whether the young person has been through puberty. Most young males go through puberty between the ages of 9 and 14. After puberty, semen contains mature sperm.
Before puberty
- There are no proven fertility preservation methods for young males who have not gone through puberty.
- Freezing testicular tissue (testicular tissue cryopreservation) is being tested with young boys at high risk of infertility. Tissue that contains cells that make sperm is removed from the testicles through a small cut. This technique is not widely available and is still considered experimental.
After puberty
- Mature sperm can be collected, frozen and stored (cryopreservation) for later use with IVF. This is known as sperm banking.
- Sperm cells can be removed from the testicles (testicular sperm extraction), which are frozen and stored for later use with IVF. This technique is not widely available.
- You can have a semen analysis and various blood tests to assess fertility. Having erections and ejaculating are not signs of fertility.
Before or after puberty
- Testicular shielding involves placing a protective lead covering over the pelvis area during radiation therapy. This provides some level of protection. If this area is not protected, sperm production may be affected, which could cause infertility.
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This information is reviewed by
This information was last reviewed October 2022 by the following expert content reviewers: Prof Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne and Director, Gynaecology Research Centre, The Royal Women’s Hospital, VIC; Dr Sally Baron-Hay, Medical Oncologist, Royal North Shore Hospital and Northern Cancer Institute, NSW; Anita Cox, Cancer Nurse Specialist and Youth Cancer Clinical Nurse Consultant, Gold Coast University Hospital, QLD; Kate Cox, McGrath Breast Health Nurse Consultant, Gawler/ Barossa Region, SA; Jade Harkin, Consumer; A/Prof Yasmin Jayasinghe, Director Oncofertility Program, The Royal Children’s Hospital, Chair, Australian New Zealand Consortium in Paediatric and Adolescent Oncofertility, Senior Research Fellow, The Royal Women’s Hospital and The University Of Melbourne, VIC; Melissa Jones, Nurse Consultant, Youth Cancer Service SA/NT, Royal Adelaide Hospital, SA; Dr Shanna Logan, Clinical Psychologist, The Hummingbird Centre, Newcastle West, NSW; Stephen Page, Family Law Accredited Specialist and Director, Page Provan, QLD; Dr Michelle Peate, Program Leader, Psychosocial Health and Wellbeing Research (emPoWeR) Unit, Department of Obstetrics and Gynaecology, The Royal Women’s Hospital and The University of Melbourne, VIC; Pampa Ray, Consumer; Prof Jane Ussher, Chair, Women’s Health Psychology, and Chief Investigator, Out with Cancer study, Western Sydney University, NSW; Prof Beverley Vollenhoven AM, Carl Wood Chair, Department of Obstetrics and Gynaecology, Monash University and Director, Gynaecology and Research, Women’s and Newborn, Monash Health and Monash IVF, VIC; Lesley Woods, 13 11 20 Consultant, Cancer Council WA.