Fertility and cancer

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 – Hormones are substances produced naturally in the body. Hormones control many body functions, including how you grow, develop and reproduce. Oestrogen and progesterone, often called female sex hormones, are produced in the ovaries. These hormones control the growth and release of eggs (ova), and the timing of menstruation (periods). 

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

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. 

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 
• medicines – some medicines and cancer treatments affect fertility 
• other health concerns – endometriosis, fibroids, pelvic disease, certain hormonal conditions, some genetic conditions or cancer.

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

If you are non-binary or trans or a 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. 

Our booklet 'LGBTQI+ People and Cancer' includes a chapter on fertility. Call 13 11 20 to ask for a copy. 

For fertility information specific to your situation, talk to your health care team.

Infertility is defined as a condition where a person or couple is unable to conceive. 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 older, the term is used after 6 months of trying.

Cancer and its treatment may affect your fertility, depending on the type of cancer and treatment you have. Chemotherapy and radiation therapy can damage reproductive organs involved in creating or carrying an unborn baby, such as the ovaries, cervix, uterus or testicles. Sometimes these organs are damaged or removed during surgery, which can harm or destroy eggs or sperm, or make it difficult to carry a pregnancy to term. 

Fertility problems after treatment may only last months to years or they may be permanent.

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 this decline speeds up after 35. It then becomes harder to conceive and the risk of chromosomal conditions (e.g. Down syndrome) increases. 

From your early 40s, although you may still have regular periods, it is usually difficult to conceive a child because of lower egg quality. After menopause, it won’t be possible to conceive a child naturally. 

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

Before puberty, high doses of drugs or radiation to the pelvis may cause enough damage to the ovaries that both 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 medically induced menopause. 

Male age and fertility – The quality and quantity of sperm decreases with age. This means it may take longer for an older man to conceive with his partner. Before and after puberty, some 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 that cause a temporary state of menopause to preserve your ovaries. Other procedures include freezing ovarian or testicular tissue. If a cancer treatment may affect your fertility, fertility preservation procedures are usually done before treatment begins. Your fertility may also be protected during treatment – for example, with ovarian transposition or radiation shielding.

Timing of pregnancy and when to use contraception is an important discussion to have with your cancer specialist. 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. 

If you have a hormone-sensitive cancer and are taking anti-oestrogen drugs, you will need to wait for 9 months after you finish taking these drugs before getting pregnant.

Research shows that for most types of cancers, pregnancy does not increase the chances of cancer coming back. Research is continuing, so discuss this issue with your specialist. Studies to date suggest that survival rates for people who have children after cancer are no different from people who don’t have children after treatment.

This is a very personal decision. Many people who have had cancer do go on to have children. Others decide not to have children. Having cancer may change the way you feel about having a child. Having a family is very important to many cancer survivors and with advice from specialists, this can be safe and successful. 

If you have a partner, discuss your family plans with each other and with your treatment team. 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. Ask to be referred to a counsellor who has experience in both cancer and fertility.

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. About 5% of some cancers are caused by an inherited gene fault from either parent. This is known as familial cancer. If you inherit a gene fault from either of your parents, this will increase the risk of you developing cancer. You may also pass on this gene fault to your children. 

If your diagnosis is linked to an inherited gene fault, you may consider having preimplantation genetic testing (PGT) as part of in-vitro fertilisation (IVF). This involves testing embryos for genetic conditions. Only unaffected embryos are implanted into the uterus. This reduces the chance of the gene being passed on to the child. A fertility clinic can provide more information.

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, or whether you have children or not, or if they are focused on starting treatment immediately. If fertility matters to you, let your health professional know before treatment begins. 

Ask your cancer specialist 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). Ask to be referred to a fertility clinic or oncofertility specialist, or if it is possible to plan treatment in ways that protect or limit damage to reproductive organs to reduce the chances of infertility after treatment. 

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 
• costs of the different options 
• using donor eggs or sperm in the future 
• any counselling you might need. 

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 or haematologist

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

cancer care coordinator - a nurse specialist who coordinates your care throughout diagnosis and treatment and works closely with other members of your health care team

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

Fertility preservation can be expensive, and this may influence your decision-making. The cost of fertility treatment varies – you may be able to have treatment at a fertility unit in a public hospital or a private clinic. 

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. 

Depending on the treatment you have, costs may include: 

• fertility specialist appointments – 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, preimplantation 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. 

If you need in-vitro fertilisation (IVF) to have a baby in the future (e.g. by using your frozen sperm, eggs or embryos), private fertility clinics will usually charge their standard fees. 

▶ See our 'Cancer and Your Finances' booklet or call 13 11 20.

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.

IVF is a method for achieving a pregnancy after fertility issues, but it will only be an option for some people after cancer. IVF is when an egg is fertilised with sperm in a laboratory and later implanted into a female body. Eggs, sperm or embryos frozen before cancer treatment can be used. One full cycle of IVF takes about 2–3 weeks.

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.
5. Embryo transfer - A syringe and tube are used to implant embryos into your body (or a surrogate). This will usually happen after cancer treatment.

After a cancer diagnosis, 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” or “My family is complete”, you may be encouraged to consider fertility options to keep your choices open for the future. These decisions are personal, and you need to feel comfortable with your choices.

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 fertility specialist to explain each fertility option, including risks, benefits, side effects, costs and success rates.

Talk it over – Discuss the options with people close to you (such as your partner, a friend or family member). 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.

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.

Breast Cancer Network Australia has a resource called 'Fertility-related Choices' to help women with breast cancer make fertility-related decisions.

Being diagnosed with cancer during pregnancy is uncommon – it is estimated that 1 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.

“My oncologist wanted to start treatment as soon as possible, so my obstetrician and oncologist decided on a day to deliver my son. He was delivered safely at 32 weeks.” LILY

Chemotherapy uses drugs to kill or slow the growth of cancer cells. These drugs travel throughout the body and are designed to affect fast-growing cells such as cancer cells. This means chemotherapy can also damage other cells that grow quickly, including those in the ovaries and testicles. The risk of infertility depends on the type of drugs used, the dose and your age.

Effect on ovaries – Some chemotherapy drugs can stop the ovaries from working properly and releasing eggs (ovulation). If chemotherapy destroys or damages eggs, your body won’t be able to replace them.

Chemotherapy drugs can cause your periods to become irregular or even stop for a while. Depending on your age, number of eggs and the amount of chemotherapy you’ve had, your periods may return within a year of finishing treatment. If your periods do not return, the ovaries may have stopped working permanently, causing premature or medically induced menopause.

Effect on testicles – The effects of chemotherapy on the sperm you make may be temporary or permanent if the cells in the testicles are too damaged to produce healthy, mature sperm.

Effect on your heart and lungs – Some chemotherapy drugs can affect your heart and lungs. If this causes long-term damage, it may make a future pregnancy and birth more difficult. Your specialist will talk to you about what precautions to take during pregnancy. 

▶ For more information, see our 'Understanding Heart Health and Cancer' fact sheet.

If you have both chemotherapy and radiation therapy (chemoradiation) to treat cancer, the risk of permanent infertility is higher.

Download our booklet ‘Understanding Chemotherapy’

Radiation therapy (also called radiotherapy) uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. It can be delivered from outside the body (external beam radiation therapy) using a machine called a linear accelerator, or inside the body (usually brachytherapy). The risk of infertility will vary depending on the area treated, the dose of radiation and how many treatments you have. 

Radiation therapy to the pelvic area or the reproductive organs commonly causes permanent infertility. It may be used for cancer of the bladder, bowel, cervix, ovary, prostate, rectum, anus, uterus, vagina or vulva. Your treatment team may try to preserve your fertility by shielding your organs using a screen during radiation treatment, but sometimes this is not possible.

Radiation therapy to the ovaries – This can stop the ovaries producing hormones and eggs permanently. If you need radiation therapy near the ovaries, one or both may be surgically moved higher in the abdomen and out of the field of radiation. This is called ovarian transposition (oophoropexy).

Radiation therapy to the cervix or uterus – This can stop the ovaries producing hormones, and cause permanent menopause. Radiation therapy can also permanently damage the uterus, which means you cannot carry a baby.

Radiation therapy to the testicles – This can lower the number of sperm and affect the sperm’s ability to work normally.

Radiation therapy to the prostate – This may cause erectile dysfunction, which means not being able to get and keep an erection firm enough for penetrative sex.

Radiation therapy to the brain – This may damage the pituitary gland, which releases hormones that control reproduction. It tells the ovaries to release an egg each month and the testicles to make sperm.

Radiation therapy to the whole body – This is known as total body irradiation (TBI), and may be given before a stem or bone marrow cell transplant to treat blood cancers. Complications such as miscarriage, premature birth and low birth weight are more common with pregnancies after TBI.

If you have both chemotherapy and radiation therapy (chemoradiation) to treat cancer, the risk of permanent infertility is higher.

Download our booklet ‘Understanding Radiation Therapy’

Surgery that removes part or all of the reproductive organs to treat cancer can cause infertility.

Removal of one or both ovaries (oophorectomy) – If one ovary is removed, the other ovary should continue to release eggs and produce hormones. If you still have a uterus, you may still have periods and be able to become pregnant. If both ovaries are removed (bilateral oophorectomy), you will experience immediate medically induced menopause. You will no longer have periods or be able to become pregnant naturally.

Removal of the uterus and cervix (hysterectomy) – This type of surgery may be used to treat cancer of the cervix, ovary, uterus and, sometimes, cancer of the vagina. After a hysterectomy, there is nowhere for a baby to develop and your periods will stop. Sometimes the ovaries will also be removed. If your ovaries are left in place and continue to work, you may be able to fertilise your eggs through IVF and use a surrogate to carry the pregnancy.

Removal of the testicles (orchidectomy) – Treatment for testicular cancer usually involves removing one testicle. If you have had one testicle removed, you can go on to have children naturally. However, men with testicular cancer have lower fertility rates than the general population. The urologist may advise you to store sperm at a sperm banking facility before the surgery, just in case you have fertility problems in the future.

In some rare cases, both testicles are removed (bilateral orchidectomy). This causes permanent infertility because you will no longer produce sperm. You will still be able to get an erection.

Removal of the prostate (prostatectomy) – Surgery for prostate cancer usually involves removing the prostate and seminal vesicles, and sealing the tubes from the testicles (vas deferens). This causes permanent infertility because you will not be able to ejaculate semen during orgasm. This is known as a dry orgasm.

Removal of the penis (penectomy) – Part or all of the penis may be removed to treat cancer of the penis. The part of the penis that remains may still get erect with arousal and may be long enough for penetration. It is sometimes possible to have a penis reconstructed after surgery, but this is still considered experimental and would require another major operation.

Removal of the bladder or prostate – This may damage the nerves used for getting and keeping an erection (called erectile dysfunction or impotence). Erectile dysfunction may last for a short time or be permanent. It may be possible for the surgeon to use a nerve-sparing technique to protect the nerves that control erections. This works best for younger men who had strong erections before the surgery. However, problems with erections are common even with nerve-sparing surgery.

Download our booklet ‘Understanding Surgery’

Hormones that are naturally produced in the body can cause some cancers to grow. The aim of hormone therapy (also called endocrine therapy or androgen deprivation therapy, ADT) is to slow down the growth of these cancers by lowering the amount of hormones the tumour cells are exposed to.

Hormone therapy for breast cancer – If a cancer is growing in response to the hormones oestrogen or progesterone, the cancer cells will have hormone receptors. These are proteins found on the surface of the cancer cell. Cancer cells with oestrogen or progesterone hormone receptors on them are called hormone receptor positive or hormone-sensitive cancers. They are more likely to respond to hormone therapy. 

Anti-oestrogen drugs (such as tamoxifen) are used to reduce the risk of oestrogen-sensitive breast cancers coming back. Many anti-oestrogen drugs are taken for 5–10 years. Pregnancy should be avoided while taking the drugs and for 9 months afterwards, as there is a risk the drugs could harm an unborn child. These drugs can cause menopause symptoms, although they don’t bring on menopause. 

Although hormone treatments for breast cancer are used for many years, ask your doctor if it is possible to take a break from the drugs to try for a baby. Anti-oestrogen drugs do not damage the ovaries or eggs. Some anti-oestrogen drugs are of benefit during fertility treatment and keep your oestrogen levels low. 

Males with breast cancer who are taking the drug tamoxifen may experience increased sperm production.

Hormone therapy for cancer of the uterus – Some cancers of the uterus grow in response to oestrogen. Hormone therapy may be given if the cancer has spread or if the cancer has come back, particularly if it is a low-grade cancer.

Hormone therapy for prostate cancer – The hormone testosterone helps prostate cancer to grow. Hormone therapy may reduce how much testosterone your body makes and help slow the growth of the cancer or even shrink the cancer, but it may also cause infertility.

Stem cell transplant – For a small number of people with blood cancers, high-dose chemotherapy and, sometimes, a type of radiation therapy known as total body irradiation are given before a stem cell transplant to kill the cancer cells in the body. The risk of permanent infertility after these treatments is high.

Immunotherapy and targeted therapy – The effects of these newer drug therapies on fertility and pregnancy are unknown, but are likely to vary depending on the drug you take. Talk to your cancer and fertility specialists about how these treatments may affect your fertility.

Download our fact sheet ‘Understanding Immunotherapy’

Download our fact sheet ‘Understanding Targeted Therapy’

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.

While you’re having chemotherapy and radiation therapy, and for some time afterwards, the ovaries often stop producing hormones. This is known as acute ovarian dysfunction. You will have occasional or no periods, and symptoms similar to menopause, before regular periods return. If you have no periods for several years, your ovaries may not work normally again.

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. 

A permanent end to your periods may 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. 

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. 

Menopausal hormone therapy (MHT) – MHT was previously known as hormone replacement therapy or HRT. It 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.

Your feelings about menopause 

Menopause affects people in different ways. 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. Talk about how you’re feeling with a family member, friend, counsellor or sex therapist. Some studies show that mindfulness exercises can also help with worries and fear.

Menopause can cause the bones to weaken (osteoporosis) and may increase your risk of heart disease. Talk to your doctor about having a bone density test and what you can do to maintain strong bones and a healthy heart. Doing weight-bearing exercise and eating calcium-rich foods can help keep your bones strong. Visit Healthy Bones Australia or call 1800 242 141 for more information. 

In some cases, after some surgeries or treatment, the nerves involved in ejaculation are damaged. During orgasm, semen may go back towards the bladder instead of forward into the penis. This is called retrograde ejaculation. If this happens, 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.

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. 

If you are not able to have penetrative sex, you may be able to have testicular sperm extraction to help you conceive.

What this is

• no methods are used to try and preserve fertility

When this is used

• when you don’t have time to consider fertility preservation and choose to start cancer treatment immediately

How this works

• no action

What to consider

• more likely to lead to premature ovarian insufficiency

Pregnancy rate

• depends on age and cancer treatment

What this is

• collecting, developing and freezing eggs or embryos as part of an in-vitro fertilisation (IVF) cycle

When this is used

• when you want to store eggs or embryos for use in the future, the frozen egg will be fertilised using IVF, or the embryo will be implanted in your uterus

How this works

• egg and embryo freezing is part of IVF – the most common and successful assisted reproductive technology for preserving female fertility 
• one cycle of IVF can take 2–3 weeks 
• egg collection is done in an operating theatre as a day procedure

What to consider

• you can only freeze eggs or embryos before cancer treatment if you have time – your cancer specialists will advise how quickly cancer treatment should begin 
• talk with your fertility specialist about whether to freeze eggs, embryos or a mix of both 
• ask the fertility clinic about the cost of storing eggs and embryos and any legal limits on how long they can be stored (different in each state) 
• sperm from a partner or donor sperm is needed to create an embryo 
• to use a frozen embryo, you will need consent from the sperm donor 
• legal documents outlining instructions if a relationship breaks down are required for male donors with a partner

Pregnancy rate

• freezing eggs works nearly as well as freezing embryos
• for every 10 eggs frozen, you can expect to get 1–4 embryos
• depending on your age, the success rate of the fertility clinic and the stage at which the embryos are stored, there may be a 25–40% chance per cycle of a frozen embryo developing into a pregnancy

What this is

• the process of removing, slicing, freezing and storing tiny pieces of tissue from an ovary so it can be used later

When this is used

• if treatment needs to start immediately
• if taking hormones to encourage egg production is unsafe
• if there is a high risk of infertility
• if the person hasn’t gone through puberty
• can be used in addition to egg freezing

How this works

• tissue is removed from your ovaries during keyhole surgery (laparoscopy); if you have abdominal surgery as part of cancer treatment, tissue can be removed at this time
• tissue is frozen until it is needed
• when needed, the tissue is thawed and put back (grafted) into the ovary
• tissue may produce hormones and eggs may develop

What to consider

• tissue stored before treatment has a risk of containing cancer cells, and you may not want to put this tissue back into your body; risk is higher for people with leukaemia
• legal limits on how long ovarian tissue can be stored are different in each state and territory
• ask your fertility clinic how much you will have to pay for storage

Pregnancy rate

• there have been a small number of births worldwide from ovarian tissue removed before puberty, and several births from ovarian tissue removed after puberty
• about 1 in 3 people who have tried to use ovarian tissue to become pregnant have been successful

What this is

• surgery that moves one or both ovaries to prevent damage to the ovaries during radiation therapy

When this is used

• when one or both ovaries are in the path of radiation therapy
• limits how much radiation the ovaries receive

How this works

• one or both ovaries are moved away from the field of radiation and stitched in place
• put back in place after radiation therapy ends

What to consider

• procedure may cut off blood supply, causing damage to the ovaries

Pregnancy rate

• depends on your age, the amount of radiation that reaches the ovaries and whether you start menstruating again

What this is

• trachelectomy removes part or all of the cervix and keeps the uterus, fallopian tubes and ovaries in place
• unilateral-salpingo oophorectomy removes only one ovary

When this is used

• trachelectomy is for small tumours found only in the cervix
• unilateral-salpingo oophorectomy is for early-stage cancer found only in one ovary

How this works

• the uterus is stitched tight with a small opening to allow blood to pass out during a period and for sperm to enter

What to consider

• risk of miscarriage and premature birth; may have a stitch placed in what remains of the cervix to reduce the risk

Pregnancy rate

• number of births after this procedure is increasing

What this is

• gonadotropin-releasing hormone (GnRH) analogue is a long-acting hormone that stops the ovaries making oestrogen for a short time
• may protect eggs from being damaged

When this is used

• at least 1 week before chemotherapy starts, continuing until chemotherapy finishes

How this works

• hormone injections given 7–10 days before chemotherapy starts or during the first week of treatment, then every month or every 3 months during chemotherapy

What to consider

• backup to other fertility preservation options
• can affect bone density if used for more than 6 months

Pregnancy rate

• studies show that treatment is suitable for young women with breast cancer but there is no evidence for other types of cancer

What this is

• collecting, freezing and storing sperm
• this is the standard way of preserving fertility in males

When this is used

• when you want to store sperm for the future
• samples can be stored for up to 20 years. depending on the laws of each state and territory

How this works

• the procedure is performed in hospital or in a sperm bank facility (also called an andrology unit) 
• samples are collected in a private room where you can masturbate or have a partner stimulate you, and then ejaculate into a jar
• it’s recommended that you provide 2–3 samples; you may need to visit the clinic more than once to make sure enough semen is collected 
• sperm is then frozen until needed 
• when you are ready to have a child, the frozen sperm is thawed and used to fertilise an egg using IVF

What to consider

• if you collect semen at home, you must keep the sample close to body temperature and get it to the sperm bank facility within an hour 
• if you want to collect semen during sex, you must use a special condom from the sperm bank facility
• if you are unable to ejaculate, there are medical ways to encourage ejaculation 
• if you are unable to produce a sample of semen, sperm may be collected using testicular sperm extraction
• you may feel nervous and embarrassed going to a sperm bank, or worry whether you will be able to ejaculate; the medical staff are used to these situations; you can also bring someone with you

What this is

• protecting the testicles from external beam radiation therapy with a shield

When this is used

• if the testicles are close to where radiation beams are directed (but are not the target of the radiation), they can be protected from the radiation beams

How this works

• protective lead coverings called shields are used

What to consider

• this technique does not guarantee that radiation will not affect the testicles, but it does provide some level of protection

What this is

• a way of looking for sperm inside the testicular tissue
• also called surgical sperm retrieval

When this is used

• when you can’t ejaculate
• when there is not enough sperm in the semen sample
• to collect sperm from men with retrograde ejaculation

How this works

• under anaesthetic, a fine needle is inserted into the epididymis or testicle to find and extract sperm; this is called testicular aspiration
• if no sperm is found, your specialist may do an open biopsy to retrieve a larger tissue sample
• collected sperm is frozen and can later be used to fertilise eggs during IVF

What to consider

• in rare cases, no sperm is found in the testicular tissue

Dr Sally Reid, Gynaecologist and Fertility Specialist, Obstetrics and Gynaecology (Adelaide) and Royal Adelaide Hospital, SA; Dr Sarah Ellis, Clinical Psychologist and Postdoctoral Research Fellow, Kids Cancer Centre, Sydney Children’s Hospital and UNSW, NSW; John Booth, Consumer; Hope Finlen, Haematology Nurse Consultant, Gold Coast University Hospital, QLD; Dr Michelle Harrison, Medical Oncologist – Gynaecological cancers, Chris O’Brien Lifehouse, NSW; Melissa Jones, Nurse Consultant, Youth Cancer Service SA/NT, Royal Adelaide Hospital, SA; Dr Violet Kieu, Clinical Director, Melbourne IVF and Fertility Specialist, The Royal Women’s Hospital, VIC; Prof Declan Murphy, Consultant Urologist, Director – Genitourinary Oncology, Peter MacCallum Cancer Centre and The University of Melbourne, VIC; Stephen Page, Family and Fertility Lawyer, and Legal Practice Director, Page Provan, QLD; Ann Retzlaff, 13 11 20 Consultant, Cancer Council WA; A/Prof Kate Stern AO, Fertility specialist, Gynaecologist and Reproductive Endocrinologist, Royal Women’s Hospital and Melbourne IVF, VIC; Georgia Webster, Consumer.