Treatment side effects and fertility

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 early menopause.

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

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 delivery more difficult. Your specialist will talk to you about what precautions to take during pregnancy.

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) or inside the body (usually brachytherapy).

The risk of infertility will vary depending on the area treated, the dose of radiation and the number of treatments.

Radiation therapy to the pelvic area or any of 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 or protecting your organs during radiation treatment, but sometimes this is not possible.

Radiation therapy to the ovaries – This can stop the ovaries producing hormones, and cause permanent menopause. 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 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. You will still have periods and, if you still have a uterus, you may be able to become pregnant. If both ovaries are removed (bilateral oophorectomy) to treat ovarian cancer, you will experience immediate and permanent 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) – Treatment 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. In some cases, semen may go back towards the bladder instead of forward into the penis (retrograde ejaculation.

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, prostate or one or both testicles – 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 surgical 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. There are two main types of hormone receptors: oestrogen receptors and progesterone receptors. Cancer cells with hormone receptors on them are said to be hormone receptor positive or hormone-sensitive cancers. They are 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 after treatment. 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. Anti-oestrogen drugs do not damage the ovaries or eggs. Males with breast cancer who are taking the drug tamoxifen may experience increased sperm production.

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.

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 high-dose chemotherapy or radiation therapy 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 or fertility specialist about how these treatments may affect your fertility.

Download our fact sheet ‘Understanding Immunotherapy’

Download our fact sheet ‘Understanding Targeted Therapy’