Fertility after cancer

Many LGBTQI+ people hope to start a family. The path to becoming a parent is different for everyone. Having biological children is one way of starting a family,  and one that is possible for some LGBTQI+ people. But it can be made difficult due to cancer treatments affecting your fertility.

Before starting treatment, it’s important to discuss how cancer treatments may affect your ability to conceive a child or maintain a pregnancy (fertility) and your options for fertility preservation. You can still consider your fertility later, but there may not be as many options available after treatment.

Your doctor may not discuss whether you want children in the future if they make assumptions based on your sexual orientation, gender or intersex variation. If fertility matters to you, let your health professional know.

How cancer treatments affect fertility

Cancer and its treatment may affect your fertility. This will depend on the type of cancer, whether you’ve had surgery, chemotherapy or radiation therapy, and your age.

Infertility caused by treatment can be temporary – difficulty conceiving may happen only during treatment or for months or years after treatment. Sometimes it is permanent. Treatments can also cause early menopause. You will be advised to avoid conceiving during cancer treatment and for a period of time afterwards.

Ways to preserve fertility

There are different ways to preserve fertility before and after treatment. Keep in mind that these methods don’t work all of the time.

Options before treatment

Ask your cancer care team for details about the cost of having fertility preservation and storing eggs, embryos or sperm. Options include:

• freezing or banking sperm
• freezing eggs or embryos
• freezing ovarian tissue
• surgically moving one or both ovaries out of the field of radiation to preserve their function (oophoropexy)
• preserving the uterus, fallopian tubes and ovaries during surgery
• for early cervical cancer, surgically removing part or all of the cervix, the upper part of the vagina and the lymph nodes in the pelvis, but leaving the uterus, fallopian tubes and ovaries in place (trachelectomy)
• suppressing the ovaries with a long-acting hormone called GnRH analogue treatment before chemotherapy to cause a temporary menopause and protect eggs from damage
• shielding the testicles during radiation therapy to protect them.

Options after treatment

This will depend on how cancer treatment has affected your fertility. Ways to become a parent after treatment include:

• using donor eggs from your partner, another known donor or from an overseas donor
• using donor sperm from your partner, a friend or family member or overseas donor
• asking someone (a surrogate) to carry your embryo if you do not have a uterus or it is medically too risky for you to carry a pregnancy
• adopting a child
• fostering a child for emergency, respite, short-term or long-term care – in Australia there are more opportunities to foster than there are to adopt.

Checking fertility after treatment

After treatment, you may want to do some tests to see how your fertility has been affected. These may include: blood tests to measure different hormones; sperm count; or ultrasound to check the health of reproductive organs. Some tests, such as certain types of ultrasound, may be challenging for some LGBTQI+ people.  The results help your fertility specialist or reproductive endocrinologist recommend the best options for having a child after cancer treatment.

Pregnancy after cancer treatment

You might be advised that you need to wait several years after treatment ends before trying to get pregnant. There are many ways to approach conceiving a  child, either on your own, or with a partner.

If you or your partner can become pregnant – Options include:

• Your partner could have their eggs fertilised with donor sperm through IVF and then carry the pregnancy.
• If your eggs were collected before treatment or are undamaged after treatment but you’ve had your uterus removed, you could consider reciprocal IVF. This means you go through the IVF cycle and once the embryos mature, they are transferred to your partner to carry the pregnancy.
• If your eggs have been damaged, but you have your uterus and your partner has ovaries, your partner’s eggs could be fertilised with donor sperm and then you carry the pregnancy.
• If neither of you can provide eggs, you could use donated eggs.

If you and your partner produce sperm – You will need an egg donor and a surrogate to start a family. If your sperm has been damaged, your partner may be able to provide sperm. If neither of you can provide sperm, you could use donated sperm.

If you are single – You could consider using eggs and/or sperm donated by another person or from overseas.

Emotional impact of infertility

How people respond to infertility varies. Common reactions include shock at how cancer or its treatment has affected fertility; grief from the loss of future plans; anger or depression from disruption of life plans, and loss of control over life direction.

These feelings may be intensified by the physical and emotional process of having infertility treatment and by not knowing if it will work. People who didn’t get a chance to think about their fertility until treatment was over say the emotions can be especially strong. It may also help to consider other ways of becoming a parent, such as adoption or fostering, or you may decide to stop trying to have a child.

Infertility and relationships

Cancer and infertility can cause tension within a relationship. How your relationship is affected may depend on how long you have been together, expectations about becoming parents, the strength of your relationship before cancer and infertility, and how well you communicate.

Changes to your fertility may mean renegotiating who will provide eggs or sperm or carry the pregnancy. If your partner is unwilling to be the biological parent, you might feel like you’ve missed the opportunity to have a family. Seeing a fertility counsellor can help you talk about these issues and suggest ways to cope.

If you’re starting a new relationship, you may want to share your cancer diagnosis and impact on fertility when you feel you can trust the person.

Download our booklet ‘Fertility and Cancer’