Fertility and Cancer Treatment

The simple versionExplain▾

Fertility is the ability to have children. Some cancer treatments can lower fertility or cause infertility — sometimes for a while, sometimes permanently. If having a biological child one day may be important to you, the National Cancer Institute encourages raising the topic with your doctor before treatment begins. Sometimes you may need to be the one to start that conversation.

It can feel overwhelming to think about fertility decisions right when you and your team are focused on planning cancer treatment. But research has found that survivors were less regretful if they had met with a fertility specialist — regardless of whether they decided to preserve their fertility.

What affects whether fertility changesExplain▾

Whether cancer or its treatment affects your fertility depends on things like:

• the type of treatment(s), the dose, and how long treatment lasts
• your age at the time of treatment
• how much time has passed since treatment
• the type of cancer, and whether the tumor is near reproductive organs
• your fertility before treatment, and other personal health factors

How treatments can affect fertilityExplain▾

Cancer treatments may affect fertility by harming reproductive organs or the endocrine glands that control fertility. Changes may be temporary or permanent.

• Chemotherapy destroys cancer cells but can also harm healthy cells — including egg cells in the ovaries and the germ cells that become sperm. Some drugs, such as alkylating agents, pose a high risk. Higher doses, or several drugs at once, can raise the risk. In women, chemotherapy can lead to primary ovarian insufficiency, where the ovaries stop developing mature eggs and producing estrogen.
• Radiation therapy to the reproductive organs or pelvic area can damage ovaries, eggs, or sperm-forming cells. Radiation to the brain can affect the glands that make hormones needed for fertility. The dose, the body area treated, and your age all play a role.
• Hormone therapy can cause primary ovarian insufficiency in women and can decrease sperm count in men.
• Surgery that removes reproductive organs — such as a hysterectomy or removal of both ovaries or both testicles — can cause infertility. Surgery in the abdomen or pelvis can also affect nearby organs and nerves.
• Stem cell transplant usually involves high doses of chemotherapy, radiation, or both, which can damage ovaries or sperm-forming cells.
• Immunotherapy and targeted therapy effects on fertility are still being studied — ask your doctor what is known about your specific drug.

Fertility preservation optionsExplain▾

Fertility preservation means saving or protecting eggs, embryos, sperm, or reproductive tissue so you may be able to have biological children in the future. Options NCI describes include:

• For women and girls: embryo freezing, egg freezing, ovarian tissue freezing (an option for girls who have not gone through puberty), ovarian shielding during radiation, and ovarian transposition — surgery that moves the ovaries away from the area receiving radiation.
• For men and boys: sperm banking (the most common method after puberty), testicular shielding during radiation, and testicular sperm extraction.

If you choose to preserve fertility, your cancer doctor and a fertility specialist work together on a treatment plan that includes it — including whether any delay to start of treatment is safe. Success rates, costs, and availability vary, and many hospitals have patient navigators who can help you find fertility resources and financial support.

Birth control still matters during treatmentExplain▾

Even when treatment lowers fertility, there may still be a chance of pregnancy. Because some treatments may be harmful to a pregnancy or cause miscarriage, your doctor may advise using birth control during treatment — and sometimes for a period afterward.

You get to decide what mattersExplain▾

Many people want children someday; others don't, or plan to build families in different ways. NCI's advice is to make decisions that reflect what is important to you — and to lean on your health care team, fertility specialists, and support groups along the way.