Cancer treatments and fertility

Written by: 
Suzi Lewis-Barned, medical writer

The benefits of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. treatment are usually greater than the downsides, but sometimes 
fertility can be affected.

A wide range of procedures to preserve fertility may be offered to people having treatment for cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. If you may wish to start a family in the future, it is important to discuss this with your doctor before your treatment begins. That way, you can be aware of the options and make informed choices.

Young children who have treatment for cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. may also be at risk of lower fertility when they are older, so it is important for parents to discuss these implications with doctors

How do cancer treatments affect fertility?

Here you can find out more about the main treatment options for cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. and how they affect fertility.

Surgery

Surgery to the reproductive organs or the surrounding areas can affect fertility in both men and women. Specifically:

  • Removal of the uterus The womb, where embryo implantation occurs and the growing foetus is nourished.(womb) - a procedure known as a hysterectomy - means that a woman will be unable to carry a child
  • If a woman has surgery to remove both of her ovaries, she will no longer be able to produce eggs (however, if one ovary remains, she may still generate eggs)
  • Men who have a single testicle removed may continue to produce sperm, but surgery to remove both testicles will result in infertility (also sometimes called sterility)
  • Surgery for prostate cancer that removes the prostate glandAn organ with the ability to make and secrete certain fluids. and/or the seminal vesicles means that a man can no longer produce sperm. Other types of surgery may damage the nerves that enable a man to ejaculate (that is, discharge sperm in the usual way).

In addition, surgery to certain parts of the head can also affect fertility. The pituitary glandAn organ with the ability to make and secrete certain fluids. in the brain produces hormones that stimulate the ovaries and testicles; surgery that damages or removes a portion of the pituitary glandAn organ with the ability to make and secrete certain fluids. can cause problems with ovulation (in women) or sperm production (in men).

Chemotherapy and radiotherapy

In men, chemotherapyThe use of chemical substances to treat disease, particularly cancer. and radiotherapy can reduce the mobility and quantity of sperm produced; sometimes, sperm production stops altogether, resulting in infertility (also known as sterility).

In women, chemotherapyThe use of chemical substances to treat disease, particularly cancer. and radiotherapy used to treat cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. of the ovary or uterus may affect the menstrual cycleThe monthly sequence by which a woman’s body prepares for potential fertilisation of an egg released from the ovaries, involving thickening of the uterus lining and then shedding of the lining when pregnancy does not occur. (periods).

This can stop eggs being produced, either temporarily or permanently, or may cause a woman to have an early menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle..

If a woman is able to become pregnant after these treatments, there is a risk that the baby may be born prematurely.

Some other facts to be aware of:

  • Chemotherapy drugs called alkylating agents are the most likely to affect fertility if given in high doses. In addition, platinum-based chemotherapyThe use of chemical substances to treat disease, particularly cancer. agents may also reduce fertility
  • To increase the chances of remission The lessening or disappearance of the symptoms or signs of a disease.(that is, a state where there is no detectible cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.) in cases of leukaemiaA malignant condition in which increased numbers of white blood cells, leucocytes, are produced in an immature or abnormal state., lymphomaA type of cancer that affects the lymph nodes, part of the immune system., myeloma and testicular cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., your doctor may recommend a high dose of chemotherapyThe use of chemical substances to treat disease, particularly cancer. and sometimes radiotherapy supported by stem-cellThe basic unit of all living organisms. replacement using either your own bone marrowTissue within the bones where blood cells are formed. or bone marrowTissue within the bones where blood cells are formed. transplanted from a donor. The high doses of treatment used in these procedures cause a number of side-effects - including, usually, infertility
  • Radiotherapy treatment for cancers of the brain can also affect fertility. The pituitary glandAn organ with the ability to make and secrete certain fluids. in the brain produces hormones that stimulate the ovaries and testicles. If this small glandAn organ with the ability to make and secrete certain fluids. is damaged during radiation therapy, it can lead to problems with ovulation (in women) or sperm production (in men)
  • Chemotherapy and radiotherapy can in some cases cause damage to a fetusAn unborn child from eight weeks of development onwards.. It is therefore very important to be certain that you are not pregnant before having treatment. You may want to discuss appropriate methods of contraceptionA means of preventing pregnancy. with your doctor before having treatment.

There are other possible complications caused by chemotherapyThe use of chemical substances to treat disease, particularly cancer. and radiotherapy that can increase risks to the mother during pregnancy:

  • Radiotherapy and high doses of chemotherapyThe use of chemical substances to treat disease, particularly cancer. may cause heart problems, especially in treatments for breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. Heart problems may pose an extra risk for women during pregnancy
  • Chemotherapy and radiotherapy to the chest may cause damage to the lungs. For those who are treated with a combination of the two treatments (for example, during a bone-marrow transplant), there is a higher risk of lung damage. As a woman's lungs are already under pressure during pregnancy, this too can increase the risk for a woman.

Read more on Chemotherapy

One of the side-effects of hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. treatment is that menstruation (periods) may stop - this may be temporary or permanent

Hormone therapy

Hormone therapy is used to treat certain types of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., including cancers of the breast, uterus and prostate. These are often called 'hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect.-sensitive' or 'hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect.-dependent' cancers because they need hormones, specifically sex hormones, to grow.

By using drugs to stop the hormones being made in the first place, or to prevent them from reaching the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells that would otherwise multiply, doctors can slow down or stop the growth of such cancers. There is a range of different hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapies that may be used to treat each of these types of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

Hormone therapy may affect fertility in the following ways:

  • For women who have not gone through the menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle., one of the side-effects of hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. treatment is that menstruation (periods) may stop - this may be temporary or permanent
  • Men having hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. treatment for prostate cancer may experience erectile dysfunction (also called impotence). This may have an indirect impact on a man's fertility by affecting his relationship with his partner
  • Other possible side-effects include lethargy, weight gain and muscleTissue made up of cells that can contract to bring about movement. loss as well as more serious problems, for example, a worsening of conditions such as diabetes (information on diabetes coming soon) and heart, lung and liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats. diseases.

Procedures to help preserve fertility

The procedures used to help preserve fertility vary between patients. Factors that may determine what fertility-preserving options are available to you include your:

  • Age
  • Gender
  • Type of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Primary site of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Stage or severity of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Type and dosage of proposed treatment.

Because these factors differ from person to person, not all fertility-preserving techniques may be available or appropriate for you and none can be guaranteed to be 100 per cent successful.

Some fertility-preserving techniques are still at an early stage of development and may not yet be available at your local hospital or clinic.

You may want to discuss the benefits and risks of any procedures with your doctor so that you can make an informed choice.

There are many other ways to become a parent if fertility-preserving options are not possible or successful. You can find out more about fertility treatments using donor eggs, sperm or embryos, options such as surrogacy and adoption. See the quick guide on Infertility for more about these options.

Procedures to help preserve fertility in men

Some of the procedures used to help preserve male fertility are better established than others.

Sperm (semen) freezing and banking

Sperm can be collected using a variety of methods - including directly from the testicles if necessary - for freezing and storing in a sperm bank for future use (known as cryopreservation). However, collection of sperm after masturbation is the preferred and most effective method.

Fertility treatments such as intracytoplasmic sperm injection (ICSI) have meant that even 'low-quality' sperm may lead to a successful pregnancy. ICSI is a technique available in some countries whereby a single sperm is injected into a single egg in the laboratory. The egg is then placed back into the woman's uterus The womb, where embryo implantation occurs and the growing foetus is nourished.(womb), without surgery, three days later. Success rates for ICSI vary depending on the age of the woman.

In some cases, sperm might be used from frozen (cryopreserved) testicular tissue, which can be combined with the ICSI procedure, although this approach is still in the early stages of development. Tissue may also be taken from boys who have not yet reached sexual maturity to be used in the future. However, this technique is also still in development and may not be widely available.

Radiation shields

These devices can shield the testicles from harmful radiation if the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. being targeted is present in other parts of the pelvis.

Procedures to help preserve fertility in women

While some of these procedures are well established, others are still in the early stages of development.

Embryo freezing and banking

Cryopreservation is the term for freezing and banking. Eggs are collected before treatment commences, then fertilised in the laboratory using in vitro fertilisationFertilisation of the female reproductive cell (ovum) outside the body, before implantation into the uterus (womb). Abbreviated to IVF. (IVFIn vitro fertilisation. Fertilisation of the female reproductive cell (ovum) outside the body, before implantation into the uterus (womb).). The resulting embryos are then frozen for later use. This is the most established technique for preserving fertility in women.

Radiation shield

Here, a radiation shield reduces the dose of radiation delivered to the reproductive organs. An alternative option may be a procedure called an oophoropexy, which involves surgically moving one or both ovaries out of the radiation field. Both methods can be used before or after puberty.

Abdominal radical trachelectomy

For patients suffering from early-stage cervical cancer, it is sometimes possible to remove the cervixAny neck-like structure; most commonly refers to the neck of the uterus. while keeping the uterus and ovaries intact. If the woman subsequently becomes pregnant, the baby is then delivered by Caesarean section because it is unable to travel down the birth canal.

Methods in the early stages of development

The following methods to help preserve fertility in women are in early stages of development:

  • Ovarian-tissue cryopreservation (freezing): With this method, ovarian tissue is removed, preserved, then reimplanted after the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. treatment. This method can be used both before and after puberty. Sometimes a whole ovary has been removed for later reimplantation. In July 2009, there had been 30 reported attempts, resulting in six live births and several ongoing pregnancies.
  • Unfertilised egg (oocyte) freezing (cryopreservation): In this technique, unfertilised eggs are frozen. Results so far suggest that this is a less reliable means of achieving a successful pregnancy than freezing embryos.
  • Oral contraceptionA means of preventing pregnancy.: Research has indicated that women who take oral contraceptives (birth control pills) during chemotherapyThe use of chemical substances to treat disease, particularly cancer. are less likely to have problems producing eggs after treatment.

It is important to discuss with your doctor the likely benefits or any possible harm that may arise if you consent to having any of the procedures offered to help preserve fertility.