Fertility

Cancer and cancer treatment can affect a person’s ability to conceive a child or maintain a pregnancy. If you have been diagnosed with cancer and want to start or add to a family in the future the information below can help you understand more about the impact of cancer treatment on fertility.

What is fertility?

Fertility is the ability to conceive a child and maintain a pregnancy. Infertility means difficulty in getting pregnant. This can be the result of male or female factors, or a combination of both. Infertility affects one in six Australian couples.

How does cancer affect fertility?

Cancer and cancer treatment can cause fertility problems. Infertility can be temporary, lasting months or years, or it can be permanent.

How cancer can affect female reproductive organs

Some cancer treatments, particularly radiation therapy (also known as radiotherapy) and chemotherapy, can damage the ovaries and decrease the number of available healthy eggs. Radiation therapy can also damage other sexual organs such as the vulvar or cervix.

Surgery can also have an effect on fertility. For example, the reproductive organs may be removed during surgery. This can lead to early menopause and the loss of your ability to conceive children.

How cancer can affect male reproductive organs

Cancer treatments, especially radiation therapy and chemotherapy, can affect sperm quantity, quality or mobility (the sperm move poorly).

In some cases, the reproductive organs may be damaged or removed during surgery. For example, if testicular cancer is suspected, the only way to be sure of the diagnosis is to surgically remove the affected testicle for examination in a laboratory. In most cases, only one testicle needs to be removed so you can go on to have children naturally. However, if both testicles are removed you will no longer be able to produce semen and will be infertile.

Does age affect fertility?

Age is one of the most important factors influencing the impact of cancer treatment on fertility.

Age and female fertility

Females are born with all the eggs they will have in their lifetime. The number of eggs reduces as they age and fertility begins to decline after the age of 30.

The effect of radiation therapy and chemotherapy on fertility, before and after puberty, can range from mild to severe.

Age and male fertility

The quantity and quality of sperm decreases with age meaning it will take longer for an older man’s partner to get pregnant. Chemotherapy and radiation therapy, before and after puberty can affect sperm production and may cause infertility.

Should I avoid pregnancy during cancer treatment?

For men – some cancer treatments can affect sperm and cause birth defects. You may want to use contraception during treatment as you may still be fertile.

For women – some cancer treatments can cause birth defects or harm an unborn baby. You may still be fertile even if your periods stop during treatment so you may want to use contraception.

How long after treatment should I wait before trying to get pregnant?

How long you should wait to conceive after treatment will depend on many factors such as the type of cancer and treatment given. You may be advised to wait between six months and two years after treatment ends – this may be to allow your eggs or sperm to recover and ensure you are in good health.

Is there a risk of my children getting cancer?

Studies have shown that if one or both parents have a history of cancer, their children are at no greater risk of getting cancer than anyone else.

A small percentage of some cancers are caused by an inherited faulty gene from either parent. This is called familial cancer.

What if I am already pregnant?

It is uncommon to be diagnosed with cancer during pregnancy – around one in every 1000 pregnant women is diagnosed with cancer. If you are diagnosed during pregnancy it may still be possible to have treatment. Discuss any potential risks and benefits with your oncologist before treatment begins.

You will be advised not to breastfeed during chemotherapy, immunotherapy or targeted therapy as drugs can pass to the baby through breastmilk. If you are having radiation therapy you should talk with your doctor about whether it is safe to breastfeed during treatment.

I want to have children some day, what can I do?

There are procedures you can use to help maintain your ability to have children. This is called fertility preservation and includes freezing eggs, embryos or sperm. These procedures are usually done before you have any treatment that may affect your fertility.

There are also other paths to parenthood.

Surrogacy

Surrogacy is an option for women who are not able or don’t wish to carry a pregnancy. A surrogate is a healthy female who carries a donated embryo to full term. An embryo can be created from the sperm and egg of the intended parents or a donor. The surrogate can’t use her own eggs. The embryos are implanted into the uterus of the surrogate via in-vitro fertilisation (IVF).

It is important to understand that surrogacy is a complex process. The fertility clinic organising the surrogacy will ensure that both the surrogate and the donor go through counselling and psychiatric testing before the process starts. This ensures that everyone involved makes a well-informed decision.

If surrogacy is an option, the intended parents need to pay the medical costs of the IVF and any additional expenses.

Adoption and fostering

Adoption involves taking legal permanent parental status of a child who is not biologically yours. Adoption may be possible in Australia or from an overseas country. You can visit the family and community service government website in your state or territory for more information.

Fostering or foster care means taking responsibility for a child without having legal parental status. Fostering can include emergency care, short-term or long-term care. There are more opportunities to foster that to adopt in Australia.

While most fostering and adoption agencies say they don’t rule out cancer survivors on the basis of their medical history, you will need to declare your health status.

Being child-free

If fertility treatment has not been successful, some people come to accept that they won’t have a child. This may cause a range of emotions including sadness, a sense of loss or grief, relief or empowerment if you have made the choice. Some people say they feel child-free rather than childless.

Learning that cancer treatment has affected your fertility and ability to have children can be challenging and there is no right or wrong way to cope. Some strategies that may help include:

• gathering information about your options
• finding support from family and friends
• counselling
• talking to people who have been in a similar situation.

Treatment team for fertility issues

You may see a range of health professionals to discuss fertility which may include:

• a cancer specialist such as a medical oncologist, radiation oncologist, gynaecological oncologist, surgeon or haematologist, who will discuss possible impacts on fertility before treatment
• a fertility specialist who diagnoses, treats and manages infertility such as a gynaecologist, obstetrician or reproductive endocrinologist
• fertility counsellor which provides support and advice for people experiencing fertility issues
• a paediatric gynaecologist, surgeon or endocrinologist who specialise in fertility care in children with cancer.

Let the specialist or fertility clinic know that you are having cancer treatment so that they can give you an appointment as soon as possible.

How much does fertility treatment cost?

Fertility treatment can be expensive. Costs will depend on whether you are a public or private patient. The costs of specialists and private clinics varies across Australia. You may be able to have treatment at a fertility unit in a public hospital. Ask your fertility clinic/specialist about their fees and any Medicare rebates If you belong to a private health fund, ask what costs they will cover and what you will have to pay.

You can read more in our Cancer Care and Your Rights and Cancer and Your Finances booklets.

Where can I get reliable help and information?

Talking to your doctor and asking questions can help you make informed choices. You can also call Cancer Council 13 11 20 for information and support.