Listen to the Cancer.Net Podcast: Fertility and Cancer Treatment, adapted from this content
- Some types of cancer treatment reduce a person’s fertility (ability to have children).
- Temporary or permanent infertility occurs when treatment affects the function of the endocrine system (the glands and other organs responsible for making hormones and producing oocytes [eggs] or sperm).
- Before treatment begins, talk with your doctor about the possible fertility-related side effects of your treatment plan, and ask about options you may have for preserving your fertility.
When you are first told you have cancer, it may be difficult to think beyond your diagnosis. However, discussing life after treatment, even before treatment begins, is very important, especially when it comes to fertility. Although not everyone wants to have children, most people would like to have the option. Unfortunately, infertility (not being able to have children) can be a temporary or permanent side effect of some cancer treatments.
How cancer treatments affect fertility
The endocrine glands and endocrine-related organs, such as the ovaries, testes, thyroid, and adrenal gland, release hormones that stimulate puberty, control fertility, and regulate growth throughout the body. Problems occur when cancer or cancer treatments, such as surgery, radiation therapy, or chemotherapy, damage one of these glands or organs or alters the part of the brain that controls the endocrine system.
For men, the biggest concern is usually whether their treatment plan can damage sperm, affect their ability to make new sperm, or reduce or stop the production of semen (fluid in which sperm travels during sex). All of these changes reduce the chances that a man will be able to father a child naturally.
For a woman to become pregnant after finishing cancer treatment without reproductive assistance, she must have at least one healthy ovary (organ where eggs are produced and stored), one fallopian tube (the structure that the egg travels through), a healthy uterus where the baby can grow, and optimum levels of specific hormones. However, any of these parts of the reproductive system can be damaged during treatment, especially for cancers of the ovaries, cervix, and uterus.
It is important to talk with your doctor about whether your treatment may affect your fertility before you start treatment. However, here is a brief overview of cancer treatments that have been identified as having potential fertility-related side effects.
Chemotherapy. Drugs that have been linked to fertility issues include cisplatin (Platinol), and alkylators, such as cyclophosphamide (Cytoxan, Neosar), chlorambucil (Leukeran), busulfan (Busulfex, Myleran), procarbazine (Matulane), carmustine (BiCNU), lomustine (CeeNU), mechlorethamine (Mustargen), and melphalan (Alkeran).
Radiation therapy. This includes radiation to the whole body, as well as radiation directed at the abdomen, pelvis, lower spine, testicles (or near the testicles), ovaries (or near the ovaries), uterus, and pituitary gland in the brain.
Surgery. Men who have their prostate (which makes semen), bladder, both testicles, or lymph nodes in the pelvis removed experience decreased fertility, as do women who have had their uterus, pelvic lymph nodes, or one or both ovaries removed.
Fertility effects for men
For some men, cancer treatment leads to permanent infertility. In others, treatment may stop or slow sperm production for years before it returns. In general, the higher the dose of radiation therapy or chemotherapy given, the longer the amount of time needed for sperm production to begin again.
It is important to keep in mind that other factors, such as age, also affects fertility. Younger boys who receive treatment for cancer before undergoing puberty typically do not have as much damage to their sperm, while men over the age 40 are less likely to regain their fertility.
Fertility effects for women
A woman’s ability to have menstrual periods (periodic discharge of blood and tissue from the uterus that occurs in a woman from puberty until menopause except during pregnancy) after cancer treatment often predicts her ability to become pregnant. However, regular periods are not always reliable indicators of fertility. Some women who continue to have menstrual periods may be infertile, while other women may be fertile without having them.
In some women, cancer treatments may lead to early menopause (time of life when menstrual periods stop) and permanent infertility. In other women, menstrual periods will stop during treatment but will return over time, although the amount of time varies. In general, the higher the dose of radiation therapy or chemotherapy, and the older the woman is when she starts treatment, the longer the amount of time needed for her menstrual periods to return and the greater the chance that they will not return. Even if a woman continues to menstruate and remains fertile after treatment, she might go through menopause at an earlier age.
Younger girls who have treatment before the age of puberty typically do not have as much damage to their ovaries as a result of treatment as young adults or teens. Also, women who receive treatment before age 30 are more likely to remain fertile than women who receive treatment after age 30. However, all of this depends on the type of treatment received. It is important to talk with your doctor or a fertility specialist before treatment begins so you will have a clear understanding of what to expect.
Questions to ask the doctor
It is important to talk with your doctor as early as possible about how cancer treatment may affect your fertility because most fertility-preserving procedures need to be done before cancer treatment begins. Consider asking your doctor the following questions:
- What are the possible short-term and long-term effects of my treatment plan on fertility?
- What is the risk of permanent infertility associated with the treatments recommended for my type, stage, and grade of cancer? Are there other treatments that do not pose as high a risk but are equally effective?
- Is there a way for me to still be able to become pregnant or father a child after treatment?
- Where can I find support for coping with fertility issues?
- Whom can I contact if I need help talking with my spouse or partner about fertility issues?
Moving Forward Videos: Fertility for Young Adults with Cancer