Key Points

• Some types of cancer treatment may affect the ability of a man to father a child or a woman to become pregnant.
  
  
• Before trying to have a child, talk with your doctor to learn how your cancer treatment may affect your ability to have children.
  
  
• Becoming pregnant does not cause cancer to come back, and children born to cancer survivors do not have a higher than normal risk of getting cancer. The exception is if you have one of the few cancers that are hereditary.
  

A cancer survivor’s ability to have biologic children after treatment depends on the type and location of cancer, the type and dose of treatment, and the age when treatment was received. Although not all types of cancer or cancer treatment cause infertility (the inability to start or maintain a pregnancy), it is important to talk with your doctor before you start a family to learn how your body may have been affected by having a history of cancer. In this two-part series, learn how fertility may be affected in cancer survivors and find out about some fertility procedures and other parenthood options to discuss with your doctor. This article explains how cancer treatment may affect fertility and addresses some common questions and concerns of cancer survivors.

How cancer treatment may affect a man’s fertility

The most important consideration for men treated for cancer is whether the cancer treatment damaged their sperm, including the ability to make new sperm and produce semen (fluid in which sperm travels during sex). The following types of chemotherapy, radiation therapy, and surgery may damage sperm and semen.

Chemotherapy

• High doses of chemotherapy
  
  
• Doses of chemotherapy called alkylators, including cyclophosphamide (Clafen, Cytoxan, Neosar), chlorambucil (Leukeran), busulfan (Busulfex, Myleran), procarbazine (Matulane), carmustine (BCNU, BiCNU), lomustine (CeeNU), mechlorethamine (Mustargen), and melphalan (Alkeran)
  
  
• Treatment with more than one of the alkylator drugs
  
  
• High doses of cisplatin (Platinol) or bleomycin (Blenoxane)
  
  
• Chemotherapy combined with radiation therapy to the abdomen and pelvis

Radiation therapy

• Radiation therapy to the testicles or near the testicles
  
  
• Radiation therapy to the whole body
  
  
• Radiation therapy to the pituitary gland (which signals the body to make sperm) in the brain

Surgery

• Removal of the prostate (which makes semen) or the bladder
  
  
• Removal of both testicles
  
  
• Removal of lymph nodes in the pelvis
  
  
• Spinal surgery

For some men, these treatments may lead to permanent infertility. In others, sperm production may have been stopped or slowed by treatment, but may return in one to four years, or in as long as 10 years. In general, the higher the dose of radiation therapy or chemotherapy, the longer amount of time needed for sperm production to resume.

Younger boys before the age of puberty typically do not have as much damage to sperm from treatment, while men over age 40 are less likely to regain fertility.

How cancer treatment may affect a woman’s fertility

Women who want to become pregnant without reproductive assistance must have at least one healthy ovary (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 specific hormones. Any part of the reproductive system can be damaged by the following types of chemotherapy, radiation therapy, and surgery.

Chemotherapy

• High doses of chemotherapy, such as alkylators (cyclophosphamide)
  
  
• Chemotherapy combined with radiation therapy

Radiation therapy

• Radiation therapy aimed directly at or near the ovaries
  
  
• Radiation therapy aimed at the abdomen, pelvis, lower spine, or uterus
  
  
• Radiation therapy to the whole body
  
  
• Radiation therapy to the pituitary gland (which signals the body to produce hormones that control the ovaries) in the brain

Surgery

• Removal of the uterus
  
  
• Removal of one or both ovaries

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, some women with ongoing menstrual periods may be infertile while some women may be fertile without having them. In some women, cancer treatments may lead to permanent infertility. In other women, the 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 age of the woman, the longer the amount of time needed for the menstrual periods to return or the greater likelihood that they will not return. Even if a woman continues to menstruate and remains fertile after treatment, she might go through menopause (time of life when menstrual periods stop) at an earlier age.

Younger girls before the age of puberty typically do not have as much damage to the ovaries during treatment than young adults or teens. Women who receive treatment before age 30 are more likely to remain fertile than women who receive treatment after age 30. However, all of these factors depend on the type of treatment received.

Common questions

People considering having a child after cancer treatment often have many questions. Share these and other questions you may have with your doctor, and ask about support services available.

How long after treatment do I need to wait before trying to have a child?

There are no set guidelines for how long men or women should wait to have a child after cancer treatment. Some doctors recommend that women not get pregnant within the first six months of chemotherapy because damaged eggs are thought to leave the body within six months. If an egg damaged by treatment is fertilized, there is a chance the woman will have a miscarriage (losing a pregnancy early) or that the child will have health problems. Other doctors recommend waiting at least two to five years because that is the window of time in which a cancer is most likely to recur (come back) and/or the time to receive optimal treatment for some types of cancer, such as hormone-sensitive breast cancer.

For men, doctors typically recommend waiting at least two to five years before trying to start a family. Doctors have estimated that sperm damaged by chemotherapy or radiation therapy may repair itself in two years.

Do cancer treatments raise the risk of miscarriage or birth complications in cancer survivors?

Some cancer treatments can increase a woman’s risk of miscarriage and other labor and birth complications.

• Radiation therapy to the uterus may increase risk of miscarriage, premature birth, and low birth weight.
  
  
• Removal of all or part of the cervix may increase risk of miscarriage or early delivery.
  
  
• Radiation therapy to the whole abdomen, pelvis, lower spine, or to the entire body may increase risk of miscarriage, early delivery, or other problems.
  
  
• Anthracycline chemotherapy, such as doxorubicin (Adriamycin), daunorubicin (Daunomycin, Cerubidine), epirubicin (Ellence) and idarubicin (Idamycin), in addition to radiation therapy to the upper abdomen or chest, may cause heart problems that can worsen during pregnancy and labor.

No matter what treatment you have had, it is important to talk with your doctor about whether your body can safely handle a pregnancy. Your doctor may refer you to a fertility specialist or obstetrician (a doctor who cares for a woman during and shortly after a pregnancy) who specializes in dealing with patients who have other health concerns.

Risk of children getting cancer. Although many cancer survivors are concerned that their children may be at risk for cancer, research studies show that children born to survivors do not have a higher than normal risk of getting cancer. The exception is if you have one of the few cancers that are hereditary. If so, talk with your doctor or a genetic counselor about having children. They can help you understand any risks. Learn more about cancer risk and genetics.

Risk of cancer recurrence. Research studies also show that getting pregnant does not appear to cause cancer to recur. Some doctors advise breast cancer survivors to wait two years before trying to get pregnant because of the link between certain hormones that increase during pregnancy and the growth of breast cancer cells. However, there is no evidence that having a pregnancy sooner will increase the risk of recurrence.

More Information

Having a Child After Cancer Treatment (Part II)

Fertility and Cancer Treatment

Pregnancy and Cancer

Additional Resources

American Cancer Society: Cancer Treatment and Fertility in Men

American Cancer Society: Cancer Treatment and Fertility in Women

Lance Armstrong Foundation: Female Infertility

Lance Armstrong Foundation: Male Infertility

Comments? Got an idea for an article? Send an e-mail to contactus@cancer.net.

Last Updated: January 12, 2009