Infertility—the inability to conceive a child or maintain a pregnancy—is a concern for young adults and an often overlooked complication of some cancer treatments. Too often, the problem of infertility is not discussed before cancer treatment is started. Once treatment has begun, there are fewer options for fertility preservation. Because many young adults anticipate having children in the future, loss of fertility is a critical issue.

Causes of infertility

Infertility resulting from cancer treatment has a number of causes and may be temporary or permanent. The endocrine glands, such as the ovaries, testes, thyroid, and adrenal gland, release hormones that regulate fertility and pregnancy. The body's endocrine system is vulnerable to the effects of cancer treatment. Fertility problems can occur when cancer or cancer treatment damages one of these glands or alters the part of the brain that controls these glands. It can also occur because of severe psychological stress.

Chemotherapy and radiation therapy, especially radiation therapy to the pelvis, can affect the function of endocrine glands and fertility. For example, chemotherapy and radiation therapy in men may reduce the number of sperm cells or limit their movement. In women, chemotherapy and radiation therapy can damage the ovaries and reduce their ability to produce hormones, which can cause ovulation to stop and induce premature menopause.

For women, surgery to the reproductive organs, such as the cervix, fallopian tubes, uterus, and ovaries, may affect fertility. For men with testicular cancer, removal of a single testicle does not cause infertility, if the remaining testicle still produces sperm. Removal of both testicles, which is rare, does cause infertility.

Questions to ask the doctor about cancer treatment and fertility

It is important to talk with your doctor about how cancer treatment may affect fertility before treatment begins. Even if your doctor has not mentioned fertility concerns, consider asking the following questions:

• What are the short-term and long-term effects of cancer treatment on my fertility?
  
  
• What is the risk of sterility? What are the estimates from the oncology literature of permanent or temporary compromise of fertility or hormonal status associated with the treatments recommended for my type, stage, and grade of cancer? Are there other treatments that could be considered that do not pose as high a risk but are equally effective?
  
  
• Is there a proven way to preserve my fertility before, during, or after treatment?
  
  
• Will my desire to attempt to preserve fertility adversely affect the effectiveness of my cancer treatments?
  
  
• What are my options for reproduction or starting a family in the future?
  
  
• How long must I wait following treatment before trying to become pregnant?
  
  
• Can I become pregnant (female) or impregnate someone (male) while receiving chemotherapy or radiation therapy? What happens if pregnancy results during treatment? Is there a risk of birth defects and/or harm to the fetus and/or mother?
  
  
• Do I need to obtain a referral to consult a specialist in reproductive endocrinology (a doctor specializing in fertility issues)?
  
  
• Are there support groups available for people who lose fertility because of cancer treatment?

Cancer treatment and fertility-preserving options

Recent advances in oncology and reproductive endocrinology have made it possible for many people with cancer to receive treatment while preserving their fertility. As a young adult, factors such as gender, type and stage of cancer, and relationship status (for example, whether a woman currently has a partner for sperm donation) affects which options are available for fertility preservation. Your doctor and/or a reproductive specialist can help you learn about the following options for preserving fertility:

Fertility-preserving options for men

• Sperm banking
  
  
• Testicular tissue preservation
  
  
• Testicular sperm extraction and preservation
  
  
• Testicular shielding during radiation therapy

Fertility-preserving options for women

• Embryo (fertilized egg) cryopreservation
  
  
• Oocyte (unfertilized egg) cryopreservation
  
  
• Ovarian-tissue preservation
  
  
• Gonadotrophin-releasing hormone (GnRH) treatment during chemotherapy to reduce damage to reproductive organs
  
  
• Abdominal radical trachelectomy (ART)—a more conservative surgery for cervical cancer
  
  
• Ovarian shielding during radiation therapy
  
  
• Surgical repositioning of ovaries during radiation therapy (ovarian transposition)
  
  
• Oral contraception

For more information about these options, please read Fertility and Cancer Treatment.

Unfortunately, fertility preservation is not always successful and may not be available or appropriate for everyone. Fertility-preserving options can also be expensive and are frequently not covered by insurance. Facing infertility at the same time you are coping with cancer can be overwhelming. Consider seeking counseling or joining a support group to help you cope.

Additional resources

American Cancer Society: Will My Sexual Function & Fertility Be Affected?

American Cancer Society: What Side Effects Occur With Radiation Therapy to the Pelvis?

American Society of Reproductive Medicine

More Information

Cancer.Net: Chat and Q&A Transcripts: Cancer, Sexual Health and Fertility

Cancer.Net: 2004 Meet the Expert: Cancer Survivorship—Infertility Risks and Options

Cancer.Net: Cancer in Young Adults