Key Messages:

• Infertility—the inability to conceive a child or maintain a pregnancy—is a common concern for young adults and an often overlooked complication of some cancer treatments.
  
  
• Many options are available for fertility preservation; it’s important to talk with your doctor regarding fertility issues before you start your cancer treatment.

Cancer and its treatment can affect your ability to conceive a child. 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 can be temporary or permanent. The causes include:

• Damage to the endocrine glands, such as the ovaries, testes, thyroid, and adrenal gland
  
  
• Damage to part of the brain that controls the endocrine glands, since they release hormones that regulate fertility and pregnancy
  
  
• Chemotherapy (the use of drugs to kill cancer cells)
  
  
• Radiation therapy, especially to the pelvic area
  
  
• Surgery to any of the reproductive organs, such as the cervix, fallopian tubes, uterus, and ovaries in women and the testicles in men can cause infertility. 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. For women, removal of an ovary does not cause infertility unless the other ovary is not producing eggs.

In men, chemotherapy and radiation therapy 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.

Questions to ask the doctor about cancer treatment and fertility

Talk with your doctor about how cancer treatment may affect your fertility before starting treatment. 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 infertility from this treatment?
  
  
• 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 treatment? What about during or after treatment?
  
  
• Will my desire to attempt to preserve fertility make this cancer treatment less effective?
  
  
• Do I need to obtain a referral to consult a specialist in reproductive endocrinology (a doctor specializing in fertility issues)?
  
  
• What are my options for starting a family in the future?
  
  
• What support resources can you recommend for people facing fertility issues because of cancer treatment?

For women:

• How long must I wait after treatment before trying to become pregnant?
  
  
• What are the risks of becoming pregnant during cancer treatment, both to me and the unborn baby?

For men:

• Can I impregnate someone while receiving chemotherapy or radiation therapy? What are the risks to the unborn baby if this happens?

Options for preserving your fertility

Many options for preserving your fertility are available, depending on the type and stage of cancer; your beliefs, values, and comfort level of the various preservation methods, and whether you are in a relationship (for example, whether a woman currently has a partner for sperm donation). You have the most options to preserver fertility before treatment begins; learn more about fertility preservation.

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)

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.

More Information

Fertility and Cancer Treatment

Having a Child After Cancer Treatment (Part I)

Having a Child After Cancer Treatment (Part II)

Cancer and Your Body

Additional resources

LiveStrong: Female Infertility

LiveStrong: Male Infertility

American Society of Reproductive Medicine