Infertility refers to the ability to conceive a child or maintain a pregnancy and is a significant, yet often overlooked, complication of cancer treatment for men and women. It is important to discuss concerns about preserving fertility openly with the treatment team from the time of diagnosis. Today, there are many options to help people diagnosed and treated for cancer to preserve their fertility.

How cancer treatment affects the body

Surgery, chemotherapy, and radiation therapy may all cause infertility. Surgery to the sex organs or areas around these organs may lower fertility. The risk of infertility from chemotherapy depends on the type and dose of drug and how it’s given. The risk of infertility from radiation therapy depends on the dose of radiation and the area of the body that is irradiated.

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 the cancer treatment damages one of these glands or alters the part of the brain that controls these glands. For example, chemotherapy and radiation therapy may reduce a man’s number of sperm cells or limit their mobility. In women, chemotherapy and radiation therapy may affect a woman's menstrual cycle, possibly causing her to stop ovulating and cause premature menopause.

Children past the age of puberty may be at greater risk for infertility than younger children. For example, a man’s testes are more vulnerable than a boy’s testes to the damaging effects of chemotherapy and radiation therapy. In the same way, the ovaries of girls can often tolerate higher doses of chemotherapy than the ovaries of women.

Because it is possible for a woman to become pregnant, or a man to impregnate a woman, during chemotherapy or radiation therapy, both men and women should talk with their doctor about birth control methods if they are sexually active during this time. Chemotherapy and radiation therapy may cause birth defects or harm the fetus.

Cancer treatment and fertility-preserving options

Decisions about how to attempt to preserve your fertility need to happen before cancer treatment. Age, gender, physical and sexual maturation, and, in some cases, relationship status (for example, whether a woman currently has a partner) affect the options available for fertility preservation. Your doctor and/or a reproductive endocrinologist (a doctor who specializes in fertility issues) can help you learn about your options.

Unfortunately, not all options are available or appropriate for everyone. Fertility-preserving procedures may be stressful during an already difficult time and are not always effective. A person may consider seeking counseling and guidance through this time when many decisions will need to be made. Also, be aware that many options, including in vitro fertilization (a process that involves collecting a woman’s eggs and fertilizing them with sperm outside her body and later transferring the embryo back into her body for it to develop) and embryo cryopreservation (freezing fertilized eggs for later reimplantation), may be costly. In addition, some people may face ethical questions about various options, so it is important to talk with your doctor and find the information you need to make the best decision.

Fertility-preserving options for men

Protection of the testes from radiation therapy. In men, it is possible to shield the testes from radiation if the cancer is present in other parts of the pelvis.

Sperm cryopreservation (sperm banking). This procedure involves freezing and storing of semen for men who wish to father children later in life. It is an option for most men who have reached sexual maturity.

Testicular-tissue cryopreservation and reimplantation. This investigational option is for men who have or have not yet reached sexual maturity and involves the removal, freezing, and storage of testicular tissue that is surgically reimplanted after cancer treatment.

Hormonal gonadoprotection. This is the use of hormone therapy to protect testicular tissue during chemotherapy or radiation therapy and is still investigational.

Fertility-preserving options for women

Protection of the ovaries from radiation therapy. For women receiving radiation therapy to the pelvic region, shielding one or both ovaries becomes more difficult. In many cases, both ovaries do not receive radiation treatment, so any resulting infertility may not be permanent. If both ovaries receive radiation treatment, infertility may be permanent. Another option is oophoropexy, which is surgically moving one or both ovaries out of the radiation field.

Embryo cryopreservation. This is the process of harvesting eggs for in vitro fertilization and freezing embryos for later use for women of reproductive age. Some ethical issues arise with this technique and require careful discussion, such as what to do with unused fertilized embryos.

Oocyte (unfertilized egg) cryopreservation. Freezing unfertilized eggs is currently investigational.

Ovarian-tissue preservation. This method is currently investigational; it requires surgical intervention with the removal, preservation, and reimplantation of ovarian tissue both before and after puberty. This may not be a practical option for girls under the age of 18 because of informed consent issues.

Gonadotropin-releasing hormones (GnRH) analog treatment. In this investigational approach, GnRHs are given with chemotherapy to potentially reduce the possible harmful effects of chemotherapy on the reproductive organs and lower the risk of infertility after treatment.

Abdominal radical trachelectomy. Recent research shows women with cervical cancer who have surgery to remove the cervix while keeping the uterus intact may become pregnant, and the baby can be delivered by cesarean section.

Oral contraception. Some research shows women who take oral contraceptives (birth control pills) during chemotherapy may conserve eggs following treatment. This approach is still investigational and may not be recommended for a woman with a tumor that is sensitive to hormones (such as some types of breast cancer).

Questions to ask the doctor about cancer treatment and fertility

It is important to talk with your doctor (or your child’s doctor) about how cancer treatment may affect fertility as early as possible in the treatment process. Many interventions to preserve fertility need to take place before cancer treatment begins.

Consider asking your doctor the following questions:

• What are the short-term and long-term effects of cancer treatment on my (or my child’s) fertility?
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• 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 could be considered that do not pose as high a risk but are equally effective?
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• What are the options for preserving my fertility before treatment?
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• What are the options for preserving my fertility during or after treatment?
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• Do any of these fertility preservation options make my cancer treatment(s) less effective?
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• Do any of these fertility preservation options increase the risk that the cancer may come back?
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• Can I become pregnant (women) or impregnate someone (men) while receiving chemotherapy or radiation therapy? What happens if pregnancy results during treatment? What is the risk of birth defects and/or harm to the fetus and/or mother?
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• How long must I wait after treatment before trying to become pregnant (women) or impregnating someone (men)?
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• Is it appropriate for me to consult a specialist in reproductive endocrinology?
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• Where can I find support for coping with fertility issues?

More Information

What to Know: ASCO's Guideline on Fertility Preservation

Having a Child After Cancer Treatment

Sexual and Reproductive Health

Survivorship

Additional Resources

Fertile Hope

Lance Armstrong Foundation: LiveSTRONG

American Cancer Society: Fertility and Cancer: What Are My Options?

American Society for Reproductive Medicine (ASRM)

RESOLVE: The National Infertility Association