Some cancer treatments can make it hard to have children. The ability to have children is called fertility. Chemotherapy, radiation therapy, and surgery that harms the reproductive organs can affect fertility.
Infertility is the inability to have a child. Infertility is the inability to have a child. It may be caused by:
Low levels of sperm or eggs
Low levels of hormones that control reproduction
Scarring or removal of the reproductive organs, which prevents conception or normal development of a pregnancy
However, there are usually options to protect fertility during cancer treatment. These include:
Collecting and freezing sperm, eggs, or embryos before treatment.
Protecting a person’s reproductive organs during treatment.
You may also be able to start or expand your family through what is called third-party reproduction. This includes:
Egg donation for women (if your ovaries do not produce healthy eggs anymore)
Sperm donation for men (if your testicles do not produce healthy sperm anymore)
Surrogacy for women (if your uterus is not able to carry a pregnancy or it is unsafe for you to get pregnant)
Be aware that these options may be expensive or legally complicated. Seek help and support as you make a decision.
Options for women
Women are born with a set number of eggs in their ovaries, called the ovarian reserve. This reserve naturally lowers as a woman ages. But certain types of chemotherapy may further lower it.
Having fewer eggs may make it hard to become pregnant. And a low ovarian reserve may lead to early menopause, meaning no eggs are left. Your doctor can test your ovarian reserve using blood tests and an ultrasound.
If you have or are at risk for low ovarian reserve because of cancer treatment, a fertility specialist can tell you about options to preserve your fertility or improve your chances of becoming pregnant. These may include the following:
In vitro fertilization (IVF). This is a common form of assisted reproduction. IVF uses specific drugs to stimulate the ovaries to make eggs. These eggs are collected and then fertilized with sperm in the laboratory. If this is successful, the egg will develop into an embryo. Later on, the embryo will be put back into the woman’s uterus to grow into a baby.
Donor eggs. A woman may store her eggs before treatment. Doing this is a way of preserving fertility. If a woman did not store her eggs before starting treatment, she can use donor eggs.
Donor eggs are from another woman. They may be used to become pregnant when a woman's ovaries no longer has eggs. The donor eggs are fertilized in a laboratory with sperm. The sperm may come from the woman’s partner or a donor. Fertilized eggs, called embryos, are then put into the uterus of the woman who wants a child. A woman’s uterus must be healthy to become pregnant and to carry a pregnancy to term. She will have to take hormones before and after receiving the embryos.
Donor eggs allow the child to carry the genes of at least 1 parent. Egg donors may be:
Known donors from an agency
Before they can donate eggs, all donors are screened for:
Potential genetic diseases
Donor embryos. Similar to storing eggs before treatment, a woman may preserve embryos before treatment. Infertility treatment can result in extra embryos. When this happens, couples may donate their embryos. The process is like egg donation. Donated embryos are put into the uterus of the woman who wants a child.
A child born from a donated embryo will not carry the genes of the parents who chose a donor embryo. But the procedure allows a woman to experience pregnancy. This is also called embryo adoption.
Surrogacy and gestational carriers
Sometimes, a woman may not be able to give birth to a child. For some women, being pregnant could even be dangerous. In situations like this, having another woman carry the baby during pregnancy may be an option.
Surrogacy. Surrogacy involves a woman who will carry the baby through pregnancy. The woman carrying the baby is called a surrogate. The sperm of the man who will be the child’s biological father is inserted into the cervix or uterus of the surrogate. This process is called artificial insemination. The child will carry the genes of the woman.
Gestational carrier. A gestational carrier is a woman who will carry an embryo from another woman’s egg and her partner’s sperm. The child will not carry the genes of the gestational carrier.
Surrogacy and gestational carrier laws are different in each state. It is important to consult an attorney if you choose this path for having a baby.
Options for men
Donor sperm. A man may store his sperm before treatment. Doing this is a way of preserving fertility. If a man did not store his sperm before starting treatment, then he can use donor sperm. Donor sperm is given to a sperm bank by another healthy man. The donor is usually anonymous. But sperm banks typically record the donor’s physical traits and screen the sperm for infectious diseases. The child will carry the genes of the sperm donor.
Testicular sperm extraction. A man may have no sperm in his semen after cancer treatment. But he may still have healthy sperm in his testicles. During a testicular sperm extraction, the doctor removes small pieces of testicular tissue. Any healthy sperm cells found in this tissue can be used to make a baby. The sperm can be used in IVF or frozen for future use. This method is not as successful as other ways of collecting and storing sperm.
When a couple or individual adopts a child, they are the permanent, legal parents of the adopted child. Most adoption agencies allow cancer survivors to adopt. Some agencies may require a health care provider’s letter saying that you are in good health. Other agencies may require a certain amount of time to pass after cancer treatment before you can adopt.
Adoption options include:
Domestic or international adoption. Domestic adoption is when you adopt a child from the country you live in. Domestic adoption can include newborns or toddlers and school-age children from foster care.
International adoption is when you adopt a child from a country you do not live in. Most international adoptions involve toddlers or school-age children.
Different countries have different restrictions for people who want to adopt. These may include a health history, income requirements, age, or marital status. If you are interested in adoption, talk with a social worker to learn more.
Open or closed adoption. In open adoptions, the birth parents and adoptive parents communicate. This is also called a fully disclosed adoption. In a closed adoption, details about the birth parents and adoptive parents are kept private. Closed adoptions are rare.
Agency or independent adoption. Public adoption agencies are run by a country, state, or locality. Agencies are licensed and have to follow strict laws and rules. Independent adoptions are handled by an adoption lawyer or facilitator instead of an agency.
Questions to ask your health care team
Consider asking your health care team the following questions about having a baby:
How do I know if I can have a baby?
If I cannot have a baby, what are my options for becoming a parent?
Did cancer treatment affect my chances of becoming pregnant?
Can you recommend a fertility specialist?
Can fertility hormones or drugs cause my cancer to return? Can they cause a new cancer to develop?
Which infertility clinics specialize in cancer survivors?
How does my age affect my options?
Where can I learn more about the cost of each option?
Who can help me find resources about ways to pay for fertility treatment or adoption?
What legal or ethical issues surround my fertility options?
Where can I find adoption resources or support?
Where can I find surrogacy or gestational carrier resources or support?