How are cancer treatments and fertility linked?  

There are many common conditions and situations that can impact a person's ability to conceive a child. Cancer and its treatments can have an impact on fertility at many points, including before, during or after treatment. Even if you are not sure if you want to have children in the future, it is recommended that you explore your options with a reproductive specialist.  

What do fertility and infertility mean? 

• Fertility is the ability to conceive a biological child   

• Infertility is the inability to conceive a biological child.  

• Biologic means that you are genetically related.   

What treatments or factors can cause infertility?  

• There are many contributing factors to infertility and cancer. Some cancer treatments may affect fertility due to effects on hormones, organs or glands that regulate hormones, like the hypothalamus, ovaries, testes, or uterus.   

• The type of treatment, comorbidities, and age at the time of cancer diagnosis can impact fertility.  

• Cancer treatments may damage or destroy the cells essential for reproduction or damage the reproductive organs themselves.  

• Chemotherapy: Specific types of chemotherapy are known to affect fertility. One class of medications with an elevated risk of damage to reproductive cells are alkylating agents.    

• Radiation therapy: Radiation to specific parts of the body, including abdomen, pelvis, lower spine, testicles, prostate, or to the pituitary gland in the brain may cause problems with fertility.  

• Surgery: Removal of certain glands or organs may affect fertility including, but not limited to removal of the prostate, one or both testicles, ovaries, uterus, or hypothalamus.  

• Hormone therapy: Hormone therapies used to treat certain cancers, including breast cancer in women, may affect fertility. Depending on the patient, treatment and other factors, infertility associated with treatment may be either temporary or permanent. 

What is fertility preservation?  

Fertility preservation refers to procedures or interventions used to protect your ability to conceive a child after treatment. To make an informed decision about your future, it is important for you to fully understand the impact your cancer treatment could have on future fertility. Discussions about fertility can be complex and multifaceted. Given the effects that many cancer treatments may have on reproductive function, you should discuss your risks of infertility, and any risks associated with future goals of conception as soon as possible and ideally before you initiate treatment. In some cases, it is safe to undergo fertility preservation before treatment. In other cases, starting treatment may be urgent, not allowing time for fertility preservation.  

Questions to consider when making the fertility choice that is best for you: 

• How important is it for you to have a biological child?  

• How comfortable are you using assisted reproductive technology?  

• What concerns do you have about the safety or risks of any reproductive technology, fertility treatments?  

• Are there religious, cultural, or ethical factors that impact your decision?  

• What are the perspectives of any spouses or partners?  

• Are there financial considerations to utilizing reproductive technologies?  

• Different states may have mandated coverage for fertility treatments related to cancer treatment.  

Note: It might be helpful to talk to a mental health therapist to support decision making or explore the emotional impact of fertility changes. Consider making an appointment with an Iris mental health therapist.   

Prevention and treatment of infertility  

Fertility preservation options are best pursued before the start of treatment if your doctor thinks this is safe. Some options you may consider include:  

• Sperm banking   

• Egg freezing  

• Embryo cryopreservation  

• Ovarian suppression  

• Ovarian tissue freezing   

• Radiation shielding   

Alternative options 

It is important to remember that even if it is not possible for you to have biological children (or children that share your DNA), it may still be possible for you to be a parent. Here are some alternatives: 

• Donor sperm or eggs  

• Donor embryo 

• Adoption 

Preventing pregnancy during treatment  

Certain treatments can damage your reproductive cells, but not render you infertile. It is important to use contraception while undergoing treatment. Discuss with your oncologist which methods of contraception are suitable for you and your partner.  In certain cases, like with some breast cancers, there are types of birth control that may not be recommended.  

Questions you might consider asking your doctor   

To make informed decisions about your care, we recommend asking your doctor the following list of questions: 

• Is it safe for me to continue to have sex during treatment?   

• Will my cancer/treatment affect the potential for me to have children in the future?   

• If so, is it safe to pursue fertility preservation prior to starting treatment?   

• Is there a risk to the outcome of the cancer treatment if we delay?   

• Is there a fertility specialist with experience working with cancer patients that you recommend?  

• Does any treatment I previously had affect my ability to have children in the future?  

• What should I do if I am unsure if I want children in the future?  

• Now that I have finished treatment, when might it be safe to try to conceive?