Fertility in Women
Cancer treatments can affect fertility in different ways:
- chemotherapy can affect the ovaries. It can cause fewer or no eggs to be produced. Chemotherapy can have a temporary or permanent effect on fertility
- radiotherapy can affect egg production. It can also damage the ovaries or womb, and reduce hormone levels. Different types of radiotherapy have different effects on fertility
- surgery to your womb, ovaries or pituitary gland can affect your fertility
- hormonal therapy reduces or blocks the hormones in your body. The effects on fertility are usually temporary
- targeted therapies may have an effect on fertility but not much is known about this yet
Changes to fertility are permanent for some women, but temporary for others. Your doctor will be able to talk to you about any possible fertility risks with your treatment. You can speak to your doctor about having your fertility tested after you finish cancer treatment.
It is important to use contraception during cancer treatment as treatments could harm a developing baby.
Talking about fertility before treatment starts
Some cancer treatments can affect your fertility (your ability to have children). For some women, the possibility of losing their fertility can be very difficult to accept. Fertility in women depends on having:
- a supply of eggs from the ovaries
- suitable hormone levels
- a healthy womb (uterus)
Before your treatment starts, talk to your doctor or nurse about how your fertility may be affected. It’s not always possible for doctors to predict what will happen. Your age and planned treatment can help give an idea of your individual risk. Try to think about the questions you want to ask your doctor or nurse so you can get all the information you need. If you have a partner, it’s usually a good idea to include them too.
You may be able to visit a fertility expert before you start treatment to look at ways to increase your chances of having a baby later on. This depends on when your treatment has to start.
Preserving your fertility
You may be referred to a fertility clinic for advice before you start cancer treatment. This depends on your age and type of cancer. Doctors will talk about options that may allow you to have a baby in the future.
There are different ways of preserving your fertility:
- freezing eggs – your ovaries are stimulated to produce more eggs. These eggs are collected and then frozen
- freezing embryos – the collected eggs can be fertilised with sperm in a sterile dish. The sperm can be from a partner or donor. If the fertilised egg develops into embryos, these are frozen and stored
- if you later decide to try to get pregnant, the frozen eggs or embryos can be thawed and put into your womb
Scientists are researching a technique which involves removing and freezing ovarian tissue that may contain eggs. But very few babies have been born from this technique.
Using donated eggs, sperm or embryos
Some women or couples who have been affected by cancer may choose to use donated eggs or sperm. This isn’t funded by the NHS in all areas and there’s also a shortage of donors, so it may not be an easy option.
Women without a partner who want to freeze embryos rather than eggs before their cancer treatment may choose to use donor sperm. It can take a while to find a suitable donor and this may cause too long a delay to cancer treatment.
Women who are permanently infertile and didn’t have their own eggs or embryos stored before cancer treatment may consider using donor ones.
Choosing to use donated eggs, sperm or embryos is a difficult decision and it isn’t going to suit everyone. Some religions are against any type of fertility treatment; others are against using donors. Talk to your partner, family or religious advisor about any concerns you have. You can also talk to the staff at the fertility clinic about this.
Embryos are sometimes donated by other couples who have had fertility treatment previously. They may have several embryos stored and have to decide what to do with them when their family is complete.
Everyone who donates eggs, sperm or embryos is carefully selected:
- usually a donor is matched as closely as possible for eye and hair colour, physical build and ethnic origin
- the donor has to be fit and healthy with no previous medical problems
- the donor is tested for infectious diseases such as HIV, hepatitis B and C and some genetic conditions
Some women may consider adoption or surrogacy which is when another woman carries a baby for you. If you have had your womb removed or radiotherapy directly to the womb, adoption or surrogacy are your only options. The Human Fertilisation and Embryology Authority (HFEA) has information about surrogacy on its website hfea.gov.uk.
Some women choose not to have fertility treatment, adoption or surrogacy and go on to enjoy life without children. Everyone is different.
Fertility in men
Cancer treatments can affect fertility in different ways. You will be able to have your sperm tested after your treatment to see if you are producing healthy sperm.
- chemotherapy can slow down or stop sperm production. The effect it has will depend on the drugs you are having. You should still be able to get an erection and enjoy sex
- radiotherapy to the pelvic area can affect sperm production and erections. Radiotherapy to the brain or testicles can also reduce the levels of the male hormone, testosterone
- surgery in the pelvic area can cause problems with erections and ejaculation. Surgery to the pituitary gland in the head or to both testicles can reduce the levels of the male hormone, testosterone
- hormonal therapy reduces the level of testosterone. This can cause a loss of sex drive and problems with erections
These issues are permanent for some men, but temporary for others. Your doctor will be able to talk to you about any possible problems in your situation.
Talking about fertility before treatment starts
From puberty the testicles begin to make and store millions of sperm. This is mainly controlled by the hormone testosterone. You also need testosterone for your sex drive and to be able to get an erection.
Normally you need to have sex for a woman’s egg to be fertilised by your sperm. This involves getting an erection (erect penis) and ejaculating into a woman’s vagina. The fluid ejaculated (released) is semen, which contains sperm that can fertilise a woman’s egg.
Some couples need to have fertility treatment to have a baby. This is also called assisted conception. Different treatments can be used to help people who have difficulty getting pregnant naturally.
Being told you have cancer and that treatment may make you infertile can be very difficult. For some men, the possibility of losing their fertility may be as difficult to accept as the cancer diagnosis.
It’s important to talk to your cancer doctor or specialist nurse about fertility before starting treatment. Think about the questions you want to ask so you can get all the information you need. If you have a partner it’s usually a good idea to include them too.
If treatment can make you infertile, your doctor should talk to you about having your sperm stored before treatment starts. This is sometimes called sperm banking. It means you and a partner may be able to have a child later on, even if treatment makes you infertile.
If you decide to have fertility treatment later, it is important to remember that NHS rules will apply to your partner as well as to you. Fertility treatment rules and funding vary across the UK. Talk to your fertility specialist about this.
Your cancer doctor can refer you to a fertility clinic straight away. This means that having your sperm stored won’t cause too much delay to your treatment. But in some situations treatment has to start immediately, so sperm banking may not always be possible.
If you had cancer treatment in the past and are having problems with fertility talk to your cancer doctor. They can refer you and your partner to a fertility expert for tests and advice.
Preserving your fertility
It’s sometimes difficult to know whether cancer treatment will affect your fertility. Your doctors may advise you to store some sperm, even if you have a low chance of becoming infertile. Your sperm can be used after cancer treatment to help you and a partner have a child.
If you decide to store sperm, you will have to sign a consent form. You will usually be asked to provide samples of your sperm by masturbating. This will be in a private room at the fertility clinic. Sometimes you can provide a sample produced at home.
If you can’t provide a sample of sperm, there are still options for storing sperm. It may be possible to take fluid or tissue straight from the testicle. Doctors may be able to collect sperm from your urine if you have retrograde ejaculation. Researchers are looking into other ways of preserving fertility. Speak to your doctors about these options, as they can tell you if they are suitable for you.
Fertility options after cancer treatment
After cancer treatment, you may decide that you want to start a family. If you stored sperm before treatment, it may be used in the following ways:
- your sperm may be inserted in your partner’s womb
- your sperm may be mixed with your partner’s eggs in a laboratory
- a single sperm may be injected into one of your partner’s eggs
These techniques are thought to be safe and there don’t seem to be any risks to the child. However, there aren’t any guarantees that using these techniques will result in a pregnancy. You can talk to your fertility expert about this.
If cancer treatment has made you permanently infertile and you haven’t stored any sperm, you may be able to use donated sperm. Everyone who donates sperm is carefully selected but there is a shortage of donors in the UK.
Some men are offered testosterone replacement therapy to help with problems getting an erection or having a reduced sex drive. This treatment can affect sperm production. If you want to have children in the future, speak to your doctor before starting this treatment.
Infertility can be distressing to live with. Having children is an important part of many people’s lives or their future plans. It may seem especially hard when you’re already coping with cancer. Not knowing whether your fertility will come back or not can be hard to cope with.
Some people find it helpful to talk things over with their partner, family or friends. Others might prefer to talk to a trained counsellor. Your GP or cancer specialist can arrange this for you. Many hospitals also have specialist nurses who can offer support, and fertility clinics usually have a counsellor you can talk to.
Talking to other people in a similar position may help you feel less isolated. Some organisations can arrange this for you as well as providing specialist advice and counselling. Or you can talk to people online. The Macmillan online community is a good place to talk to other women or men who may be in a similar situation.