Fertility and cancer
It is common for people affected by cancer to wonder about their ability to have children now or in the future. Sometimes cancer and its treatment can affect a person’s ability to conceive a child or maintain a pregnancy (fertility).
If you want to become a parent, add to your family, or even if you’ve not thought about having children, we hope this information will help you understand how to preserve your fertility before treatment and protect it during treatment, and explain your options after treatment.
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Cancer and its treatment may cause fertility problems. This will depend on the type of cancer and treatment you have. Infertility can range from difficulty having a child to the inability to have a child. Infertility after treatment may be temporary, lasting months to years, or permanent.
Women – Some cancer treatments may damage the ovaries and decrease the number of available eggs. Hormone production between the brain and the ovaries may also be affected. Surgery, radiation therapy and chemotherapy to treat cancer may damage reproductive organs.
Men – Some cancer treatments may affect sperm quantity (low numbers of sperm are made), quality (the sperm that are made do not work properly) or motility (the sperm move poorly). Sometimes the testicles also become damaged or other reproductive organs are removed during surgery.
Age is one of the most important factors that influences the impact of cancer treatment on fertility.
Women’s age and fertility – Women are born with all the eggs they will have in their lifetime, but as women age, the number of eggs reduces. Fertility starts to decline after 30 and the decline speeds up after 35. It then becomes harder to conceive and the risk of genetic abnormality in the baby increases.
The impact of cancer treatments can vary with age.
Before puberty, the ovaries are more protected from chemotherapy or radiation therapy, although the effect of these treatments on fertility can range from mild to severe, depending on the drugs used and the dose. High doses may sometimes cause enough damage to the ovaries that both the onset of puberty and future fertility are affected.
After puberty, the ovaries are more sensitive to the effects of both chemotherapy and radiation therapy, and the risks increase as women get older. Even if reproductive function returns after treatment, women may experience early menopause.
Men’s age and fertility – The quality and quantity of men’s sperm decreases with age. This means it will take longer for their partner to get pregnant. Before and after puberty, chemotherapy and radiation therapy may affect sperm production and may cause infertility. The effect of radiation will depend on where the radiation is given and dose.
Dr Yasmin Jayasinghe, Paediatric Gynaecologist, Royal Children’s Hospital Melbourne, Co-chair Fertility Preservation Taskforce, Melbourne, and Senior Lecturer, Department of Obstetrics and Gynaecology, University of Melbourne, VIC; Dr Peter Downie, Head, Paediatric Haematology-Oncology and Director, Children’s Cancer Centre, Monash Children’s Hospital, and Director, Victorian Paediatric Integrated Cancer Service, VIC; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Aaron Lewis, Consumer; Pampa Ray, Consumer; Dr Sally Reid, Gynaecologist, Fertility SA and Advanced Gynaecological Surgery Centre, Visiting Consultant, Women’s and Children’s Hospital, and Clinical Senior Lecturer, School of Paediatrics and Reproductive Health, The University of Adelaide, SA; A/Prof Kate Stern, Head, Fertility Preservation Service, The Royal Women’s Hospital and Melbourne IVF and Head, Endocrine/Metabolic Clinic, Royal Women’s Hospital, and Co-chair, AYA cancer fertility preservation guidance working group, VIC.
Fertility and Cancer was developed as part of a research study into the experience of fertility after cancer led by Prof Jane Ussher at the Centre for Health Research, Western Sydney University. We acknowledge the input of Dr Amanda Hordern and Prof Jane Ussher, who collaborated on the original draft. We thank CanTeen Australia and the American Cancer Society for permission to draw on their resources. We also thank the cancer survivors who took part in the Western Sydney University research project on fertility and cancer, and whose accounts have been quoted in this booklet.
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