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.
Learn more about:
- How cancer affects fertility
- How age affects fertility
- Risk of infertility
- Making decisions
- Costs for fertility treatments
How cancer affects fertility
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 treatments may cause the ovaries to produce fewer eggs. Hormone production between the brain and the ovaries may also be affected. Surgery to treat cancer may involve removing reproductive organs.
Men – Some treatments may cause issues with sperm quantity and quality (low numbers of sperm are made or the sperm that are made do not work properly) or poor sperm movement (motility). The tubes carrying the sperm may also be blocked. Sometimes reproductive organs are removed during an operation.
How age affects fertility
Age is one of the most important factors that influences the impact of cancer treatment on fertility. It affects both women and men.
Women’s age and fertility
- Age is the most important factor affecting future pregnancies for women.
- Women are born with all the eggs they will have in their lifetime, and as women age, their eggs age too.
- Fertility starts to decline after 30 and the decline speeds up after 35. It then becomes harder to conceive and the risk of genetic abnormalities increases.
- Before puberty, the effect of chemotherapy on the ovaries can be minimal. Radiotherapy may cause enough damage to the ovaries that puberty doesn’t occur normally.
- After puberty, the ovaries are very sensitive to the effects of both chemotherapy and radiotherapy, and the risk increases 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 puberty, the effect of chemotherapy on the testicles is minimal, but radiotherapy may cause enough damage to testicles so puberty doesn’t occur normally.
- After puberty, chemotherapy and radiotherapy affect sperm production and may cause infertility.
Risk of infertility
The risk of infertility varies between people. You will need to discuss the effect of treatment on your fertility with your oncology team and fertility specialists for individual advice.
The US organisation Livestrong provides an online tool that shows the risk of infertility based on treatment and type of cancer. See livestrong.org/we-can-help/fertility-services/risks.
After a cancer diagnosis, you will probably need to make several decisions about your fertility. This can be a confusing and complex process, particularly if you have several options to consider. You may feel that everything is happening too fast.
Gather information – Generally, people make better decisions – and have fewer regrets later – if they gather information and think about the possible consequences. Understanding your fertility options and considering the pros and cons of each option may help you make a well-informed decision.
Get expert advice – Ask your health professionals to explain your treatment options and the benefits and side effects of each.
Use a decision aid – A decision aid is designed to help you make choices about different treatment options by focusing on what matters most to you. Breast Cancer Network Australia has developed a resource called Fertility-related choices to help younger women with breast cancer make fertility-related decisions. Visit bcna.org.au/media/3685/bcn1189_fertility_booklet_2016_online.pdf.
Talk it over – Discuss the options with those close to you, like your partner or a close friend. As most decisions will affect others in your life, it’s also important to consider their opinions.
Expect to experience doubts – It’s common to feel unsure when making tough decisions. Keeping a journal or blog about your experience may help you come to a decision and review and reflect on your feelings later.
Costs for fertility treatments
Fertility treatments can be expensive, and this may be a factor in your decision. Costs vary across Australia and between organisations. Ask your doctor about Medicare rebates and talk to your provider if you have private health insurance.
Initial fertility specialist consultation and pre-treatment tests – You need a referral from your GP or a specialist obstetrician/ gynaecologist or cancer specialist to be eligible for Medicare rebates. A referral should list both you and your partner to enable you to claim the maximum benefit.
Ask the fertility specialist if they have special fees for people diagnosed with cancer, as sometimes this is the case.
The procedure (e.g. IVF cycle/day surgery) – The fees will depend on the procedure and whether you are a public or private patient.
There may be Medicare rebates for various IVF or ICSI procedures, including blood tests, fertility specialist consultations and medicines. Although there is no Medicare rebate for private day surgery procedures, some rebates exist for anaesthetist services.
If procedures occur in a public hospital fertility unit, there will be no fees for either day surgery or anaesthetist services. You may, however, experience lengthy delays waiting for treatment.
Egg, sperm and embryo storage/cryopreservation – These may be called advanced science costs. Storage costs vary for reproductive tissue.
It may be useful to ask about up-front payments, instalment payments and annual fees.