Assessing fertility after treatment

After cancer treatment, you may want to do some tests to see how your fertility has been affected. The results will help the specialist recommend the best options for having a child after cancer treatment.

You may decide to wait until you feel physically and emotionally prepared to know the results – this may be months or even years later. A partner, friends, family or your medical team might provide support to you when you receive the results.

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Fertility tests for women

Your fertility specialist or reproductive endocrinologist can do a number of tests to assess your likely fertility status after treatment.

Follicle-stimulating hormone (FSH) – A blood test can measure the hormone FSH, which may indicate how close to menopause you are. This hormone is produced in the pituitary gland, and stimulates the follicles in the ovaries, which will in turn release eggs. FSH levels need to be measured on specific days of the menstrual cycle – usually the first couple of days – as levels change throughout the month.

Transvaginal ultrasound – An ultrasound probe is inserted into the vagina to examine the structure of the reproductive organs, such as the cervix, uterus, fallopian tubes and ovaries.

Antral follicle count (AFC) – An ultrasound probe is inserted into the vagina to count the number of follicles in the ovaries. Each follicle contains a single immature egg.

Anti-Müllerian hormone (AMH) – This blood test measures AMH, which is a hormone secreted by the developing egg sacs (follicles). The level of AMH in a woman’s blood is an estimate of the number of eggs left in the ovaries.

Ovarian volume – An ultrasound probe is inserted into the vagina to show the volume of the ovaries. Usually the combined volume is about 10 mL. Women with an ovarian volume of less than 4 mL often find it challenging to become pregnant.

Oestrogen (oestradiol) – This is produced mainly in the ovary. The level of oestradiol in a women is a sign of ovulation.

Luteinising hormone (LH) – A blood test can measure LH levels. This hormone helps a woman’s ovaries release an egg. High levels of LH may be a sign of premature ovarian insufficiency.


Fertility tests for men

After treatment, you may be able to have an erection and achieve ejaculation, but this doesn’t necessarily mean you are fertile.

Follicle-stimulating hormone (FSH) – A blood test can measure FSH. This hormone is produced in the pituitary gland. In males, FSH stimulates sperm production. The level of FSH goes up during puberty, and varies throughout the day.

If FSH levels are high, this is a sign that fewer sperm are being produced. If FSH levels are low, this indicates that the pituitary gland is damaged. This will affect the number of sperm produced. This does not necessarily mean that sperm production is too low for a pregnancy but it is a sign of whether or not fertility has been affected.

Luteinising hormone (LH) and testosterone – A blood test can measure LH and testosterone levels. LH is important in fertility, because it maintains the amount of testosterone that is produced by the testicles. This also helps with sperm production, muscle strength, and general sexual health including sex drive (libido).

Like many hormones in the body, LH and testosterone levels are different at different times of the day. They are highest in the morning, so the test is done earlier in the day. It is important to tell your doctor whether or not you’ve been smoking marijuana, as this will lower LH and testosterone levels.

Semen analysis (sperm count) – This test can show if you are producing sperm and, if so, how many there are, how healthy they look, and how active they are. You will go into a private room and masturbate until you ejaculate into a small container. The semen sample is sent to a laboratory for analysis. The results will help the fertility specialist determine whether you are likely to need stance to conceive.

If you stored sperm in a sperm bank before cancer treatment, your doctor can compare this sample to your sperm sample after treatment.


If cancer genes are present

A small number of people have a greater risk of developing certain cancers, such as breast, ovarian or bowel cancer, because they carry a changed gene. You can discuss the risk of any future children inheriting a predisposition to cancer with your doctor or a genetic counsellor.

If you have a faulty gene, you may want to consider having a pre-implantation genetic diagnosis (PGD) test. During a PGD, a woman goes through the IVF cycle. While the embryos are developing in the laboratory, a few cells are removed from each embryo and tested for genetic conditions. Only unaffected embryos are implanted into the woman’s uterus, increasing the chance of the faulty gene not being passed onto the child. You can discuss this option with your fertility specialist.

If you are concerned about your family history of cancer, visit a familial cancer centre for advice. To find a familial cancer clinic, visit Cancer Council Australia.


Click on the icon below to download the booklet Fertility and Cancer.


Printed copies are available for free - Call 13 11 20 to order

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Apple devices

The iBooks application must be installed on your Apple device before you can read the EPUB.
Different ways to download an EPUB file to your Apple device:

  • email EPUB files to yourself and transfer the attachment to iBooks.
  • copy EPUB files into DropBox (or a similar service) and use the DropBox app to send them to iBooks.
  • open EPUB files directly from Mobile Safari and open them in iBooks, where they are saved automatically by downloading the EPUB from the website.

Need more help? Visit: http://support.apple.com/kb/HT4059

Kobo

To download an EPUB file to your Kobo from a Windows computer:

  • download and save the EPUB directly onto your desktop.
  • connect your Kobo to your computer using the USB cable and tap “Connect” on your eReader.
  • select “Open folder to view files” to view the contents of your Kobo.
  • navigate to where you have stored your EPUB file in “Finder”, in documents or downloads, and drag and drop it into the Kobo window. You can now disconnect your Kobo to read the eBook.

To download an EPUB to your Kobo from a Mac:

  • download and save the EPUB directly onto your desktop.
  • connect your Kobo to your computer using the USB cable and tap “Connect” on your eReader.
  • open your “Finder” application.
  • select “Kobo eReader” from the listed devices to view the contents of your Kobo.
  • navigate to where you have stored your EPUB file in “Finder”, probably in documents or downloads, and drag and drop it into the Kobo window. You can now disconnect your Kobo to read the eBook.

Turn on your Kobo and your EPUB will be located in “eBooks”, while a PDF will be located in “Documents”.
Need more information? Visit: http://www.kobo.com/help/koboaura/response/?id=3784&type=3

Sony Reader

To download an EPUB file on your Sony Reader™:

  • ensure you have already installed the Reader™ Library for PC/Mac software
  • select the eBook you want from our website and click the link to download it.
  • connect the Reader™ to your computer.
  • open the Reader™ Library software and click “Library” in the left-hand pane and select the eBook to view it.

Need more help? Visit: https://au.readerstore.sony.com/apps_and_devices/

Amazon Kindle 2nd Generation devices

EPUB files can’t be read on the Amazon Kindle™. However, like most eReaders, Kindle™ 2nd Generation devices are able to display PDFs. We recommend that you download the PDF version of this booklet if you would like to read it on a Kindle™.
To transfer a PDF to your Kindle™ via USB cable from your computer or Mac:

  • download the PDF directly onto your computer.
  • connect the USB cable to your computer’s USB port, and the micro USB end of the cable to your Kindle™. Note: the Kindle™ won’t be available as a reading device while it is connected to your computer until it has been disconnected.
  • open the Kindle™ drive and several folders will appear inside. The “Documents” folder is where you will need to copy or drag the PDF to.
  • safely eject your Kindle™ from your computer and unplug the USB cable. Your content will appear on the Home Screen.

Kindle also provides a Kindle Personal Documents Service that allows users to send documents as an attachment directly to your eReader. For more information on this service, visit http://www.amazon.com/gp/help/customer/display.html/ref=help_search_1-1?ie=UTF8&nodeId=200767340&qid=1395967989&sr=1-1
For more information on accessing a PDF on your Kindle™, visit www.amazon.com/manageyourkindle, log in to your account and click on Personal Document Settings.
Need more help? Visit https://www.amazon.com/gp/help/customer/display.html?nodeId=200375630

Android and PC

You can also download and open eBooks on Android devices and PCs with appropriate apps or software installed. Suitable eReader apps for Android include Google Play Books, FBReader and Moon+ Reader. Suitable software for PCs include Calibre and Adobe Digital Editions.


This information was last reviewed in May 2018
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