Key questions

Below are some common questions that people ask about the affects of cancer on fertility.

Learn more about:

• What is infertility?
• How does cancer affect fertility
• What is fertility preservation?
• How does age affect fertility after cancer?
• Should I have a child after I’ve had cancer?
• How long should I wait to conceive after treatment?
• Will getting pregnant cause the cancer to come back?
• If I’ve had cancer, will my children get cancer?
• What if I’m already pregnant?
• Which health professionals will I see

What is infertility?

Infertility is defined as difficulty getting pregnant (conceiving). This may result from female or male factors, or a combination of both. For females under 35, the term usually refers to trying unsuccessfully to conceive for 12 months; if a female is 35 or over, the term is used after six months of trying.

Infertility is more common than many people realise – it affects one in six Australian couples. Learn more about how infertility can affect how you feel and your relationships.

How does cancer affect fertility?

Cancer and its treatment may cause fertility problems. This will depend on the type of cancer and treatment you have. Infertility after treatment may be temporary, lasting months to years, or permanent.

Female reproductive organs

Some cancer treatments, especially chemotherapy and radiation therapy, may damage the ovaries and decrease the number of available healthy eggs. Radiation therapy may also damage other reproductive organs. Cancer treatments can reduce the level of hormones produced in the brain and the ovaries. Sometimes the reproductive organs are removed during surgery. All of these treatments can lead to early menopause.

For more on this, see Female fertility and cancer treatments.

Male reproductive organs

Some cancer treatments, especially chemotherapy and radiation therapy, may affect sperm quantity (low numbers of sperm are made), quality (the sperm do not work properly) or motility (the sperm move poorly). Sometimes, the reproductive organs are damaged or removed during surgery.

For more on this, see Male fertility and cancer treatments.

What is fertility preservation?

This describes the procedures that someone can use to help maintain their ability to have children, for example, freezing eggs, embryos or sperm. These procedures are usually done before you have cancer treatment that may affect your fertility, but some are also used after treatment.

How does age affect fertility after cancer?

Age is one of the most important factors that influences the impact of cancer treatment on fertility.

Female age and fertility

Females are born with all the eggs they will have in their lifetime. As they 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 problems in the eggs increases.

From the early 40s, although a woman still has regular periods, it is difficult to conceive a child because of poor egg quality. After menopause, it is no longer possible to conceive a child naturally.

The impact of cancer treatments can vary with age. Before and after puberty, the effect of chemotherapy and radiation therapy on fertility can range from mild to severe, depending on the drugs used and the dose.

Before puberty, high doses of drugs or radiation may sometimes cause enough damage to the ovaries that both the start of puberty and future fertility are affected. After puberty, treatment to the ovaries can cause periods to stop. Even if periods return after treatment, some women may experience early menopause.The first time I met my surgeon she said, ‘You should go and see a fertility specialist’. It all happened very quickly. The only way to describe the process is that it was overwhelming. However, it’s better not to delay it.

Male age and fertility

The quality and quantity of sperm decreases with age. This means it will take longer for an older man’s 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 in the body the radiation is given and the dose.

Should I have a child after I’ve had cancer?

This is a very personal decision. A cancer diagnosis may affect the way you think and feel about having a child. If you have a partner, you may want to discuss your family plans together. Fertility clinics often have counsellors who can talk through the pros and cons of your situation.

I was given a good prognosis, but we’re still nervous about what happens if it comes back and we leave a child without a parent. That’s my biggest concern.

Liam

How long should I wait to conceive after treatment?

This depends on many factors, including the type of cancer and type of treatment. Some cancer specialists advise waiting between six months and two years after treatment ends. This may be to allow your sperm or eggs to recover, and to ensure you remain in good health during this time. It’s best to discuss the timing and suitable contraception with your doctor.

For some fertility treatments, you will need to take extra hormones or stimulate your hormones. If you have a hormone-sensitive cancer, you may be given hormone receptor blockers to reduce the risk of the cancer coming back. For more on this, see Hormone therapy.

Discuss the potential risks of particular fertility treatments with your cancer or fertility specialist. Taking hormone receptor blockers during egg collection can help reduce the risks.

Will getting pregnant cause the cancer to come back?

Research shows that for most cancers pregnancy does not increase the chances of cancer coming back (recurring). However, sometimes it is hard to do any follow-up tests for cancer when a women is trying to conceive or is pregnant. Research is continuing, so it’s best to discuss this issue with your specialist.

Studies to date suggest that survival rates for people who have children after cancer treatment are no different from people who don’t have children after treatment.

Learn more about pregnancy and cancer here and here.

If I’ve had cancer, will my children get cancer?

Studies show that if one or both parents have a history of cancer, their child is at no greater risk of getting cancer than anyone else. A small percentage of some cancers (up to 5%) are caused by an inherited faulty gene from either the mother or father.

This is known as familial cancer. The faulty gene increases the risk of cancer, but even then it does not mean that a child will inherit the gene and develop cancer. For more on this, see If cancer genes are present.

A genetic counsellor is the most qualified person to give you up-to-date information about the genetic risks of cancers for family members. For more information call Cancer Council 13 11 20.

What if I’m already pregnant?

Being diagnosed with cancer during pregnancy is uncommon – it is estimated that one in every 1000 pregnant women is diagnosed with cancer.

It may still be possible to have cancer treatment during pregnancy. It’s best to discuss the potential risks and benefits with your oncologist before treatment begins. In some cases, treatment can be delayed until after the baby’s birth. For some cancers, chemotherapy may be safely used after the first trimester (12 weeks), usually with a break of a few weeks before the birth.

Some people diagnosed with cancer in the early weeks of pregnancy decide to terminate the pregnancy so they can start treatment immediately, while others who are diagnosed later in the pregnancy choose to have their baby before the due date.

You will be advised not to breastfeed during chemotherapy, targeted therapy or immunotherapy as drugs can be passed to the baby through the breastmilk. If you are having radiation therapy, talk with your doctor about whether it is safe to continue breastfeeding during your treatment course.

My oncologist wanted to start treatment as soon as possible, so it was a case of my obstetrician and oncologist deciding on a day to deliver my son, then starting my cancer treatment. He was delivered safely at 32 weeks.

Lily

Listen to our podcast on Coping with a Cancer Diagnosis