Fertility options after cancer treatment may be limited.
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Overview
Your ability to become pregnant depends on the effects of cancer treatment on fertility, your age and whether you have been affected by premature ovarian insufficiency or early menopause.
Options to consider include:
- conceiving naturally
- using eggs or embryos you harvested and stored before treatment, implanted into either your body or a surrogate
- freezing eggs or embryos after treatment ends for later use (if your ovaries are still working)
- using donor eggs or embryos.
Checking fertility after treatment
Before trying to conceive, you may want to do some tests to see how your fertility has been affected. While there is no reliable way of checking how treatment has affected your fertility, these tests provide your fertility specialist or reproductive endocrinologist with some information. You can ask them how much the tests will cost.
Blood tests
You may have a variety of blood tests.
Follicle-stimulating hormone (FSH) – This can measure the hormone FSH, which may indicate how close to menopause you are. This hormone is produced by the pituitary gland in the brain, 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 2–4 days – as levels change throughout the month.
Anti-Müllerian hormone (AMH) – This measures the hormone AMH, which is released by the developing eggs in the follicles. The level of AMH in the blood is an estimate of the number of eggs left in the ovaries. A high level of AMH may mean you have more eggs. It does not reflect egg quality or the ability to have a baby. AMH is usually low after cancer treatment but may increase once you’ve recovered from chemotherapy. If it remains low or unmeasurable after chemotherapy for breast cancer, this is a sign menopause is permanent.
Oestrogen (oestradiol) – This is produced mainly in the ovaries. The level of oestradiol rises and falls throughout the menstrual cycle, so a single measurement does not give good information about fertility.
Luteinising hormone (LH) – This hormone helps the ovaries release an egg. High levels of LH may be a sign that your ovaries have stopped working (premature ovarian insufficiency or POI).
Ultrasound
Transvaginal ultrasound – An ultrasound uses echoes from soundwaves to create a picture of the cervix, uterus, fallopian tubes and ovaries. A technician will insert an ultrasound wand, which is covered with a disposable plastic sheath and gel, into the vagina. A scan of the abdomen is an option for younger people.
Antral follicle count (AFC) – An ultrasound wand is inserted into the vagina to show the number of follicles in the ovaries. Each follicle contains a single immature egg.
Natural conception
You may be able to conceive naturally after finishing cancer treatment if your ovaries are still releasing eggs and you have a uterus. If fertility tests suggest it may be possible for you to get pregnant, your medical team will encourage you to try for a baby naturally.
Even if your periods return after chemotherapy or pelvic radiation therapy, there is a high risk of early menopause. If menopause is permanent, you will no longer be able to conceive naturally.
If your ovaries are still working, you may be able to freeze eggs or embryos after treatment ends for later use.
Donor eggs and embryos
If after cancer treatment you have early menopause but a healthy uterus, you could try for a pregnancy using eggs or embryos donated by another person. You may be able to use eggs or embryos from overseas, but there are strict rules about importing them into Australia. Donors cannot be paid but you can cover (reimburse) their medical expenses.
Using donor eggs
In most cases, eggs are donated by a family member or friend. Your fertility clinic may have an egg bank, but there is usually a long waiting list. All donors are required to have blood tests, answer questions about their genetic and medical information, and have counselling.
After the eggs are collected from the donor, they are combined with sperm from your partner or a donor using IVF. The embryo is frozen until needed.
Using donor embryos
Donor embryos usually come from people who still have frozen embryos after they’ve had successful IVF treatment. Embryos may be donated for ethical reasons (instead of discarding the embryos) or compassionate reasons (to help someone with infertility).
If you use a donated embryo, you will take hormones to prepare your uterus for pregnancy. When your body is ready, the embryo will be thawed and implanted into your uterus using IVF. A child born from a donated embryo is deemed to be the child of the birth mother. Donors have no legal or financial obligation to the child. It is common to have counselling before beginning the IVF process.
Finding information about the donor
In Australia, fertility clinics can only use eggs and embryos from donors who agree (consent) that people born from their donation can find out who they are. This means that the donor’s name, address and date of birth are recorded.
Once donor-conceived people turn 18, they are entitled to access identifying information about the donor.
In some states, a central register is used to record details about donors and their donor-conceived offspring. Parents of donor-conceived children, and donor-conceived people who are over the age of 18, can apply for information about the donor through these registers. In other states and territories, people who want information about their donor can ask the clinic where they had treatment.
It is important to discuss possible issues for donor-conceived children with a fertility counsellor.
Uterus transplant is being studied in clinical trials. Talk to your doctor about the latest research and whether there are any suitable clinical trials for you.
→ READ MORE: Male options before cancer treatment
More resources
Prof Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne and Director, Gynaecology Research Centre, The Royal Women’s Hospital, VIC; Dr Sally Baron-Hay, Medical Oncologist, Royal North Shore Hospital and Northern Cancer Institute, NSW; Anita Cox, Cancer Nurse Specialist and Youth Cancer Clinical Nurse Consultant, Gold Coast University Hospital, QLD; Kate Cox, McGrath Breast Health Nurse Consultant, Gawler/ Barossa Region, SA; Jade Harkin, Consumer; A/Prof Yasmin Jayasinghe, Director Oncofertility Program, The Royal Children’s Hospital, Chair, Australian New Zealand Consortium in Paediatric and Adolescent Oncofertility, Senior Research Fellow, The Royal Women’s Hospital and The University Of Melbourne, VIC; Melissa Jones, Nurse Consultant, Youth Cancer Service SA/NT, Royal Adelaide Hospital, SA; Dr Shanna Logan, Clinical Psychologist, The Hummingbird Centre, Newcastle West, NSW; Stephen Page, Family Law Accredited Specialist and Director, Page Provan, QLD; Dr Michelle Peate, Program Leader, Psychosocial Health and Wellbeing Research (emPoWeR) Unit, Department of Obstetrics and Gynaecology, The Royal Women’s Hospital and The University of Melbourne, VIC; Pampa Ray, Consumer; Prof Jane Ussher, Chair, Women’s Health Psychology, and Chief Investigator, Out with Cancer study, Western Sydney University, NSW; Prof Beverley Vollenhoven AM, Carl Wood Chair, Department of Obstetrics and Gynaecology, Monash University and Director, Gynaecology and Research, Women’s and Newborn, Monash Health and Monash IVF, VIC; Lesley Woods, 13 11 20 Consultant, Cancer Council WA.
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