Chemotherapy and fertility

Published: 13 Mar 2019

Following on our menopause series, our final blog looks at the issues surrounding cancer treatment induced menopause and fertility. Learning that you have cancer is an extremely difficult experience and for many women. There are so many complex issues to consider and if you are young or of childbearing age, one of these might be how your treatment could affect your fertility. 

Speak with your doctor about your concerns - how your treatment could affect you. 

How can cancer affect fertility

There are many different cancers and treatments, some of which can result in temporary or permanent infertility whereas others infertility can be temporary.

Chemotherapy, radiotherapy, surgery, hormonal therapy and targeted therapy can affect your fertility in the following ways: 

•    It can result in surgery to remove womb and ovaries
•    It can reduce the quality of eggs in the ovaries 
•    Affect the function of the pituitary gland, which is responsible for reproductive hormones
•    Damage the womb, cervix or ovaries 
•    The onset of menopause

Will I get the menopause or menopause symptoms?

•    Chemotherapy can stop your ovaries from working, which can result in temporary or permanent infertility. You may still get symptoms of the menopause even if it is a temporary side effect
•    If higher doses of drugs are being administered it can start the menopause
•    If you’re nearing the natural age of menopause, chemotherapy can kick start menopause. This is usually permanent
•    If you require surgery to remove your ovaries and womb this will result in permanent infertility and the onset of menopause

What can you do if you are thinking about protecting your fertility?

With many women choosing to have children later, a growing number find themselves dealing with a cancer diagnosis at a time when they may have hoped to have children or increase their brood. Regardless of age, the biggest issue facing women that want to protect their fertility following a cancer diagnosis is the time it takes to implement precautionary measures.

If you want to start a family in the future, talk to your doctor about the option to freeze your eggs, embryos or ovarian tissue until your treatment is over. Not all of these methods are guaranteed and you will need to do it before beginning your treatment. 

•    Egg Harvesting is the process of stimulating ovaries to produce eggs for harvesting, freezing and storage. If you have the time to proceed before your treatment starts, fertility specialist clinics can harvest your eggs, which can be frozen and returned to your womb using in vitro fertilisation (IVF) when you are ready to use them
•    Embryo creation and freezing is a step on from egg harvesting.  Once eggs have been harvested, your partner’s sperm or donor sperm can be used to create embryos, which can be frozen and stored until you are ready to have them implanted. If you have had a hysterectomy, or if you have had a cancer linked to hormones, such as breast cancer, you can opt to use a surrogate/gestational carrier
•    Freezing ovarian tissue is another option to consider as a means to preserving your fertility before chemotherapy starts. Healthy ovarian tissue can be harvested before cancer treatment and implanted back in to your womb after treatment ends, which can help your body to produce eggs and remain fertile

This is a relatively new treatment and there is insufficient data on the number of children that have been born as a result of using the treatment, but it’s extremely effective at encouraging healthy reproductive patterns in women and girls after cancer treatment.

Periods and contraception

Many women notice that their periods stop during chemo but this doesn’t necessarily mean that you’re not producing eggs and it doesn’t guarantee you won’t get pregnant during your treatment. Contraceptives are usually recommended until your treatment is over if you have not already gone through the menopause.  

•    Barrier contraception is usually advised while you are undergoing chemo to stop your partner absorbing the medication through shared body fluids
•    If you’re a woman having cancer treatment and take the contraceptive pill, injection, use a Merina coil you should check with your doctor to see if it’s still safe to use these medications during treatment 
•    If you are taking HRT you should check with your doctor to see if it’s still safe to use during treatment


Getting pregnant after chemotherapy


Most women are advised to wait a couple of years after their treatment before trying to get pregnant.  This is because if cancer is going to return, it is most likely to happen in the first two years following diagnosis and treatment. Speak to your doctor or a fertility specialist to get their advice about the best time to start trying for a baby.


Living with infertility


Although many people go on to have healthy children after cancer treatment, learning that you are unable to have children can be devastating. If you haven’t been able to take fertility preventative measures before treatment, don’t be disheartened, you can try:

•    Donated embryos, eggs and sperm can help women to conceive using IVF
•    Adoption
•    Surrogacy 

Some people aren’t affected by the prospect of infertility when they are first diagnosed, but may feel differently after treatment or even years later.  Not being able to have children may make you feel less attractive to your partner or future partners and it’s not uncommon to feel sad or angry.

If you have a partner, talk to them about the implications, options and share your feelings on the subject of starting a family so that can both make informed decisions for the future. If you’re not in a relationship, talk to a close friend, relative or your ‘cancer family’, whose stories and experiences may provide you with comfort or ideas on things to try.   

Your cancer care team may be able to suggest books, support groups or recommend a specialist fertility counsellor that can give you support and ideas to help you come to terms with issues arising from your cancer treatment.

Why not join the chemo support group on Facebook.