If you’re a young woman having treatment for cancer, there’s a possibility that your fertility will be affected. Here we explain which treatments can affect fertility and about protecting fertility before you start treatment.
Your feelings about your fertility
Finding out that treatment will affect your fertility can be as devastating as the cancer diagnosis for some women. It’s a huge thing to take in when you’re already trying to deal with your feelings about having cancer. Obviously how you feel will be different if you’ve already got children. But even if you have, you may have wanted to have a bigger family. Even if you weren’t intending to have more kids, knowing that you can’t may be hard to accept and can change how you feel about your body.
If having a baby in the future is important to you, do tell your cancer specialist how you feel. They will do everything they can to try and choose treatment that won’t affect your ability to have children. Unfortunately, the options open to women to keep their fertility take time. And it’s often not possible to delay your cancer treatment long enough. But you need to have these conversations. Then in future, at least you’ll know you did everything you could. That might not seem like much comfort now, but it may help you to accept the situation in the future.
A lot of people feel they need counselling to help them sort through their feelings about fertility. Only you will know when the right time for this is. You may want to speak to someone as soon as you find out. Or you may feel you need to focus on your treatment for now. With some treatments, you won’t know for a while whether your fertility has been affected or not.
There is more about ways of keeping fertility below.
Which cancer treatments affect fertility in women?
Any treatment that affects your ovaries can cause infertility. That means:
- Surgery to remove your womb and ovaries
- Radiotherapy to your pelvis (lower abdomen), which includes or is near to your ovaries
- Hormone therapies that switch your ovaries off
- Some chemotherapy drugs
- Some targeted therapy drugs (also called biological therapies)
If you need to have your womb and ovaries removed to treat your cancer, you will definitely be infertile afterwards. If you have very early ovarian cancer, your doctor may be able to remove just one ovary so that you could get pregnant afterwards.
If you are young and have cervical cancer, your surgeon may be able to do a smaller operation called a trachelectomy. This removes only the lower part of the cervix. You can get pregnant after this but you will have to have a stitch put in to hold the cervix closed and prevent miscarriage. You may have to be on bedrest during the later part of your pregnancy to help stop the baby being born too early.
Any radiotherapy to your lower abdomen (tummy) can affect your ovaries. They are very sensitive to radiation. In some cases, it’s possible for a surgeon to move one or both ovaries so that they’re further away from the area being treated, so less likely to be affected. If at all possible, this is also done for girls who haven’t yet been through puberty, to give them the best chance of keeping their fertility in the future.
Your womb is also sensitive to radiation. After treatment, it will be less stretchy. Scar tissue may make it difficult for it to stretch enough to carry a baby throughout a full pregnancy.
Rarely, radiotherapy for a brain tumour can cause infertility, if your pituitary gland is in the treatment area. The treatment can stop you producing hormones that are involved in producing and releasing eggs.
Young women who’ve had breast cancer may have a type of hormone therapy that’s reversible. Zoladex (goserelin) switches off your ovaries. They may start working again once you stop having treatment, but this isn’t guaranteed. The closer you are in age to the start of your natural menopause, the more likely you are to be permanently infertile.
Having Zoladex during chemo may help to stop the treatment making you infertile. This is currently being researched and we don’t know for sure whether it works.
Most people think of chemo when they think of cancer treatment making you infertile. But in fact, not all chemo drugs will do this. Your specialist will try to use chemo drugs that are less likely to cause infertility if you’re young and would like to have children in the future.
Unfortunately they can’t always tell how treatment will affect you. Even chemo drugs that are less likely to affect fertility can do. It also depends on the amount of treatment you have and your age when you’re treated. The closer you are to the age when you’d naturally have your menopause, the more likely it is that chemo will cause infertility and a premature menopause.
Your periods may stop or be irregular during chemo but come back afterwards. About a third of women whose periods stop have regular periods again 6-12 months after treatment finishes.
Targeted and biological therapies
Many of these treatments haven’t been around for long enough for doctors to know how they will affect your fertility. We already know that some do. A drug called Avastin (bevacizumab) can cause ovarian failure.
Contraception and cancer treatment
If you’re pre-menopausal and you are having any sort of drug treatment for cancer, it’s really important to use contraception. Chemo and biological therapies can severely damage a developing baby so you really don’t want to get pregnant during treatment. Your doctor may ask you to use contraception for up to six months after treatment finishes. With some treatments, the risk of birth defects is so high that they may suggest using two different types of contraception.
You also have to use contraception if your partner is having treatment that could affect his sperm. We have more information about cancer treatment affecting men’s fertility.
Are there any ways of keeping your fertility if you need cancer treatment?
There are, but they’re not always possible. It depends to some extent on the type of cancer you have and the treatment you need.
If you need surgery or radiotherapy, talk to your specialist. If at all possible, they will try to make sure you can still have children after treatment. There is more in the section above on the types of treatment that affect fertility.
IVF and egg freezing
With drug treatment for cancer, any measures you take need to be done before you start treatment. The only established ways of preserving fertility are IVF (in vitro fertilisation) and egg freezing. This takes time, as you have to have treatment to stimulate your ovaries to produce eggs. The eggs are then harvested. For IVF, they are fertilised with your partner’s sperm and frozen. If you don’t have a partner, the eggs are frozen unfertilised. There’s no guarantee that IVF or egg freezing will work. The Human Fertilisation and Embryology Authority (HFEA) say that just under 1 in 5 IVF treatments with frozen eggs will result in a successful pregnancy. For IVF with a frozen embryo, the success rates depend on your age. If you’re under 37, the birth rate is between 1 in 3 and 1 in 4 attempts.
There are a number of issues with this. If you have a hormone dependent cancer, such as breast cancer, you may not be able to have the hormone treatment necessary for the egg harvest. It also takes time. Even if you have a cancer that isn’t affected by hormones, your cancer specialist may not advise delaying treatment for weeks or months.
It can also be expensive. You can usually have egg or embryo storage and IVF paid for by the NHS if you’ve had cancer, but you’ll need to confirm that with your specialist.
If you can’t – or didn’t – freeze eggs or embryos before you start treatment, another option is to have IVF with donor eggs.
Freezing ovarian tissue
A newer way of preserving fertility is having ovarian tissue frozen. This is the only way that girls who haven’t yet started their periods can try to keep their fertility. It is still experimental though. As of January 2019, around 80 babies have been born worldwide to women who’ve had ovarian tissue freezing. The treatment involves having one ovary removed and frozen. The idea is that you have some of this tissue put back after your treatment and it starts producing eggs and hormones again. Although this is experimental, it is available in the UK. Again, there are no guarantees and this technique is still being developed. But two advantages are that you don’t need to have egg stimulating hormone treatment and you don’t need to wait for an egg harvest. The surgery is relatively minor and can potentially be done quite quickly. If you are very young, you may feel it’s worth considering - it will be some years before you need to use the tissue and hopefully the techniques will improve and become more successful in the future. Ask your cancer specialist for advice.