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When you learn you have cancer, your first concern is getting into cancer treatment. But when you’re in your childbearing years or younger, you also need to consider the effects of cancer treatment on your reproductive organs. You need to consider whether you want to have children in the future.

Each type of cancer treatment may affect fertility. Learn about the different kinds of cancer treatments, their effects on female fertility, and how fertility preservation methods can help future families.

Ways Cancer Treatments Can Affect Fertility

When you’re facing cancer treatment, thinking about your future family may seem like a low priority. But your future self will thank you for talking with your cancer care team now about your risk of infertility later.

Talk to your doctor about how cancer treatment can affect your fertility. Do this before you start it.

How does chemotherapy affect female fertility?

Chemotherapy (chemo) works by killing all rapidly dividing cells in your body.

Chemo kills most of the cancer cells. But it also kills your oocytes. Oocytes are the cells within your ovaries that make hormones.

Your ovaries won’t release eggs or prepare the uterus for pregnancy without these hormones. This may make you infertile.

You might also go into early menopause. This may prove temporary or permanent.

How does radiation therapy affect female fertility?

Radiation therapy can affect fertility if the radiation targets your brain or your reproductive organs.

How much radiation affects your fertility depends on:

• The method of radiation.
• The total dose given.
• Your age and developmental stage at the time of treatment.

The radiation’s target location can also affect fertility in the:

• Brain — Radiation that reaches the brain can affect the pituitary gland. This makes hormones that signal the ovaries to ovulate (release an egg).
• Ovaries — Both internal and external radiation therapy that targets the ovaries can damage them enough to affect fertility. High-dose radiation can destroy some or all of the eggs in your ovaries. This can cause early menopause and infertility.
• Pelvis — Radiation that reaches the pelvis can cause sudden, early, or premature menopause. You could go through menopause between five and 20 years earlier than expected. This is the case even if your period returns after treatment.
• Uterus — Radiation delivered to the uterus can sometimes damage muscles and blood supply. This will limit how much it can expand during pregnancy. The risk of miscarriages, premature births, and low birth weights as a result. This is particularly the case among those who had radiation before puberty.

How does cancer surgery affect female fertility?

Cancer surgeries on the pelvis or abdomen can affect your ability to conceive a child, including:

• Adhesions (scarring) — Prior surgeries can sometimes cause adhesions that block your fallopian tubes, ovaries, or uterus. This prevents fertilization, implantation, or carrying to term.
• Hysterectomy — The surgical removal of the uterus (womb) and cervix. You can’t carry a child without a uterus.
• Oophorectomy — The surgical removal of one or both ovaries. This may include one or both fallopian tubes as well. Because eggs are in the ovaries, without them, you would no longer make eggs.
• Trachelectomy — Surgical removal of the cervix. The cervix is the lower part of the uterus. It meets the upper part of the vagina. It can be used as a fertility-sparing effort to treat certain cancers.
• Tumor resection (removal) surgery — Surgical resection of tumors on any of the reproductive organs may affect conception. These organs include the cervix, fallopian tubes, ovaries, uterus, or vagina, or the elimination system. The elimination system includes the anus, bladder, colon, and rectum.

How do targeted therapy and immunotherapy affect female fertility?

Researchers haven’t conducted enough studies to determine whether targeted therapies and immunotherapies can cause infertility issues. Some related medications have the potential to cause birth defects. More studies are ongoing.

Other cancer treatment factors that can affect fertility

Other factors that also might affect your fertility include:

• Your age and life stage at the time of treatment, such as before or after menstruation or menopause.
• The type of treatment.
• The dose or extent of that treatment.

Can I get pregnant after having cancer?

For most people, having cancer doesn’t interfere with fertility. Instead, the type and extent of cancer treatment can affect their ability to conceive.

If you’re thinking of getting pregnant after having cancer treatment, consider a preconception counseling session with your cancer care team before making your pregnancy plan. They may recommend that you wait for at least six months to two years before trying to get pregnant. This will depend on the type of treatment you had.

Can I get pregnant during cancer treatment?

You shouldn’t get pregnant if you’re currently undergoing cancer treatment because of potential harm to the developing fetus from:

• Chemotherapy — It’s important not to get pregnant while undergoing chemotherapy because many chemo medications may cause birth defects and miscarriages. Use an effective form of birth control during chemo if there’s a chance you could become pregnant during treatment. Remember that temporarily missing periods during and after treatment may not mean you’re infertile. Talk to your cancer care team about how long to wait after treatment before trying to conceive.
• Hormone therapy and immunotherapy — Because these therapies are newer, less is known about their effects on fertility, pregnancy, or an unborn baby. Some medications may cause birth defects.
• Radiation — If the possibility that you’re still fertile remains, talk to your cancer care team about how long to wait before having unprotected sex or trying to conceive.

Fertility Preservation Options Before Cancer Treatment

If you have female reproductive organs, then cancer treatment could affect your ability to have a child. You might qualify for one or more fertility preservation methods.

Fertility counseling for young cancer patients

Don’t assume your doctor will ask you about your future plans for a family. Before starting treatment, ask your cancer care team how your treatment might affect your fertility. You should also ask how they can improve your chances of having children in the future.

What is female fertility preservation?

Female fertility preservation involves freezing eggs, ovarian tissue, or embryos for future use and keeping your reproductive organs safe during cancer treatment.

Egg freezing

To freeze your eggs, you go through the same first steps of in vitro fertilization (IVF). This process involves hormone injections and egg retrieval under anesthesia. Specialists freeze and store the unfertilized eggs for future use.

When you’re ready for pregnancy, the lab that’s storing your eggs thaws them out and fertilizes them. Doctors then transfer them to your uterus (or the uterus of a gestational carrier). You may receive hormonal support for several months to help maintain the pregnancy.

You’re a candidate for egg freezing if you’ve gone through puberty but haven’t reached menopause. You don’t need sperm for egg freezing. The number of eggs frozen depends on your age and ovarian reserve at the time of undergoing the stimulation process.

You have a better chance of pregnancy and a live birth if you freeze your eggs at a younger age. In general, younger women have better-quality eggs. Your odds of getting pregnant with stored eggs are most closely tied to how old you were when doctors froze your eggs.

Embryo freezing

Embryo freezing is when a laboratory freezes and stores embryos created through IVF. You receive hormone injections, and doctors extract eggs with a needle while you’re under anesthesia. The laboratory combines the eggs with sperm.

If an embryo or embryos result, doctors will freeze and store them for future use. You may opt to do genetic testing on the embryos before the doctors freeze them to screen for chromosomal abnormalities. As they do for frozen eggs, specialized facilities store frozen embryos under strict supervision and monitoring.

When you’re ready to get pregnant, doctors place the thawed embryo in your uterus or the uterus of a gestational carrier. If the embryo implants in the uterine lining, pregnancy occurs.

You’re a candidate for embryo freezing if you’re post-puberty to premenopausal and willing to use your partner’s (or a donor’s) sperm to create an embryo.

Embryo freezing has been in use for more than 30 years. Pregnancy rates for frozen embryos range from over 40% for women under 35 to almost 18% for women over 42.

Ovarian tissue freezing

Ovarian tissue freezing is a relatively new treatment. It was an experimental procedure until 2020. Generally, those choosing this method of fertility preservation have an upcoming cancer treatment with a high risk of infertility.

Ovarian tissue freezing involves freezing and storing tissue from the cortex of the ovary, or the outer portion. This tissue contains primordial follicles, each of which contains a single immature egg.

In ovarian tissue freezing, doctors remove part or all of the ovary. Then they cut the cortex into thin strips and freeze it. Later, doctors thaw the tissue and return it to the body.

When the tissue is back in the body, it starts producing hormones and releasing eggs. You can try to become pregnant naturally or through assisted reproduction procedures like IVF.

You may undergo procedures such as in vitro maturation (IVM) in the future to mature the small/immature eggs from within the frozen ovarian tissue in the laboratory so that they can result in embryos for transfer. This process is still in its experimental stage.

Oophoropexy (ovarian transposition)

Ovarian transposition is another fertility preservation option for people going through cancer treatment. If you’re receiving radiation treatment in your pelvic area, you may find it’s a good way to protect your ovaries.

This minimally invasive procedure happens before radiation therapy begins. Doctors separate one or both ovaries and fallopian tubes from the uterus. Then, they attach them to the abdominal wall to reduce the amount of radiation the ovaries receive.

Your ovaries may still receive some radiation. Your doctor may recommend that you freeze your eggs before the surgery to improve your odds of having children later.

Ovarian suppression

Because it affects the whole body, chemotherapy for any kind of cancer can hurt the ovaries. It reduces the number and quality of your eggs, making it harder to get pregnant.

Ovarian suppression can potentially minimize the destruction of eggs from chemotherapy treatments for cancer. The procedure involves using medications called GnRH agonists (leuprolide and goserelin) to keep the ovaries from making the sex hormones estrogen and progesterone.

Ovarian suppression is still an experimental technique for fertility preservation. If your doctor recommends this method, you’ll have injections of the GnRH agonist either monthly or every three months. They’ll start a few weeks before you begin chemotherapy and continue throughout your cancer treatment.

Ovarian suppression treatment can cause temporary symptoms of menopause. Your doctor may offer you egg or embryo freezing in addition to ovarian suppression treatments.

Emotional Effects of Infertility After Cancer

Learning that you have cancer is hard enough. Worrying that your cancer treatments might make you infertile can feel overwhelming.

The psychological impact of struggling to conceive can feel like a profound sense of loss and cause a significant life crisis. Couples dealing with infertility can experience many emotions, such as anger, sadness, and guilt. They may also suffer from depression and anxiety and have issues with low self-confidence and self-esteem.

Talk to your cancer care team if you’re having trouble processing the emotions related to your cancer treatment and fertility issues. Or connect with a support group for others who are also dealing with infertility.