After cancer treatment, your cancer doctor or nurse can explain if and when your fertility is likely to recover. You may have worries and questions about fertility that did not seem important before cancer treatment.
The decision to try for a baby is a big one for anyone to make. If you have had cancer, this can bring extra challenges. If you are considering this, you can talk to your cancer doctor or nurse again.
If there is a chance that your fertility will recover after cancer treatment, you may decide to wait and try to have a baby naturally. Your cancer doctor may advise you to wait for some time before trying to have a baby. This is to make sure you are producing healthy sperm again.
Often it is difficult to know exactly how or when your fertility will recover. Fertility testing can check the quality and amount of sperm you are producing.
If your fertility does not come back after cancer treatment, you may be able to use your own frozen sperm to help you have a baby. If you did not store sperm before cancer treatment, you may decide to use donor sperm.
Some men still produce sperm but the cancer treatment has caused problems with erections or ejaculation. It may still be possible to collect sperm. This can be used with fertility treatments to help you have a baby.
You may decide not to try for a baby at all. Or some people choose to adopt or foster a child. Whatever you decide, support is available. Talking to other people can also be helpful while you are thinking through your options.
Cancer and family history
Some people worry about passing cancer or cancer genes onto their children. Cancer cannot be passed from a parent to child.
A small number of people have an inherited cancer gene that makes their risk of getting cancer higher. But this is rare and most cancers are not caused by inherited cancer genes. Talk to your doctor if you are worried about the risk of cancer running in your family.
- What type of contraception should I use and for how long after cancer treatment?
- When should I have tests to check my fertility?
- My partner and I want to try to get pregnant naturally. When can we start trying?
- What are my options for having children?
After treatment, you can have your sperm tested to find out if you have started to produce healthy sperm again. Being able to get an erection and ejaculate does not always mean that you are fertile. Sometimes the semen may not have any sperm in it.
Your cancer doctor or GP can arrange a fertility test for you. This test is available free on the NHS and can be repeated if needed. You may pay a fee to have it done privately.
If cancer treatment has damaged your fertility or made it difficult to have sex, you and your partner may decide to have fertility treatment.
Fertility treatment does not always result in a pregnancy. Your fertility expert will discuss this with you. But many people have had babies as a result of collecting and storing sperm and using fertility treatments.
The NHS will usually pay for several fertility treatments, depending on your situation. There are rules about fertility treatment in the NHS. If you decide to have fertility treatment, it is important to remember that these rules will apply to your partner as well as to you. Fertility treatment rules and funding vary across the UK. Your local fertility doctor will be able to give you information about this.
Many children have been born using fertility treatments. There do not appear to be any long-term health risks to the child. Your fertility doctor can give you more information about any possible risks with these treatments.
If you had sperm collected before treatment, you may decide to use your frozen sperm. Your sperm will be carefully thawed in a laboratory when it is needed.
If you did not have sperm collected before cancer treatment, it may still be possible to use your fresh sperm. Even if you are only producing very low numbers of sperm, sometimes this can be collected and used.
Fertility treatments you may be offered include:
- Intra-uterine insemination (IUI)
This is also known as artificial insemination. Your sperm is directly inserted into the womb.
- In vitro fertilisation (IVF)
Eggs are mixed with the sperm in a laboratory to see if an egg fertilises and becomes an embryo. The embryo is then transferred into the womb.
- Intra-cytoplasmic sperm injection (ICSI)
This is done in the laboratory. Under a microscope, a fine needle is used to inject a single sperm directly into the egg. If an egg is fertilised, the embryo can later be placed in the womb to see if a pregnancy develops.
ICSI may be used when the number of sperm is low. For example:
- if you had sperm collected surgically by PESA or TESE
- if the freezing process has reduced the quality of your sperm
- if you are still fertile but cancer treatment has reduced the number or quality of your sperm.
Organisations such as Fertility Network UK can provide more information about these treatments.
If your pituitary gland is affected by treatment
The pituitary gland controls hormones called gonadotrophins. These stimulate the testicles to produce testosterone and sperm. Cancer treatment to the pituitary gland may reduce your testosterone levels and sperm production. Low testosterone levels can make it difficult to get an erection and can leave you with a lower sex drive. It can also cause other problems such as thinning of the bones (osteoporosis), tiredness and a low mood.
You can take testosterone replacement therapy to reduce some of these problems. It can be given for life. But this does not stimulate the testicles to make sperm so you will not be able to conceive a child while you are taking it.
If you want to have children, it is possible to have gonadotrophin replacement injections instead.
These injections stimulate the testicles to start producing sperm again. You have the injections regularly until you have managed to conceive naturally or collected sperm samples to use with fertility treatments. It can take several months of injections to start sperm production. Usually you have injections for up to two years. After that you start taking testosterone replacement therapy again.
If you have not had sperm stored, you and your partner may think about using donated sperm.
Choosing to use donated sperm can be a difficult decision. The fertility doctor will offer you and your partner counselling about this. It may not be acceptable for some people for religious reasons. If you are worried or unsure about this, speak to your religious adviser.
You may have to wait to find a suitable sperm donor. Some people decide to use sperm from sperm banks in other countries.
Treatment with donor sperm may not be funded by the NHS in some areas of the UK. The staff at your fertility clinic can talk to you about this.
Everyone who donates sperm is carefully selected:
- The donor is usually matched as closely as possible for eye and hair colour, physical build and ethnic origin.
- The donor has to be fit and healthy with no medical problems.
- The donor is tested for infectious diseases such as HIV, hepatitis B and C and some genetic conditions.
Adoption and fostering
If medical treatment does not feel like the right way for you to become a parent, you could consider adoption or fostering.
Adoption means becoming the legal parent of a child. Fostering means looking after a child who can’t stay with their own family – this might be short-term or long-term.
People from all backgrounds can apply to become a parent in these ways. Sexuality, gender and disability are not barriers. And you don’t have to be in a relationship or married.
Adoption and fostering can be rewarding ways to start a family. They are arranged through an organisation or local authority. If you want to find out more, ask:
Surrogacy is where a woman, called the surrogate (or host), becomes pregnant and gives birth to a baby for you. The pregnancy may be started using IUI (intrauterine insemination) or IVF (in vitro fertilisation). This might be something to consider if:
- you are single
- in a same sex relationship
- your female partner is unable to carry a pregnancy.
Surrogacy is not very common in the UK and there are laws that can make it a complicated process. Some organisations, such as Childlessness Overcome Through Surrogacy (COTS) and Surrogacy UK, offer detailed information about this.
Talking to other people can be helpful while you are thinking about your options. Macmillan’s Online Community is a good place to start. You can also talk things over with our cancer support specialists free on 0808 808 00 00.
If you prefer to talk to a counsellor, your GP or cancer doctor can help to arrange this. Many hospitals also have specialist nurses who can offer support, and fertility clinics will have a counsellor you can talk to.