Fertility in women
Your fertility means being able to get pregnant (conceive) and give birth to a baby.
The parts of your body that help you do this are called your reproductive system. This includes the:
- fallopian tubes
- womb (uterus)
The pituitary gland at the base of your brain is also important for fertility. It releases hormones (chemical messengers in the body) that control how your reproductive system works.
Your fertility depends on having:
- a supply of eggs from the ovaries
- a healthy womb
- the right hormone levels.
Usually once a month, mid-way through the menstrual cycle, one of the ovaries releases an egg (ovulation). The hormones from the pituitary gland help control ovulation. This starts at puberty and happens until the menopause.
To get pregnant (conceive) one of your eggs needs to be fertilised by a sperm. This may happen if you have vaginal sex. The egg leaves the ovary and moves along the fallopian tube. This is where it can be fertilised by a sperm. The fertilised egg develops into an embryo. The embryo continues to your womb, where it can settle itself into the womb lining. The embryo stays in the womb and grows into a baby.
Every month, hormones help make the lining of the womb ready for an embryo. If the egg is not fertilised, the womb lining comes out through the vagina as your monthly period.
Some cancer treatments can affect the ovaries or the pituitary gland and cause an early menopause. Others can cause a temporary menopause or menopausal symptoms.
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Doctors may not be able to predict how female fertility will be affected. But your age and the planned treatment can help give an idea of your individual risk. Sometimes, it may be possible to reduce the effects of treatment on your fertility.
Treatments can damage or affect:
- the eggs in the ovaries
- the pituitary gland and hormone levels
- the womb, cervix or ovaries.
Cancer and cancer treatment can also change how you feel about sex or make it physically difficult to have sex. We have more information about coping with sexual difficulties that may be useful.
Chemotherapy can reduce the number of eggs stored in the ovaries. It can also make you release fewer or no eggs. This means you may be infertile for a while (temporary infertility). Chemotherapy sometimes causes permanent infertility and an early menopause.
The effects of chemotherapy on your fertility depend on your age, the drugs you have, and the dose of the drugs. The older you are and the closer you are to your natural menopause, the higher the risk of infertility.
Chemotherapy can reduce the number of eggs you have. So your menopause may start 5 to 10 years earlier than it would have done naturally. This means you have a shorter time to try to get pregnant. Sometimes it is possible to choose a chemotherapy treatment that is less likely to affect your fertility. Or your cancer doctor may give you a type of hormonal therapy during chemotherapy to try to protect the ovaries. They will tell you if these are options for you.
Radiotherapy uses high-energy rays to destroy cancer cells. It can cause fertility problems by damaging:
- the ovaries or eggs
- the womb
- the pituitary gland.
Types of radiotherapy which may affect fertility include:
Radiotherapy to the pelvis
Radiotherapy given directly to the ovaries and womb will cause permanent infertility. This treatment will cause an early menopause and you will not be able to get pregnant.
Radiotherapy to other areas of the pelvis may indirectly damage the ovaries or womb. This may stop the ovaries working for a short time or permanently. If the ovaries recover after treatment, you may be able to get pregnant.
If the womb is damaged, you may be able to get pregnant. But there will be a higher risk of miscarriage or premature birth.
Your risk of infertility depends on the dose of radiotherapy you have and your age. There is also a higher risk of infertility when you have chemotherapy with radiotherapy (chemoradiation).
The radiographer may be able to protect the ovaries with a lead shield during radiotherapy. Or in some cases, surgeons can move the ovaries out of the way of the area being treated before radiotherapy starts. This is called ovarian transposition.
Total body irradiation (TBI)
Radiotherapy to the brain
Radiotherapy to the pituitary gland at the base of the brain can sometimes affect fertility. The pituitary gland releases hormones called gonadotrophins. These stimulate the ovaries.
After radiotherapy, the pituitary gland may stop making gonadotrophins. This can happen some months or years after radiotherapy. If this happens, the ovaries may stop making hormones and releasing eggs. Your periods may stop and you may not be able to get pregnant. This is not because you have run out of eggs, but because your ovaries are not releasing them.
If you want to get pregnant, your doctor may be able to give you gonadotrophin-replacement injections. These can stimulate the ovaries to release an egg.
If you have radiotherapy to an area of the body we do not mention, this will not cause infertility.
Types of surgery that can affect your fertility are:
Surgery to the womb or ovaries
If the womb is removed but not the ovaries, you will still release eggs. You may be able to use these eggs with a surrogate in the future.
If both the ovaries are removed, you will have an early menopause and will not release eggs. You may be able to have your eggs frozen before surgery.
If one ovary is removed, the remaining ovary will continue to release eggs and hormones. Having one ovary removed is sometimes called fertility-sparing surgery. If you still have a womb, you may still be able to get pregnant naturally.
Surgery to the cervix
An operation called a trachelectomy can occasionally be used for very small, early-stage cancers of the cervix. This operation removes most of the cervix. The womb and ovaries are not removed. It may be possible to get pregnant and have a baby afterwards. But there is a higher risk of miscarriage or premature birth.
Trachelectomy is a specialised operation. It is only done in a few hospitals in the UK.
Surgery to the pituitary gland
Surgery may be used to remove a tumour in the pituitary gland. The pituitary gland is at the base of the brain. It releases hormones called gonadotrophins that stimulate the ovaries.
When surgeons remove the tumour, they try to leave some of the gland. But this is not always possible. Removing the whole pituitary gland affects hormone levels, and the ovaries stop releasing eggs.Your periods may stop and you will not be able to get pregnant. This is not because you have run out of eggs, but because your ovaries are not releasing them. If you want to get pregnant, your doctor may be able to give you gonadotrophin-replacement injections. These can stimulate the ovaries to release an egg.
For some types of cancer, hormones encourage the cancer cells to grow. Hormonal therapy drugs can reduces the levels of hormones in the body or blocks their effect on cancer cells. Doctors often use hormonal therapy drugs to treat breast cancer. These drugs can affect your fertility, but this is usually temporary.
Your periods may change or stop while you are taking a hormonal therapy drug. But it is still important to use contraception to prevent a pregnancy. This is because these drugs may harm an unborn baby.
Periods usually start again after you have finished taking the drug, but this can take a few months. If you go through your natural menopause during treatment, you may not be aware of it. This is because the side effects of hormonal therapy drugs are similar to the symptoms of the menopause.
Targeted therapy and immunotherapy
Targeted therapy drugs find and attack cancer cells. immunotherapy drugs are treatments that use the immune system to recognise and kill cancer cells. These treatments are used to treat many different cancers.
It is not yet known exactly what effect these treatments may have on fertility. If you are treated with a targeted therapy or immunotherapy drug, your cancer doctor can talk to you about possible risks to your fertility.
Contraception during cancer treatment
Cancer treatments may harm an unborn baby. You might still be able to get pregnant even if your periods stop during treatment. So it is important to use contraception to prevent a pregnancy during treatment and for a time after it. Your cancer doctor will tell you how long you need to use contraception for. If you have questions, talk to your doctor or nurse.
If your fertility does recover, it is hard to predict when this will be. This could happen without you being aware of it. If you do not want to start a pregnancy, you should keep using contraception unless doctors tell you the infertility is permanent.
If you have breast cancer, your cancer doctor may advise you not to use contraception that contains hormones, such as the contraceptive pill. This is because the hormones could encourage breast cancer cells to grow. Your cancer doctor or specialist nurse will give you more advice about this.
Your cancer doctor will explain the possible risks to your fertility. If having children is important to you, they may refer you to a fertility clinic before you start treatment. But this is not always possible. Fertility preservation takes a few weeks and your cancer treatment may need to start sooner.
Staff at the clinic can talk to you about ways of increasing your chances of getting pregnant in the future (fertility preservation, see below). A specialist fertility counsellor will be available to support you and your partner, if you have one.
Questions you could ask your medical team
Below are some questions you might want to ask your medical team before cancer treatment.
- How will my fertility be affected?
- Are there ways to protect my fertility during treatment?
- Can I store embryos, eggs or ovarian tissue?
- What type of contraception should I use during treatment?
Your doctor may refer you to a fertility clinic for advice before you start cancer treatment. This depends on your age and the type of cancer you have. The Human Fertilisation and Embryology Authority (HFEA) has information about NHS and private fertility clinics.
The doctors at the clinic will explain possible ways to save (preserve) your fertility and help you get pregnant in the future. This is called fertility preservation.
They will give you information about any risks of fertility preservation. They will also tell you how likely it is that each method will help you get pregnant. This can be a lot of information to understand. You may want to take notes or have some questions ready to ask the doctor. They will offer you counselling or further support.
What is fertility preservation?
Fertility preservation means storing one of the following before treatment:
- Embryos (eggs fertilised with sperm).
- Ovarian tissue.
Before the eggs, embryos or ovarian tissue are stored, you will be asked to sign a consent form that explains how they will be used. The staff at the clinic will talk to you about this and explain your options.
You will have a blood test, to check for infectious diseases such as hepatitis and HIV. This is standard procedure for anyone storing eggs, embryos or ovarian tissue.
This is a common and effective way of preserving fertility. You can have hormone injections to help you release more eggs. These can then be collected and frozen. The frozen eggs can be fertilised in the future using a partner’s sperm or donor sperm.
To collect the eggs, you usually have daily injections under the skin of a type of hormone called gonadotrophin. The hormone makes the ovaries release more mature eggs than usual (ovarian stimulation). Collecting as many eggs as possible increases your chance of getting pregnant in the future.
Ovarian stimulation takes at least 2 weeks.
It is not suitable for everyone. There may not be time for this if you need to start cancer treatment straight away.
The gonadotrophin used to stimulate the ovaries increases your level of the hormone oestrogen. Oestrogen may encourage some cancers to grow, including some types of breast cancer, ovarian cancer and womb (endometrial) cancer.
If you have one of these cancers, your eggs can be collected in one of the following ways:
- Without using hormone drugs to stimulate the ovaries. Your doctor can collect 1 or 2 eggs in this way. But having fewer eggs collected reduces your chance of getting pregnant in the future.
- With just one injection of ovarian stimulation in the usual way.
- Using a second hormone drug called letrozole during ovarian stimulation. Letrozole helps protect you from the effects of oestrogen on cancer cells.
Your doctor will explain any risks of ovarian stimulation and give you information about your options.
Monitoring ovarian stimulation
During ovarian stimulation, you will be monitored at the fertility clinic with blood tests and ultrasound scans. An ultrasound uses sound-waves to make a picture of the ovaries. This is to check how the follicles containing the eggs are developing in the ovaries. The hormones make the ovaries more swollen, so they are easier to see on the ultrasound.
The ultrasound probe is put inside the vagina. This is not usually painful. The probe is about the same width as a tampon. If you cannot or do not want to have the scan through the vagina, the probe can be put over the tummy (abdomen).
Collecting the eggs
A doctor collects the eggs when they are mature. This is about 14 days after the start of ovarian stimulation. The doctor uses a vaginal ultrasound to guide a needle into the ovaries. They collect the eggs through the needle. The collection takes about 15 to 20 minutes. This can be uncomfortable, so you will be sedated while it is done. You can usually go home after a few hours.
This is another common and effective way of preserving fertility. You go through the same procedure for collecting eggs (see above). After the eggs have been collected, they are put in a sterile dish with sperm to encourage fertilisation. This is called in vitro fertilisation (IVF). The eggs that are fertilised grow into embryos. These are then frozen and stored.
Embryos can be slowly frozen or quickly frozen by vitrification. Both are safe procedures and many babies have been born using these techniques.
If you have a partner who has provided sperm for this, they have equal rights in deciding what happens to the embryos. If they withdraw the right for you to use the embryos, you will not be able to use them.
Even if you have a partner who can provide sperm, you can still choose to have unfertilised eggs frozen (see above). Your partner has no say in how those eggs are used in the future.
Storing embryos and eggs
The NHS often provides embryo or egg storage if you are affected by cancer. But in some areas of the UK, you may have to pay for it yourself. The staff at the fertility clinic will tell you what is available in your area. Even if the storage is funded, using the embryos or eggs for fertility treatment in the future may not be. This means you may have to pay for this treatment. Your doctor or nurse will give you information about costs in your area.
Embryos and eggs can be stored for at least 10 years, and for longer in some situations. They will be frozen and stored in a tank of liquid nitrogen. This is called cryopreservation.
Freezing tissue from an ovary
Before cancer treatment starts, doctors remove an ovary or small pieces of an ovary. They do this using keyhole surgery. The tissues that are removed are frozen and stored. They contain thousands of immature eggs.
After cancer treatment, if you decide to try to get pregnant, the doctors can put the pieces of ovary back into your body. This may make it possible to get pregnant naturally or with IVF treatment.
This technique is suitable for most women, including if you:
- have to start cancer treatment quickly
- cannot have fertility drugs
- have not reached puberty (started having periods).
It may not be suitable if there might be cancer cells in the ovary.
This is a newer technique and it is not widely available in the UK. Only a few babies in the world have been born using this method.
Worrying about your fertility may seem hard when you are already coping with cancer. It can be difficult waiting to see if your fertility will return. Some people have a sense of loss and sadness.
You may find it helps to talk to a supportive partner, family member or friend. Some people may find it helpful to talk to a talk to a counsellor. Your GP or cancer doctor can arrange this. Many hospitals also have specialist nurses who can offer support. Fertility clinics have a counsellor you can talk to.
Talking to other people in a similar position may help you feel less isolated. 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.
Below is a sample of the sources used in our fertility information. If you would like more information about the sources we use, please contact us at email@example.com
Human Fertilisation and Embryology Authority. Code of practice. 8th edition. October 2009 (updated October 2017).
National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment. CG156. February 2013 (updated September 2017).
Royal College of Nursing. Fertility preservation: clinical professional resource. 2017.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.