Fertility in women after treatment
If you are thinking about getting pregnant after cancer treatment, it is a good idea to talk to your cancer doctor first. You may have worries and questions about fertility that did not seem important before cancer treatment.
You may have been told there is a chance your fertility will recover after cancer treatment. This may mean you decide to wait and try to get pregnant naturally. Your cancer doctor can give you more information about when your fertility might come back and what to expect. Depending on the type of cancer and your cancer treatment, they may advise you to wait for some time before trying to get pregnant.
It is hard to know exactly how or when your fertility will recover. Fertility testing can check how close you are to the menopause.
You may be able to store your eggs, embryos or ovarian tissue before cancer treatment. If your fertility does not return after cancer treatment, you may be able to use them to help you get pregnant. If you did not store them before cancer treatment, you may decide to use donor eggs.
For some people, deciding to have fertility treatment can be hard. This may be because of moral, cultural or religious views. You may want to talk to a partner, family member or religious adviser about any concerns you have. You can also talk to the staff at the fertility clinic.
Talking to other people can be helpful while you are thinking about your options. Whatever you decide, there are organisations that can support you, such as the British Infertility Counselling Association (BICA).
When can I try to get pregnant?
There is no evidence that cancer treatments harm children conceived after treatment. But doctors usually advise you to use contraception for a while after treatment to let your body recover.
If you are thinking about getting pregnant, it is helpful to talk to your cancer doctor first. Depending on your age and the type of cancer and treatment you had, they may suggest trying sooner or waiting longer. They will also give you advice about any health checks you need before you try to get pregnant.
If you are taking hormonal therapy for breast cancer, it may be possible to stop treatment for some time so you can have a baby. Research is happening to help doctors find out more about the effects of doing this. Your cancer doctor can give you information about the risks and benefits of doing this.
Worrying about cancer coming back
It is natural to worry about cancer coming back. No one can tell you exactly what will happen in the future. But your cancer doctor may be able to give you information about what is likely to happen. For some people, the risk of cancer coming back gets less as time goes on. They may decide to wait a few years before trying to have a baby.
Can being pregnant make cancer come back?
Research suggests that for almost all types of cancer, pregnancy does not make cancer more likely to come back.
If you have one of a rare group of tumours called gestational trophoblastic disease, your doctor will talk to you more about this.
Cancer and family history
Some people worry about passing on cancer or cancer genes to their children. Cancer cannot be passed from a parent to a child. A small number of people have an inherited cancer gene that increases their risk of getting cancer. 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 in your family.
If you are single or in a same-sex relationship
If you are single or in a same-sex relationship and you want to have children, you may become a parent through:
- fertility treatment
- adoption or fostering
- co-parenting – an agreement to conceive and raise a child with someone who is not your partner
You may be able to have fertility treatment on the NHS using donor sperm. NHS funding rules still apply and may be different in different areas. You can ask your GP for more information.
There are laws about becoming a legal parent in all these situations. The Human Fertilisation and Embryology Authority (HFEA) has more information. If you are in a same-sex relationship, organisations such as Stonewall and Pink Parents also provide information and support.
Not having children
Some people decide not to have children. This may be a clear choice they are happy with. Sometimes it is more complicated. You may feel the choice has been taken away from you because of cancer. You may find this very upsetting. It may help to talk to someone about this. There is no right or wrong way to feel. Everyone is different.
Your GP can give you support and may suggest a counsellor for you to talk to. Or you can call us on 0808 808 00 00. Other organisations can also provide emotional support, such as:
Below are some questions you might want to ask your medical team after cancer treatment.
- What type of contraception should I use, and for how long after cancer treatment?
- When should I have tests to check my fertility?
- I want to try to get pregnant naturally. When can I start trying?
- What are my options for having children?
- What fertility treatments will help me?
The number of eggs in your ovaries is called your ovarian reserve. Cancer treatment can reduce your ovarian reserve, so you have an early menopause.
Usually you are referred to a fertility clinic after 1 to 2 years of trying to get pregnant. But after cancer treatment, you can be referred for fertility testing sooner. This is because of the increased risk of early menopause after cancer treatment.
Fertility tests can help measure your ovarian reserve or how close you are to the menopause. They do not always clearly show if you can have children. The tests may help you decide what to do next. You can decide if you want to have fertility treatment.
Your doctor will ask you about your periods and take blood tests. There is a blood test you can have even if you are not having periods.
You may also have a scan called an antral follicle count. This is an ultrasound scan of the ovaries. An ultrasound uses sound-waves to make a picture. The scan looks at the follicles that contain the eggs. For this scan, an ultrasound probe is put inside the vagina.
Taking the contraceptive pill or hormone replacement therapy (HRT) can affect the results of some of these tests. Let your doctor know if you are taking either of these.
If cancer treatment has caused your periods to stop, they may come back months or years after treatment ends. This is more likely if you are younger, but it also depends on the treatment you have had. If your periods change, you can have these tests done again. Your doctor will talk to you about the options available to you.
If cancer treatment has damaged your fertility or made it made it difficult to have sex, you may decide to have fertility treatment. If you have a partner, you can talk with them about this. Your doctor can talk to you about your options.
At the fertility clinic, the doctor will talk to you about your fertility and treatments that may help. They will answer your questions and arrange any tests you need. Your fertility doctor will also ask you questions about your lifestyle. This can help them see if there are changes you can make that might help improve your fertility.
If you are not using a sperm donor, the person you have fertility treatment with will need to have some tests too. They will also need to answer questions about their lifestyle.
Fertility treatment does not always result in a pregnancy. Your fertility specialist will talk to you about this.
Many children have been born using fertility treatments. There do not seem to be any long-term health risks to the child. Your fertility doctor can give you more information about any possible risks of these treatments.
Where to get fertility treatment
This depends on whether you have NHS treatment or private treatment.
Your GP can tell you which clinics offer NHS treatment in your area. If you have already had fertility preservation or fertility tests, you may be able to go back to the same clinic.
For private treatment, you can choose a clinic. You can arrange this yourself, but it can be useful to have a referral letter from your GP.
You can get details of all the fertility clinics in the UK from the Human Fertilisation and Embryology Authority (HFEA). The HFEA also provides advice about choosing a clinic.
How much fertility treatment costs
The NHS may pay for a certain number of fertility treatments. There are rules about funding fertility treatment on the NHS. The rules and funding are different across the UK. If you decide to have fertility treatment with a partner, it is important to remember these rules apply to them too. Your GP, cancer doctor or fertility doctor can give you information about this.
Private fertility treatment
Some people choose to pay for some, or all, of their fertility treatment privately. You may be thinking about this if:
- you are not eligible for NHS treatment
- you are worried about NHS waiting times
- the NHS does not provide the treatment you want or need.
There are no standard charges for private treatment. You can contact clinics directly to find out which treatments they offer, how much they charge and their success rates.
Types of fertility treatment
Types of fertility treatment include the following:
Intra-uterine insemination (IUI)
The specialist puts sperm directly into the womb. They use a fine tube, which they put through the cervix and into the womb. They do this when an ovary is most likely to release an egg. If an egg is fertilised, a pregnancy may develop. This procedure only takes a few minutes. It feels like having a cervical screening test.
In vitro fertilisation (IVF)
This happens in a laboratory. The specialist mixes collected eggs and sperm together in a dish. They see if any eggs fertilise and become embryos. If suitable embryos develop, they put one or sometimes more into the womb to see if a pregnancy develops. They use a fine tube, which they put through the cervix and into the womb. Any other embryos can be stored for future use.
Intra-cytoplasmic sperm injection (ICSI)
This happens in a laboratory. Under a microscope, the specialist uses a fine needle to inject a single sperm directly into each egg. They see if any eggs fertilise and become embryos. If suitable embryos develop, they put one or occasionally more in the womb to see if a pregnancy develops. They use a fine tube, which they put through the cervix and into the womb. Any other embryos can be stored for future use.
After cancer treatment, you may decide to use your frozen eggs, embryos or ovarian tissue to try to get pregnant. When they are needed, they will be carefully thawed in a laboratory.
If it is difficult to have sex
You may find having sex difficult after cancer treatment. If your fertility has come back, you may choose to have IUI.
Using your frozen eggs
When you are ready to try to get pregnant, the eggs are thawed and a specialist uses ICSI.
Using your frozen embryos
When you are ready to try to get pregnant, the embryos are thawed. The specialist will put them in the womb. A pregnancy may then develop. Usually the specialist puts no more than 1 or 2 embryos in at one time. Both you and the person who provided the sperm for the embryos have to give permission for this.
Some people choose to use donated eggs, sperm or embryos.
If you did not have eggs collected before cancer treatment, you could use donated eggs or embryos. This may be suitable if there is damage to the ovaries from cancer treatment but you are still able to carry a pregnancy.
Other couples who have had fertility treatment can sometimes donate embryos. They may have several embryos stored and have to decide what to do with them when their family is complete.
You may also choose to have your own eggs fertilised with a donor’s sperm. This can be an option if:
- you are in a same-sex relationship
- you are single
- you have a partner who is not able to provide sperm.
Everyone who donates eggs, sperm or embryos in the UK (a donor) is seen by a doctor at the fertility clinic before they donate. The fertility doctor examines them and asks them questions about their medical history. They also test them for infectious diseases, such as HIV, hepatitis B, hepatitis C and some genetic conditions.
You can be matched to a donor by things such as:
- ethnic origin
- eye colour
- hair colour
- physical build.
The staff at the fertility clinic can give you more information about this.
All UK donors must agree to their details being available in the future. Any child born from fertility treatment using a donor can ask for the donor’s details when they are 18 years old.
Some people ask a family member to be their donor. They still have the same tests as any other donor.
If the pituitary gland is affected
Your body needs hormones from the pituitary gland to release eggs. Some cancer treatments can affect the pituitary gland and hormone levels. You may be able to have injections that replace these hormones, so you can release eggs again. These are called gonadotrophin replacement injections. Your cancer doctor or fertility doctor can tell you if this might help you.
Unfortunately, there is always a risk fertility treatment will not work. Or eggs or embryos you had frozen may not thaw successfully. This might happen to anyone having fertility treatment, not just people affected by cancer. Your chance of fertility treatment working may depend on:
- your age
- your fertility test results
- the type of cancer treatment you had.
Your fertility doctor will explain this before you start fertility treatment. But it is still upsetting if treatment does not work.
Some people decide to try again. But this can be a hard decision to make. Fertility treatment can be stressful. It can be hard physically as well as emotionally. And if you are paying for treatment, it can be expensive.
You may want to think about whether adoption, fostering or surrogacy are right for you.
Counsellors in fertility clinics can offer support and advice. There are also organisations that offer counselling, such as the British Infertility Counselling Association (BICA). Your healthcare team might know about support groups in your area. Or you can join our Online Community to talk to other people who are going through the same thing.
Some people cannot have fertility treatment. And some decide they do not want treatment and prefer to have a child another way.
If you are thinking about adoption, fostering or surrogacy, it may help to:
- talk about it with family or friends
- talk to someone who has become a parent this way
- find out more from a support organisation.
Make sure you get all the support and information you need to make the right decision for you.
Adoption and fostering
If you do not want to use medical treatment to help you have a child, you could consider adoption or fostering.
Adoption means becoming the legal parent of a child. Fostering means looking after a child who cannot stay with their own family. This might be short or long term.
People from all backgrounds can apply to be a parent in these ways. Sexuality, gender and disability should not matter. And you do not have to be in a relationship or married.
Adoption and fostering can be rewarding ways to be a parent. An organisation or local authority can arrange this. If you want to find out more, ask:
Surrogacy means a woman, called the surrogate (host), becomes pregnant and gives birth to a baby for you. The pregnancy may be started using IUI or IVF. This might be something to think about if you cannot carry a pregnancy.
You could use:
- your own eggs or embryos
- eggs from a donor
- the surrogate’s eggs.
Surrogacy laws in the UK are quite complicated. Organisations such as Childlessness Overcome Through Surrogacy (COTS) and Surrogacy UK and Brilliant Beginnings can give you more information and support.
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. Others feel angry, anxious, lonely or disappointed.
You may find it helps to talk to a partner, family member or friend. If you prefer to 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. Some organisations, such as Fertility Network UK, can provide this, as well as specialist advice and counselling. Or you can talk to people online. Our Online Community is a good place to start. You can also talk to our cancer support specialists free on 0808 808 00 00, 7 days a week, 8am to 8pm.
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 firstname.lastname@example.org
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.