Fertility after cancer treatment

After cancer treatment, you may have worries about fertility or sex. You cancer doctor or nurse can answer any questions you have.

If you’re thinking about trying for a baby, ask your doctor for advice. They may arrange tests to check your fertility and general health. They may suggest when is the best time for you to try for a baby.

If your fertility is damaged or it’s difficult to have sex, you may consider:

  • Fertility treatment – there are several treatments, including using your frozen eggs or frozen embryos, or using eggs, sperm or embryos that have been donated.
  • Surrogacy – women who can’t carry a pregnancy may use another woman who carries the baby in her womb instead.

You may decide that none of these options are right for you. Some people decide not to have children. Some consider adopting or fostering. These decisions may be straightforward or may be upsetting. There’s no right or wrong way to feel.

Making plans

It can take time to move forward with life after cancer treatment. The decision to try for a baby is a big one for anyone to make. You may have worries and questions about fertility that didn’t seem important before cancer treatment. If and when you’re ready, you can talk to your cancer doctor again for more advice.

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 allow your body to recover.

If you’re thinking about getting pregnant, it’s a good idea 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 a bit longer. They will also give you advice about any health checks you need before trying to get pregnant.

If you’re taking hormonal therapies for breast cancer, it may be possible to stop treatment temporarily so you can have a baby. Your cancer doctor can give you information about the risks and benefits of doing this.

As well as affecting your fertility, cancer treatment can change how you feel about having sex or make it physically difficult to have sex. Even if your fertility has come back, this can make it hard to get pregnant. It’s not always easy to talk about, but your cancer doctor or specialist nurse can give you advice about this.

You can read more about coping with sexual problems.

Some people worry about passing cancer or cancer genes onto their children. Cancer can’t 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’re worried about the risk of cancer running in your family.

We have more information about cancer genes and planning a family that you may find helpful.

If you get pregnant but the cancer treatment has increased the risk of miscarriage or premature birth, you’ll be looked after by a team of specialists during the pregnancy.

If you’ve been trying to get pregnant for six months or there’s a risk that your fertility won’t recover, you can have tests to check your fertility.

Fertility treatments can be useful if your fertility does not come back or it’s difficult to have sex.

Some religions don’t agree with any type of fertility treatment. If this is an issue for you, you may want to discuss it with your partner, family or religious adviser. You could also talk in confidence with a trained counsellor or social worker.

Some women consider adoption or fostering. Some choose surrogacy, which is when another woman carries a baby for you. If you have had your womb removed or radiotherapy directly to the womb, you won’t be able to carry a pregnancy or have fertility treatment. Adoption, fostering and surrogacy may be other ways for you to have a child after cancer treatment.

You may decide that none of these options are right for you. Some people choose not to have children after cancer treatment. This can be a straightforward decision for one person and a complicated, upsetting decision for another. There’s no right or wrong way to feel. Everyone is different.

Talking to other people can be helpful while you’re thinking about your options. Whatever you decide, there’s support available.

When you have finished the treatment and life returns to being more normal, the impact of remaining childless hits home. It is something that you have to come to terms with.

Josie

I can't create a child, but I can be a positive influence on other children. I will be the best aunt, fairy godmother, foster parent or whatever life suggests, ever.

Faith


Fertility testing

The number of eggs in your ovaries is called your ovarian reserve. Cancer treatment can reduce your ovarian reserve so that you get to the menopause at an earlier age than you would have.

Usually a woman is referred to a fertility clinic after one to two years of trying to get pregnant. But women who have had cancer treatment can be referred for fertility testing sooner. This is because of the increased risk of early menopause after cancer treatment.

Fertility tests can help to measure your ovarian reserve or how close you are to the menopause. They don’t always clearly show whether or not you can have children. They may help you decide what to do next and whether you want to have fertility treatments.

Your doctor will ask you about your periods and take blood tests. If you are having periods, you can have a blood test to measure a hormone called follicle stimulating hormone (FSH). This should be done in the early part of your menstrual cycle as FSH levels vary during the month. Another test measures anti-Mullerian hormone (AMH). This can be done at any time in the menstrual cycle and even if you’re not having periods. You may also have an ultrasound scan of your ovaries to look at the follicles which contain the eggs. This is called an antral follicle count.

Taking the contraceptive pill or hormone replacement therapy (HRT) can affect the results of some of these tests. So let your doctor know if you’re taking either of these.

Some women’s periods come back months or years after cancer treatment. This is more likely if you’re younger but it also depends on the treatment you’ve had. If your periods change, you can have these tests repeated. Your doctor will talk to you about the options available to you.


Fertility treatment

If cancer treatment has damaged your fertility or made it difficult to have sex, you and your partner may decide to have fertility treatment.

The NHS will usually pay for a number of 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 fertility doctor will be able to give you information about this.

Many children have been born using fertility treatments. There don’t appear to be any increased long-term health risks to the child. Your fertility doctor can give you more information about any possible risks with these treatments.

There’s no evidence that fertility treatments increase the risk of your cancer coming back. But not a lot of research has been done in this area. If you’re worried about this, talk to your fertility doctor and cancer doctor.

Fertility treatment doesn’t always result in a pregnancy. Your fertility doctor will discuss this with you. But many people have had babies as a result of collecting and storing embryos or eggs before cancer treatment and then using fertility treatments.


If it’s difficult to have sex

After cancer treatment some women find having sex difficult. If your fertility has come back, you may choose to have sperm put into your womb at the time when your ovaries are most likely to release an egg. This is called intrauterine insemination (IUI). This procedure only takes a few minutes and feels similar to having a smear test.


Using your frozen eggs

When you’re ready to try to get pregnant, the eggs are thawed. Then, under a microscope, a fine needle is used to inject a single sperm directly into an egg. This is called intra-cytoplasmic sperm injection (ICSI) and is done in the laboratory. If an egg is successfully fertilised, the embryo can be placed in your womb to see if a pregnancy develops.


Using your frozen embryos

When you’re ready to try to get pregnant after treatment, the embryos are thawed. A doctor will place them in your womb to see if they implant. Usually, no more than one or two embryos are placed in at a time. You and your partner who provided the sperm for the embryos both have to give permission for this.


Using donated eggs, sperm or embryos

Some women who have been affected by cancer choose to use donated eggs, sperm or embryos.

Women who become permanently infertile and didn’t have eggs collected before cancer treatment may consider using donated eggs or embryos. This may be suitable if cancer treatment damaged the ovaries but you’re still able to carry a pregnancy.

Embryos are sometimes donated by other couples who have had fertility treatment previously. They may have several embryos stored and have to decide what to do with them when their family is complete.

Occasionally women choose to have their own eggs fertilised with a donor’s sperm.

Choosing to use donated eggs, sperm or embryos is a difficult decision and it isn’t going to suit everyone. It isn’t funded by the NHS in all areas. There’s also a shortage of donors, so it may not be an easy option. Some religions don’t agree with using donors. Talk to your partner, family or religious adviser about any concerns you have. You can also talk to the staff at the fertility clinic about this.

Donors

Everyone who donates eggs, sperm or embryos is carefully selected:

  • Usually a donor is 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.


Using a surrogate

Women who are unable to carry a pregnancy, may consider using a surrogate (a woman who carries the baby in her womb for you). Some of the organisations listed in our organisation database have more information about surrogacy.

We will not dismiss doing something like fostering, adoption or surrogacy. Right from the start I thought, “if we don’t want to be childless we won’t be”.

Eleanor

Back to Fertility in women

What is fertility?

Fertility in women means being able to get pregnant and give birth to a baby. Cancer and cancer treatment can affect this.

Preserving your fertility

You may be able to freeze eggs, embryos or ovarian tissue before you start your cancer treatment.

Getting support

You may find it helpful to talk to someone about any fertility worries.