Living with and beyond cancer

Fertility

Fertility, or the ability to have children, is something that most young adults take for granted. However, of those diagnosed with cancer, some may also have to face the prospect of losing their fertility as a result of the cancer or its treatment. This can be as difficult to come to terms with as the cancer diagnosis itself. Surgical removal of both ovaries, the womb, or both testicles, will cause infertility. Other cancer treatments that can damage fertility include: radiotherapy to the whole body, brain, pelvic area or testicles, high dose chemotherapy before a stem cell transplant, or certain combinations of chemotherapy drugs; not all chemotherapy has this effect and doctors cannot always be certain that fertility will be affected. For some people their treatment damages egg or sperm production temporarily but it returns to normal over time, while for others the effects are permanent.
 
It is sometimes possible to preserve male fertility by extracting and freezing healthy sperm for later use. Men may be invited to provide a sperm sample either in a private room at the hospital or at home if they can transport it to the hospital quickly.
Some men with testicular cancer were found to have a low sperm count so they weren’t able to bank a sample. A 26-year-old in this situation said he felt ‘gutted’ because, although he hadn’t been planning a family at that time, this had effectively removed his choice. Luckily his sperm count returned to normal some years after his treatment. A 29-year-old didn’t even give a sample because he was told his sperm count would be low because of the type of testicular cancer he had. A 42-year-old man with Hodgkin’s lymphoma declined to bank sperm because he and his partner were not planning a family and didn’t want to delay his chemotherapy.
 
Depending on their age and type of cancer, women may be offered an opportunity to freeze embryos (eggs fertilised with their partner’s sperm). Freezing unfertilised eggs (for later fertilisation) is still experimental but may also be offered in some hospitals. In both cases a course of hormone treatment is required to stimulate egg production before their extraction, and the process can take 3–6 weeks. Some women had considered this option but were advised against delaying their cancer treatment because it would lower their chance of survival. A newly married 28-year-old with leukaemia was encouraged to do it but declined.
Another option is extracting ovarian tissue for possible later re-implantation. However the methods for doing this are still at the experimental stage and there are only a few places where it can even be attempted. This is quicker than harvesting eggs or embryos but is still an experimental procedure and few babies have so far been born by this method. Again, because such procedures need time to carry out they may not be possible if treatment is needed urgently. Julie had this done when diagnosed with acute myeloid leukaemia aged 27. Her doctors recommended treatment that would definitely make her infertile. She initially refused this treatment in order to preserve her fertility, but was eventually persuaded because the risks to her life without it were so high.
Some women went into surgery not knowing how much of their reproductive organs would be removed. Others sought a second opinion about treatment decisions that would affect their fertility, and avoided surgery that would make them infertile. One went on to have two children after a radical trachelectomy for cervical cancer, a relatively new technique which is becoming increasingly available in the U.K.
Being told their cancer treatment would make them infertile produced a range of reactions among people we interviewed, and depended on their age and whether they already had children. Many people said that they had already completed their family so it wasn’t a problem. For others with children, having cancer treatment forced them to accept that they wouldn’t have any more. Some were childless through choice or because they hadn’t managed to conceive a baby, so now had to accept the finality of this situation. Even for those who hadn’t been planning (more) children, having the option taken away could be upsetting.
Although becoming infertile hadn’t seemed an important issue at the time for some people, because they were focusing on surviving, the emotional impact could hit them further on when things got back to normal. A young woman with ovarian cancer had two small children and only a short time to decide whether both her ovaries should be removed. At the time she believed that being strong and well for her children was more important than having any more children. Since then she wonders if it was the right decision and has had to come to terms with her infertility. Some women said that it had been difficult coming to terms with the realisation that they would not have any children or complete the family they had wanted. Although she still sometimes has regrets, one woman said she was now resigned to being infertile.
Fielding questions from well-meaning friends about plans for further children meant having to decide whether to disclose information about their cancer and the resulting infertility. Some people felt envious of others who had children or larger families than they did. It was common for people whose treatment had made them infertile to enjoy spending time with nephews and nieces or godchildren, although it could also be a reminder of their infertility.
Treatment-induced infertility could cause problems in relationships and some people said that when starting a new relationship they had disclosed this information before a long-term commitment was made. A man treated for lymphoma whose marriage broke down married again and adopted his new wife’s daughter.
No-one we spoke to had yet tried to conceive a child using their frozen sperm, eggs or embryos, but a man treated for lymphoma was intending to. One woman was reluctant to have the hormone treatment that would be required but was also told she’d be unable to carry a pregnancy because of radiation damage to her womb. Some men who banked sperm had not needed it to conceive a child.
Conceiving a child is not advised when taking a drug called Glivec (imatinib), which can keep people in remission from chronic myeloid leukaemia indefinitely. Because it is a relatively new drug there is little information about what harm, if any, it could cause to a developing fetus, so people are advised to stop taking it before trying to conceive, but doing so would risk their leukaemia recurring. People we spoke to were not prepared to take this risk.
Adoption is an alternative that some people considered. Several decided it wasn’t for them; others found they had to wait until they had survived a certain number of years before they would be eligible to apply.

See more experiences of infertility.
Last reviewed August 2015.
Last updated August 2015.

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