Concerns about fertility after treatment

Treatments for cancer cause concern about the ability to have babies in the future. Both chemotherapy and radiotherapy, in certain cases, may have a temporary or permanent effect on your fertility (ability to have children). It is rare for young women and girls to get cancer of the ovaries or womb but if they do these may have to be removed surgically and then it will not be possible to get pregnant the usual way (although it may still be possible if only one ovary is removed).
Certain cancer treatments also reduce a man's sperm count, or it may mean that sperm may not be able to reach and fertilise the egg during sex. If a cancer affects both testicles, or the prostate (both rare in young people) these may need to be removed surgically, and then it will not be possible to father a child in the usual way. 
Treatment for cancer with certain hormones can (usually temporarily) affect both male and female fertility. Chemotherapy treatment can sometimes cause women to go through an early menopause.
It is often not possible to predict whether a young person’s fertility will be affected by the treatment they are given for their cancer, and if it will return after their treatment finishes. So young men may be advised to consider ’sperm storage’ before their treatment. This needs to be decided before treatment and this can be difficult, when someone may still be deeply anxious from being told that they have cancer in the first place. Therefore, being informed about the possibility of future fertility problems can become just one more issue that they are advised about and that they may also feel that they don’t want to make an immediate decision about it. But many of the young men we interviewed were glad that they decided to take the option of having their sperm stored.
None of those we talked to had been able to talk to a counsellor before making the decision. However one man thought that this would have definitely been a good idea, especially since he had to take an HIV test before his sperm was stored.

Sometimes the question of storing sperm does not seem to have been discussed by the doctors - and this can lead to a lot of regret if the young person knows they would want a family. One young man, who asked the consultant why this had not happened in his case, was told that the type and quantity of chemotherapy that he was given was thought to be too small to have an effect on his fertility (Interview 11).

Very occasionally it is not possible to protect fertility in the best way, because chemotherapy has to be started straightaway, or there is a need for emergency surgery to remove reproductive organs. For some it was very upsetting to realise that they had no choice. But for others the initial question 'Am I going to live?’ still seems much more important than whether they might want to have children in a future. Those who thought that they would not be able to have children often pinned their hopes on medical advances in being able to treat infertility, or otherwise talked about the possibility of future adoption or fostering.

There was considerable discussion about the clinic where the young men we interviewed had to go to produce samples of sperm. Several said that it would have been rather less embarrassing if the ’setting’ had been more private but those who had stored their sperm felt reassured that they had done so.

From the interviews it appeared that doctors are not all equally good at raising issues concerning fertility and what to do about protecting it. Some doctors dealt with it really well, but others were overly formal, or seemed uncomfortable or embarrassed when discussing sperm collection. Sometimes the nurses were better at explaining the details of what was needed.

Although fertility can return after treatment you will not know when this might happen, and it is important to use contraception whenever you have sex to avoid a pregnancy. Using a condom will also help protect from sexually transmitted infections (see our sexual health section).

Girls who are undergoing treatment for cancer may also be advised to store their eggs or their ovarian tissue. For instance a 16-year-old girl was offered a new treatment in which ovarian tissue is frozen (cryo preservation) because it was almost certain that she would become infertile after chemotherapy. However, this procedure is still experimental and reimplantation of the thawed tissue may not be available at all UK hospitals. So far, only a few babies have been born using this method but the number is rising all the time. Again, because such procedures need time to carry out they may not be possible if treatment is needed urgently.

Last reviewed November 2014.

Last updated November 2014.


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