The effects of cancer treatment on fertility
Some cancers and cancer treatments can affect fertility in women and men. These effects may be temporary or permanent. This is particularly true for individuals with cancers caused by inherited mutations because they are more likely to be diagnosed at an earlier age, before they have completed their family.
Both men and women have options for preserving their fertility after a cancer diagnosis. National guidelines recommend that, if possible, oncologists speak with young adults with cancer about fertility preservation prior to starting treatment, but research shows that oncologists don’t always present all fertility options to their patients with cancer. Therefore it is important for patients to speak with their oncologist about their preferences and plans for having children and ask about their options for fertility preservation prior to beginning any treatment or surgery.
Fertility considerations for women with cancer
Some cancers and cancer treatments, especially gynecologic surgery and radiation and certain chemotherapies, can affect fertility in women. These effects may be temporary or permanent.
The following factors may influence the likelihood of chemotherapy affecting fertility:
- Type of chemotherapy: (e.g.,cyclophosphamide is often is used to treat breast cancer, but it has a high probability of causing infertility).
- Dose of chemotherapy
- A woman’s age and her ovarian reserve (i.e., the quality and quantity of her eggs). Older women have less ovarian reserve and therefore their fertility is more affected by chemotherapy treatment as compared to younger women.
Women who are diagnosed with cancer may have options to preserve their fertility. These options include:
- Menstrual suppression during chemotherapy
- Ovary shielding before radiation
- Egg freezing
- Embryo freezing
Not all experts agree that menstrual suppression protects fertility in premenopausal women who must undergo chemotherapy. Freezing embryos or eggs remains the best method to preserve fertility in women of reproductive age and is the most likely approach to result in pregnancy after cancer. Women diagnosed with cancer who are concerned about their fertility may wish to discuss the following topics with their providers:
- fertility implications before and after treatment.
- contraception after treatment.
- specific methods for fertility preservation such as freezing embryos, eggs, or ovarian tissue.
- medications to suppress menstruation and whether they may protect the ovaries during treatment with chemotherapy.
Fertility considerations for men diagnosed with cancer
Some cancers and cancer treatments, especially those that affect the urologic system, and certain chemotherapies, can affect fertility in men. The following factors may influence the effects of chemotherapy on fertility:
- Type of chemotherapy:
- Dose of chemotherapy
Men who are diagnosed with cancer may have options to preserve their fertility, such as freezing sperm before treatment or surgery. They should speak with their health care providers about their fertility preferences before beginning treatment.
The following resources can help you locate an expert near you or via telehealth.
Finding fertility experts
- The Oncofertility Consortium maintains a national database of healthcare providers with expertise in fertility preservation and treatment of people who are diagnosed with cancer or at high risk for cancer due to an .
- Livestrong has a listing of 450 sites that offer fertility preservation options for people diagnosed with cancer. Financial assistance may be available to make the cost of fertility preservation affordable for more patients.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- National Cancer Institute (NCI)-designated comprehensive cancer centers have specialists to manage the fertility effects of cancer prevention or treatment.
The following research studies related to fertility preservation are enrolling patients.
Fertility preservation studies for women
- NCT01503190: The Immune System's Response to Young Women's Breast Cancer. This an observational trial looking at tissue samples from patients with Pregnancy-Associated Breast Cancer (PABC) versus non-PABC to understand how the immune system responds.
- NCT05443737: Evaluation of a Telehealth Oncofertility Care Intervention in Adolescent and Young Adult Cancer Patients. The purpose of this study is to evaluate the effectiveness of an intervention to improve young cancer survivors' oncofertility care.
- NCT0301168: Fertility Preservation Using Tamoxifen and Letrozole in Sensitive Tumors Trial (TALES). Infertility as a result of cancer treatment affects the long-term quality of life in survivors of reproductive-age cancers. This trial will study different options for fertility preservation in patients with estrogen-receptor-positive breast cancer.
- NCT00823654: Serum Biomarkers to Characterize the Effects of Therapy on Ovarian Reserve in Premenopausal Women With Breast Cancer or Mutations. This study will look at how cancer treatment affects the ovaries. Researchers will review blood samples before, during and after cancer treatment to look at levels of hormones that are produced by the ovaries and ask patients to fill out questionnaires about their menstrual cycles (periods), overall health and pregnancies.
- NCT01788839: Longitudinal Sexual and Reproductive Health Study of Women With Breast Cancer and . This study looks at how cancer treatment affects sexual and reproductive function. The patient will be asked to give a blood sample to see if and how cancer treatment affects the ovaries and the ability to have children (fertility). These blood draws are optional; patients can participate in the study questionnaire even if they choose not to have their blood drawn.
- NCT01558544: Cryopreservation of Ovarian Tissue. This study hopes to contribute to the development of technologies for freezing and thawing ovarian tissue to preserve fertility. The study is open to women who will undergo treatment or surgery for cancer or women with an who are considering undergoing risk-reducing surgery.
Fertility preservation for men
- NCT02972801: Testicular Tissue Cryopreservation for Fertility Preservation. Testicular tissue cryopreservation is an experimental procedure involving testicular tissue that is retrieved and frozen. This technique is reserved for young male patients, with the ultimate goal that their tissue may be used in the future to restore fertility when experimental techniques emerge from the research pipeline.