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 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.