How chemotherapy might affect your fertility
Unfortunately, some chemotherapy treatments may cause infertility. Infertility is the inability to become pregnant or to father a child and may be temporary or permanent, depending on the drugs that you have. It is strongly advised that you discuss the risk of infertility fully with your doctor before you start treatment. If you have a partner, they will probably wish to join you at this discussion. Then you can both be aware of all the facts and have a chance to talk over your feelings and options for the future.
- Contraception
- Female fertility
- Pregnancy and cancer
- Male fertility
- Feelings about infertility
Contraception
Although chemotherapy can reduce fertility it is quite possible for a woman having chemotherapy to become pregnant during the treatment. The side effects of chemotherapy, such as sickness and diarrhoea, can make the pill less effective. Female partners of a man having chemotherapy may also become pregnant. Pregnancy should be avoided during chemotherapy in case the drugs harm the baby.
Female fertility
Some drugs will have no effect on your fertility, but some may temporarily or permanently stop your ovaries producing eggs. If this happens it means, unfortunately, that you can no longer become pregnant and it will also bring on the symptoms of the change of life (the menopause). During chemotherapy your monthly periods may become irregular and stop and you may have hot flushes, dry skin and dryness of the vagina.
Some women's ovaries start producing eggs again once the treatment ends and their periods return to normal. If this is the case, the infertility will have been short-term. This happens in about a third of women. Usually, the younger you are, the more likely you are to have normal periods again and still be able to have children once the chemotherapy has ended.
Depending on the type of cancer you have, your doctor may be able to prescribe hormone tablets (HRT) to help relieve the menopausal side effects. The hormones, unfortunately, will not enable you to start producing eggs again and so cannot prevent infertility. Cancerbackup has a section on coping with menopausal symptoms.
Pregnancy and cancer
If you are pregnant before your cancer is diagnosed and your chemotherapy starts, it is very important to discuss with your doctor the pros and cons of continuing with your pregnancy. It is sometimes possible to delay starting chemotherapy until after the baby is born, depending on the type of cancer you have, the extent of the disease, how advanced the pregnancy is and the particular chemotherapy you will be having. Sometimes, chemotherapy can be given in the later stages of pregnancy.
You will need to talk to your doctor about your pregnancy and be sure you are fully aware of all the risks and alternatives before making any decisions. You can also talk to the nurses at Cancerbackup.
Male fertility
Some chemotherapy drugs will have no effect at all on fertility, but some may reduce the number of sperm produced or affect their ability to reach and fertilise a woman's egg during sex. Unfortunately, this means you may no longer be able to father children. However, you will still be able to get an erection and have an orgasm as you did before you started your treatment.
If you have not completed your family before you need to start chemotherapy, you may be able to bank some of your sperm for later use. If this is possible in your case, you will be asked to produce several sperm samples over one or two weeks. These will then be frozen and stored so that they can be used later to try to fertilise an egg and make your partner pregnant. The pregnancy then continues as normal. You may be charged a fee for sperm storage, and also for the infertility treatment.
If chemotherapy causes infertility, some men will remain permanently infertile after their treatment has stopped, while others will find their sperm returns to normal levels and their fertility comes back. Sometimes it may take a few years for fertility to return. Your doctor will be able to do a sperm count to check your fertility when your treatment is over.
Teenage boys should also be aware of the infertility risk so that, if possible, their sperm can be stored for later years.
Feelings about infertility
Some people are devastated when they discover that the treatment they need for their cancer will also mean they can no longer have any children. If you had been planning to have children in the future or to have more children to complete your family, infertility may be very hard to come to terms with. The sense of loss can be very painful and distressing for people of all ages. Sometimes it can feel as though you have actually lost a part of yourself. You may feel less of a man or less feminine because you can't have children. Women especially may be distressed, and resentful that the drugs may cause bodily changes, such as the menopause, which can further undermine their self-confidence.
People vary in their reactions to the risk of infertility. Some people may shrug it off and feel that dealing with the cancer is more important. Others may seem to accept the news calmly when they start treatment, and find that the impact doesn't hit them until the treatment is over and they are sorting out their lives again.
There is no right or wrong way to react. You may want to discuss the risks and all your options with your doctor before you start treatment. You may also need an opportunity to talk to a trained counsellor about any strong emotions which threaten to become too much for you.
Your partner will also need special consideration in any discussions about fertility and future plans. You may both need to speak to a professional counsellor or therapist specialising in fertility problems. They can help you to come to terms with your situation.
Your doctor may be able to refer you to a specialist. The nurses at the Cancerbackup Cancer Support Service can discuss problems you may have and they can also help you to find a counsellor who can offer you help and advice.
