Some treatments for cancer damage the reproductive organs, like your ovaries or testicles. These changes can be short-term or long-term. Cancer treatment can cause:
Treatments that can affect fertility
Chemotherapy
Some types of chemotherapy that may affect fertility are:
- methotrexate
- fluorouracil
- doxorubicin
- epirubicin
- procarbazine
- melphelan
- cisplatin (Platinol AQ)
- busulfan (Busulfex)
- chlorambucil (Leukeran)
- cyclophosphamide (Cytoxan, Procytox)
- mechlorethamine (nitrogen mustard, Mustargen)
If you have questions about other types of chemotherapy or medicine, talk to your doctor or pharmacist.
Everyone is different. After cancer treatment, you may not have fertility problems, but there's no way to know if you'll have problems or not.
If you are younger, you are more likely to be fertile after cancer treatment. The closer you are to menopause, the more likely the cancer treatment will damage your ovaries. The longer the treatment, the longer it may take for your periods to return.
If you're getting chemotherapy or radiation, you need to use birth control because the treatments can damage sperm and eggs, which can cause birth defects. Most chemotherapy is out of the body within 48 to 72 hours. Because of this, if you get chemotherapy, use a condom for intercourse and oral sex, or don't have sex, for 72 hours.
Radiation therapy
Radiation to the pelvis can affect how your reproductive organs work. Because of this, the testicles may be shielded and the ovaries may be pinned (with minor surgery) before radiation treatment starts.
Full body radiation therapy (used for transplants) will also affect fertility.
The damage to your reproductive organs will vary depending on the dose of radiation therapy. Talk to your healthcare team about whether you're at risk for infertility.
Surgery
If you have
endometrial,
cervical, or
ovarian cancer, you may need to have a surgery to remove your uterus (called a hysterectomy) and sometimes need to have one or both ovaries removed (called an oophorectomy). This may impact your ability to have children.
If you have testicular cancer, you may need surgery to have a testicle or testicles removed (called an orchiectomy). If one testicle is removed, it likely won't affect your fertility, but having both removed means you will no longer be able to produce sperm.
Any type of surgery can cause stress on your body, even surgery that isn't done on your reproductive organs. This can affect:
- how sperm is produced
- menstrual periods (they may be irregular or missed)
Hormone-Blocking Treatment
Some types of cancer grow faster because of hormones. Because of this, you may be put on a type of medicine called a hormone blocker. Hormone blockers help control the cancer or decrease the chance of the cancer coming back. These types of medicine can cause infertility.
Prostate cancer is often treated with androgen deprivation therapy (ADT), which can decrease hormone levels. Common types of ADT are:
- leuprolide (e.g., Eligard, Lupron), which is injected
- bicalutimide (e.g., Casodex), which comes in pill form
If you will be starting or have recently started ADT, visit
LifeOnADT.com to register for a free class to learn about managing common side effects of ADT.
Breast cancer is often treated with hormone blockers called aromatase inhibitors (like exemestane, anastrozole, or letrozole) or estrogen receptor modulators (like tamoxifen). You may need to take this medicine for 5 to 10 years. Don't try to get pregnant if you're taking this type of treatment. Some people can have children after this type of treatment is completed.
Pain medicine
Some research shows that taking opiate pain relievers (e.g. morphine, dilaudid, oxycodone) can affect fertility. These types of medicine can affect hormone levels, which can affect fertility. If you’re taking these types of medicine long-term and you have questions, talk to your doctor or healthcare provider.
Preserving your fertility
You may be offered a hormone-blocking treatment like Zoladex, which is injected. It puts the reproductive system “to sleep" for a short time while you get your cancer treatments. This helps prevent damage to your reproductive system. This treatment isn't for everyone and there are side effects. If you're interested and want more information, talk to your doctor.
One way to preserve fertility is with assisted reproductive technology. Assisted reproductive technologies include storing sperm, eggs, or embryos for future use (also called banking).
- Sperm banking is when ejaculate (which contains sperm) is frozen for future use.
- You can have a section of your ovary frozen to freeze eggs for future use. This is still very experimental. It’s usually only offered at the time of cancer treatment if you aren’t in a committed relationship. If you are planning to have children using these eggs in the future, you will need a sperm donor. Eggs don’t always freeze well and may not survive the thawing process.
- Embryo freezing is when fertilized eggs are frozen for future use. Hormonal treatments are often needed before eggs can be harvested. This may not be possible with certain types of cancer that are sensitive to hormones. Harvesting eggs may also delay cancer treatment, which may not be possible with some types of cancer.
Assisted reproductive technologies are expensive and they aren't covered by Alberta Health. Costs for assisted reproductive technologies include the initial procedures and annual storage costs. Talk to your healthcare provider to see if you may be eligible for help with funding or visit
Fertile Future.
Talk to your doctor or healthcare provider if you have questions about using donor eggs or about preserving sperm or embryos. Ask your doctor for a referral to a fertility program in Calgary or Edmonton.
Visit
ethical and legal concerns with infertility to learn more about whether assisted reproductive technologies are right for you.
Talking to children about preserving their fertility during cancer treatment
It’s a good idea to talk to teens who need cancer treatment about preserving fertility, but it can be hard because it only affects them in the future. Even young children can be told that their treatment might affect them having children someday. If you have questions, talk to your healthcare provider.
Trying to get pregnant after cancer treatment
It’s usually recommended to wait 1 to 2 years after treatment is done before you try to get pregnant. Everyone is different and how long you need to wait depends on the type and stage of cancer and the treatment that you get. Talk to your doctor or healthcare provider before you try to get pregnant.
To learn more about trying to get pregnant after cancer, go to the
American Cancer Society: Having a baby after cancer.
Other Parenting Options
Adoption
People can adopt in Canada or internationally. For more information about adoption, see
Thinking about Adoption and adoption in Alberta.
Surrogacy
Surrogacy is when someone carries a baby for another person or couple. A couple can use their own egg and sperm, a donated egg or sperm, or donated embryos. Your child’s biological makeup comes from the sperm and egg that are used. For example, if the sperm and egg come from you and your partner, the surrogate would carry your biological child. If you have questions about surrogacy, talk to your healthcare provider about how to get more information.
If you live in Alberta and you're concerned about the loss of your fertility or have questions about your fertility options, you can get support and counselling through your cancer care team. Talk with your healthcare provider about connecting with the psychosocial oncology team.
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