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Cancer and Sexuality

Fertility and Cancer Treatments

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Are you concerned about how your cancer treatment might affect your fertility?

If you’ve just been diagnosed with cancer and are about to start treatment, you may not be thinking about your fertility. However, think about taking time to find out if your fertility will be affected by your treatment and what your options are. Other patients who have finished cancer treatment said they wished they’d taken more time to learn about options to preserve fertility before they started treatment. Once you’re over the initial shock of being told you have cancer, you can then take steps to preserve your fertility.

Some treatments for cancer damage the reproductive organs (ovaries, and testicles). These changes can be short-term or long-term.​​

 

Cancer treatment can cause reproductive organ changes like:

  • decreased sperm quality, number, and motility
  • irregular periods or it might stop females from having periods
  • early menopause (occurs before the age of 40)

What treatments can affect my fertility?

Your fertility can be affected by the cancer treatments listed below.

Chemotherapy

  • methotrexate
  • fluorouracil
  • doxorubicin
  • epirubicin
  • procarbazine
  • melphelan
  • cisplatin (Platinol® AQ®)
  • busulfan (Busulfex®)
  • chlorambucil (Leukeran®)
  • cyclophosphamide (Cytoxan®, Procytox®)
  • mechlorethamine (nitrogen mustard, Mustargen®)

Not all types of chemotherapy that affect fertility are listed above. If you have questions about other types of chemotherapy or medicine, talk to your doctor or pharmacist.

All people are different. After cancer treatment, many females don’t have fertility problems. However, there’s no way to know if you’ll have problems or not.

Younger females are more likely to be fertile after cancer treatment. The closer a woman is to menopause, the more likely the cancer treatment will damage the ovaries. The longer the treatment, the longer it may take for a woman’s 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 the 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.

Damage to the 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

Females with cancer to the uterus, cervix or ovaries (e.g., endometrial, cervical , ovarian) may need to have a surgery to remove the uterus (hysterectomy ) and sometimes have one or both ovaries removed (oophorectomy).

Some males with testicular cancer may need surgery to have a testicle(s) removed (orchiectomy). If one testicle is removed, it won’t likely affect fertility, but having both removed will leave a male sterile.

Any type of surgery can cause stress on the body (even surgery that isn’t done on the reproductive organs), which can affect:

  • how sperm is produced in males
  • menstrual periods for females (they may be irregular or missed)

Hormone-Blocking Treatment

Some types of cancer grow faster because of hormones. Because of this, a person 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.

Males with prostate cancer are often treated with androgen deprivation therapy (ADT). This type of treatment decreases the levels of male hormones. Common types of ADT are:

  • leuprolide (e.g., Eligard®, Lupron®), which is injected
  • bicalutimide (e.g., Casodex®), which comes in pill form

People with breast cancer are often treated with hormonal blockers called aromatase inhibitors (e.g., exemestane, anastrozole, letrozole) or estrogen receptor modulators (e.g., tamoxifen). Many females have to take this medicine for 5 to 10 years. Don’t try to get pregnant if you’re taking this type of treatment. Some females 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.

How can I preserve my fertility?

Some patients are offered a hormone-blocking treatment (e.g., Zoladex®, which is injected). It puts the reproductive system “to sleep” for a short time, while they get their cancer treatments. This helps prevent damage to the 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 (ART). ARTs include banking sperm, eggs, or embryos.

  • Sperm banking is when a man’s ejaculate (which contains sperm) is frozen for future use.
  • Females can have a section of the 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 the female isn’t in a committed relationship. If planning to have children using these eggs in the future, a sperm donor will be needed. However, 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 a woman’s 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.

ARTs are expensive and they aren’t covered by Alberta healthcare. Costs for ARTs 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 go to fertilefuture.ca.

Talk to your doctor or healthcare provider if you have questions about using donor eggs, or preserving sperm or embryos. Ask your doctor for a referral to a fertility program in Calgary or Edmonton.

To learn more about whether ARTs are right for you, go to Ethical and Legal Concerns with infertility.

How do I talk to my children about preserving their fertility during cancer treatment?

It’s a good idea to talk to teens 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.

When can I try to get pregnant?

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 Cancer.Net.

Other Parenting Options

Adoption: People can adopt in Canada or internationally. For more information about adoption, see Thinking about Adoption.

Surrogacy: This is when a woman carries a baby for another person or couple. A couple can use their own egg and/or sperm, a donated egg or sperm, or donated embryos. Your child’s biological makeup comes from whoever donates the sperm and eggs. For example, if the sperm and egg come from you and your partner, the surrogate would carry your biological child. If you have questions, talk to your healthcare provider about how to get more information.

If you live in Alberta and you’re distressed about the loss of your fertility or have questions about fertility options, you can self-refer for free support and/or counselling to the Psychosocial Resources within cancer services. Discuss this with your healthcare provider.​​​​​​​

Related Videos


Male​​​​​​​​
​​Overview of Male Fertility (Part 1 of 3)

Reproductive medicine expert John Mulhall describes the male reproductive system, including organs and hormones involved in sperm production and delivery.

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Fertility Options for Men with Cancer (Part 2 of 3)

Reproductive medicine expert John Mulhall discusses several fertility options for men who are being treated for cancer.

Sperm Banking (Part 3 of 3)

Reproductive medicine expert John Mulhall describes the use of cryopreservation to freeze and store sperm before cancer treatment.

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Learn about fertility preservation for young women and girls treated for cancer at the Children’s Hospital in Philadelphia.

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