Key questions

Sunday 1 May, 2016

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On this page: How does cancer affect fertility? | When should I discuss fertility? | What is my risk of infertility? | How does age affect fertility after cancer? | Do fertility drugs cause cancer? | Should I have a child after I’ve had cancer? | How long should I wait to conceive after treatment? | Will having children cause the cancer to come back? | Do children of cancer survivors have more health problems? | What if I was already pregnant at diagnosis?


This section covers some common questions men and women ask about fertility and cancer.

How does cancer affect fertility?

Cancer and its treatment may cause fertility problems. This will depend on the type of cancer and treatment you have. Infertility can range from difficulty having a child to the inability to have a child. Infertility after treatment may be temporary, lasting months to years, or permanent.

Women

Some treatments may cause the ovaries to produce fewer eggs. Hormone production between the brain and the ovaries may also be affected. Surgery to treat cancer may involve removing reproductive organs. For further details, see women’s fertility and cancer treatments.

Men

Some treatments may cause issues with sperm quantity and quality (low numbers of sperm are made or the sperm that are made do not work properly) or poor sperm movement (motility). The tubes carrying the sperm may also be blocked. Sometimes reproductive organs are removed during an operation. For further details, see men’s fertility and cancer treatments.

"Advances in medical technology helped treat my cancer, then gave my wife and I the chance to become parents. I’m amazed at what was possible." – Craig

When should I discuss fertility?

It’s best to talk about ways to preserve or protect your fertility before cancer treatment begins. Even if you are not sure whether you want to have children (or more children), it’s worthwhile having the discussion about storing your eggs or sperm early, so you have options in the future.

Fertility is something your treatment team should discuss with you, but you can also bring up the topic yourself. For suggestions on starting a conversation about fertility, see talking about fertility.

If you don’t have the opportunity to see a fertility specialist before treatment, ask your GP or oncologist for a referral.

"I now understand what they mean by ‘information means control’. Seeking accurate, reliable information was a huge coping strategy for me." – Sonya

What is my risk of infertility?

The risk of infertility varies between people. You will need to discuss the effect of treatment on your fertility with your oncology team and fertility specialists for individual advice.

The US organisation Livestrong provides an online tool that shows the risk of infertility based on treatment and type of cancer.

How does age affect fertility after cancer?

Age is one of the most important factors that influences the impact of cancer treatment on fertility. It affects both women and men.

Women’s age and fertility

Age is the most important factor affecting future pregnancies for women. Women are born with all the eggs they will have in their lifetime, and as women age, their eggs age too. Fertility starts to decline after 30 and the decline speeds up after 35. It then becomes harder to conceive and the risk of genetic abnormalities increases.

Before puberty, the effect of chemotherapy on the ovaries can be minimal. Radiotherapy may cause enough damage to the ovaries that puberty doesn’t occur normally. After puberty, the ovaries are very sensitive to the effects of both chemotherapy and radiotherapy, and the risk increases as women get older. Even if reproductive function returns after treatment, women may experience early menopause.

Men’s age and fertility

The quality and quantity of men’s sperm decreases with age. This means it will take longer for their partner to get pregnant. Before puberty, the effect of chemotherapy on the testicles is minimal, but radiotherapy may cause enough damage to testicles so puberty doesn’t occur normally. After puberty, chemotherapy and radiotherapy affect sperm production and may cause infertility.

Do fertility drugs cause cancer?

For some fertility treatments, you will need to take extra hormones or stimulate your hormones. It’s still not known how safe this is for people with hormone-sensitive cancer. Discuss the potential risks of particular fertility treatments with your cancer or fertility specialist. Taking hormone receptor blockers during egg collection will help reduce the risks.

Should I have a child after I’ve had cancer?

This is a very individual decision. A cancer diagnosis is likely to affect the way you think and feel about having a child. If you have a partner, you may want to discuss your family plans together. Fertility clinics often have counsellors who can talk through the pros and cons of your situation.

"I was given a good prognosis, but we’re still nervous about what happens if it comes back and we leave a child without a parent. That’s my biggest concern." – Liam

How long should I wait to conceive after treatment?

This depends on many factors, including the type of cancer and type of treatment. Some specialists advise waiting two years after treatment ends. This may be to allow your body to recover, or to see if the cancer comes back during this time. It’s best to discuss the timing with your doctor.

Will having children cause the cancer to come back?

Research shows that pregnancy does not increase the chances of cancer coming back (recurring). However, studies have mainly focused on women with breast cancer. Research is continuing, so it’s best to discuss this issue with your specialist. For more information about pregnancy and cancer, see information for women and for men.

Studies to date also suggest that survival rates for people who have children after cancer treatment are no different from those who don’t have children after treatment.

Do children of cancer survivors have more health problems?

Current research suggests that children born to cancer survivors (after treatment has ended) are no more likely to have health problems than the general population.

Studies show that if one or both parents have a history of cancer, their child is at no greater risk of getting cancer than anyone else. The exception is if cancer runs in the family through an inherited syndrome. For more information, see if cancer genes are present.

Your fertility specialist or genetic counsellor is the most qualified person to give you up-to-date information about the risks of particular fertility treatments.

What if I was already pregnant at diagnosis?

Being diagnosed with cancer during pregnancy is rare – about one in 1000 women are affected.

It may still be possible to have cancer treatment during pregnancy. The potential risks and benefits need to be discussed before treatment begins. Sometimes treatment can be delayed until after the birth. If necessary, chemotherapy can be safely used after the first trimester (12+ weeks).

Some women diagnosed with cancer in the early stages of pregnancy decide to terminate so they can immediately start treatment, while others who are diagnosed later in the pregnancy choose to deliver before the due date. Before making this decision, talk to your cancer specialist and obstetrician for information and support.

Women wishing to breastfeed need to be aware that the drugs can be passed to the baby through the breastmilk and that it’s not possible to breastfeed during chemotherapy and other cancer treatments. For support, contact the Australian Breastfeeding Association on 1800 686 268.

"My oncologist wanted to start treatment as soon as possible, so it was a case of my obstetrician and oncologist deciding on a day to deliver my son, then starting my cancer treatment. He was delivered safely at 32 weeks." – Lily

Reviewed by: Prof Roger Hart, Medical Director of Fertility Specialists of Western Australia and Professor of Reproductive Medicine, School of Women’s and Infant Health, University of Western Australia, WA; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s and Prince of Wales Hospitals, Director of the Sydney Youth Cancer Service, NSW; Brenda Kirkwood, 13 11 20 Consultant, Cancer Council Queensland, QLD; Dr Michael McEvoy, Director of Clinical Services, Flinders Fertility, SA; Eden Robertson, Research Officer, Behavioural Sciences Unit, Sydney Children’s Hospital, NSW; Kayla Schmidt, Consumer; A/Prof Kate Stern, Head of Fertility Preservation Service, The Royal Women’s Hospital and Melbourne IVF, Head Endocrine and Metabolic Service, Royal Women’s Hospital and Clinical Director, Melbourne IVF, VIC; and Prof Jane Ussher, Centre for Health Research, Western Sydney University, NSW.