Assessing your fertility

Tuesday 1 July, 2014

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On this page: Fertility tests for women | Fertility tests for men | When cancer genes are present | Preserving fertility in children and adolescents


After cancer treatment, you may want to do some tests to see how your fertility has been impacted. However, some people prefer not to know – it is up to you.

You may decide to wait until you feel physically and emotionally prepared to know the results. A partner, friends, family or your medical team might provide support to you when you receive the results.

Fertility tests for women

Your cancer or fertility specialist can talk to you about your likely fertility status after treatment, but unfortunately there are no tests that can reliably predict whether you can fall pregnant and if the pregnancy will be successful. A number of factors contribute to fertility for women, including age and the number of remaining eggs.

Follicle stimulating hormone (FSH)

A blood test can measure FSH, which may indicate how close to menopause you are. FSH levels need to be measured on specific days as levels change throughout the month.

Transvaginal ultrasound

An ultrasound scanner may be inserted into the vagina to examine the structure of the uterus, fallopian tubes and ovaries.

Antral follicle count (AFC)

Using an transvaginal ultrasound to view the ovaries and follicles. The AFC test is done on day three of the menstrual cycle.

Anti-müllerian hormone (AMH)

This blood test measures AMH, which is a hormone secreted by the follicles. Experts are undecided about the value of AMH measurements, as some recent evidence suggests that AMH is reduced in women with breast cancer prior to treatment. Your fertility specialist will discuss if AMH testing before and after treatment could help you consider your options.

Ovarian volume

A transvaginal ultrasound shows the volume of the ovaries. Usually the combined volume is about 10 mL. Women with small ovarian volume (less than 4 mL) often find it challenging to become pregnant.

Fertility tests for men

After treatment, you may be able to have an erection and ejaculate, but this doesn’t necessarily mean you are fertile. A semen analysis test can show if you are producing sperm, and if so, how many there are, how healthy they look, and how active they are.

You will go into a private room and masturbate until you ejaculate into a small container. The semen sample is sent to a laboratory for analysis. The results will help the fertility specialist determine if you are likely to need assistance to conceive.

If you stored sperm in a sperm bank before cancer treatment, your doctor can do an analysis of this sample and use it as a baseline comparison to the post-treatment analysis.

When cancer genes are present

A small number of people have a faulty gene that increases their risk of a certain type of cancer. This affects about one in 10 people with cancer.

If you are concerned about passing cancer on to future children, ask your doctor about doing a test or seeing someone who specialises in genetics and fertility.

Some people who have a faulty gene may decide to undergo pre-implantation genetic diagnosis (PGD). This means that embryos produced during IVF are tested to determine whether the faulty gene is present. Only unaffected embryos are implanted into the woman’s uterus, ensuring the faulty gene is not passed onto the child. Discuss this option with your fertility specialist.

"One of the things that really worries me is not knowing if I could pass this cancer onto my children. Nobody has raised this with us and it is my greatest fear." - James

Preserving fertility in children and adolescents

Children and teens diagnosed with cancer face many difficult issues. Often their focus is on survival, so it is hard to think beyond the present.

However, the majority of young people survive cancer, and fertility may become important to survivors as they reach puberty (sexual maturity) and adulthood.

There may be some things the medical team can do to preserve a young person’s fertility. In many cases, decisions on fertility preservation must be made before treatment begins. Your health care team will give you an overview of your options.

Parents will be required to consent to procedures. If the young person is old enough to understand fertility, they should be involved in the discussion.

Additional resource

CanTeen’s resource, Maybe Later Baby, is written specifically for young people. It provides reliable information about cancer and fertility.

  "I was diagnosed at age 13 and never thought about my ability to have children or how cancer treatment would affect this. My doctors didn’t really take into consideration the fact that I want to have children in my late 20s." - Milla

Girls

Most girls go through puberty at 9–15 years old. The table below describes some of the options that may be available. It’s important that girls receive counselling about their options with a fertility specialist.

Before puberty
  • Undeveloped, immature eggs may be collected, matured in a laboratory, then frozen. This is experimental and not widely available at this stage.
  • Ovarian tissue can be removed and frozen (for re-transplantation later).
After puberty
  • Mature eggs can be removed and frozen.
  • Hormone levels can be checked to assess fertility. It’s possible for young women to be fertile, but then go through early menopause.
At any time, a girl receiving radiotherapy to the pelvis can shield her abdominal area. The ovaries can also be surgically relocated so they are out of the radiation area (see ovarian transposition).
"Obviously I was not thinking about having kids or anything at 15. But it made me pretty upset though. The possibility of not being able to have my own child was devastating." - Zoe

Boys

Most boys go through puberty by the age of 13. At this stage, mature sperm is present in the semen. After cancer treatment, many boys have normal puberty and are able to have children naturally. A doctor will do a semen analysis to confirm if sperm are being produced.

Before puberty
  • There are no proven fertility preservation methods for boys who have not gone through puberty.
  • Some techniques, such as testicular sperm extraction, are being tested on young boys, but they are experimental and not widely available at this stage.
After puberty
  • Sperm banking and cryopreservation can be used to store mature sperm for future use.
  • Sperm may be surgically removed through testicular sperm extraction.
At any time, the testicles can be shielded for a boy receiving radiotherapy to the pelvis.
"As soon as they said ‘sterile’ it hit me pretty hard. They said, ‘We’ll speak about it when it comes up for you later in life’. It probably put me in a little bit of a depression spiral, to be honest." - Jason

Reviewers: Prof Martha Hickey, Head of Obstetrics and Gynaecology, University of Melbourne, VIC; Franca Agresta, Clinical Research Manager, Melbourne IVF, VIC; Alyssa White, National Publications Project Manager, Cancer Council NSW; and Georgia Mills, Cancer Survivor.
Updated: 01 Jul, 2014