Women's fertility and cancer treatment

Sunday 1 June, 2014

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On this page: Avoiding pregnancy during treatment | Chemotherapy | Radiotherapy | Surgery | Hormone treatment | Other treatments | Ovarian failure and menopause | Key points

Related pages: Women's options before cancer treatment | Women's options after cancer treatment


This page provides an overview of how cancer treatments can affect women's fertility. 

Avoiding pregnancy during treatment

Some cancer treatments, such as chemotherapy or radiotherapy, can harm an unborn baby or cause birth defects. Talk to your doctor or nurse about whether you need to take specific precautions (such as practising abstinence or using contraception) to avoid falling pregnant during treatment. Sometimes women become pregnant because they thought they were infertile and didn’t take precautions.

Your cancer and fertility specialists may also recommend you wait a certain amount of time before starting fertility treatment or trying to fall pregnant naturally. See women's options after cancer treatment.

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The drugs are sometimes called cytotoxics.

Although it can be an effective cancer treatment, chemotherapy often causes side effects to healthy cells in the body and can damage the eggs stored in the ovaries. The extent of the damage is determined by:

  • the type of drug/s you receive
  • the dosage and duration
  • the combination of medications you receive
  • your age and previous fertility status.

It is thought that standard chemotherapy for breast cancer ages the ovaries by 10 years.

Sometimes your menstrual cycle stops or becomes irregular during chemotherapy. You may resume having periods after finishing treatment, but there is still a risk you will experience early menopause. This is when the ovaries no longer contain the eggs and hormones necessary for reproduction. For more information, see ovarian failure and menopause.

Chemotherapy can also affect your heart and lungs. If you have long-term muscle damage as a result of treatment, it may complicate future pregnancy and delivery. Your specialist will talk to you about special considerations necessary during pregnancy.

For more information about cancer treatments, including chemotherapy, radiotherapy and surgery, call 13 11 20 for free booklets or see treatments and side effects.

Radiotherapy

Radiotherapy is the use of high-energy radiation to kill or damage cancer cells. It can be given externally, through a machine directing invisible rays toward the body, or internally, through tiny radioactive implants in the body (brachytherapy).

Whether or not radiotherapy affects fertility depends on its location (proximity to the ovaries or brain) and dose (measured in grays).

High doses of radiation to the ovaries usually destroy the remaining eggs inside and result in premature ovarian failure or early menopause.

  • Radiotherapy to the abdomen or pelvis for gynaecological or bowel cancers can damage the ovaries.
  • Brachytherapy given internally through the vagina also delivers high doses of radiation to the ovaries.
  • Treatment affecting the uterus can cause future miscarriages, premature births and low-birth-weight infants.
  • If radiation is given to the brain, it may affect the pituitary gland and interfere with the hormone signals to produce eggs. 

Surgery

Surgery to certain parts of the reproductive system can cause infertility. The effect of the operation depends on the type of cancer you have.

  • Some abdominal surgery may cause scarring in the fallopian tubes. This may block the eggs travelling to meet the sperm, resulting in infertility.
  • Removal of the uterus during a hysterectomy results in a woman being unable to carry a child.
  • If the ovaries are surgically removed (oophorectomy), a woman cannot get pregnant using her own eggs.
  • Some female reproductive organs may be removed during surgery to treat other abdominal cancers, such as bladder cancer, which can spread in the abdomen.

Sometimes it’s possible to save the reproductive organs (known as fertility-sparing surgery). For example, traditional management of early ovarian cancer involves surgery to remove the uterus, fallopian tubes and ovaries, but it may be possible to do more conservative surgery to preserve the uterus and functioning ovarian tissue.

Hormone treatment

Some types of cancer ‘feed’ off hormones (e.g. oestrogen-receptive breast cancer). In this case, you may be given hormone treatment to block natural hormone production. These are the same hormones required for fertility, so treatment can affect your ability to have a baby. However, it may be possible to store eggs or embryos before hormone treatment.

One of the commonly used drugs to treat breast cancer is tamoxifen, an anti-oestrogen drug that is usually recommended for a minimum of five years to reduce the risk of recurrence. Pregnancy should be avoided while taking hormone therapies like tamoxifen, as there is a risk it could harm an unborn child.

If you are on hormone treatment and want to become pregnant, talk to your cancer or fertility specialist about the pros and cons of stopping hormone therapy.  

Monica’s story

"I was diagnosed at age 29 with oestrogen-receptive breast cancer. My partner and I had been dating for a year and a half. However, our relationship was strong and I wanted kids in the next 1–2 years. My older sister is having problems conceiving, so I didn’t want to wait and discover that I had the same problems.

"From day one, the health professionals discussed fertility with us. However when I mentioned to the medical oncologist that I was going to see a fertility specialist, her response was, 'A lot of people are concerned about their fertility, but we need to save your life.' I found her cold, but I didn’t want to regret not exploring my options.

"The fertility specialist decided to harvest eggs through the IVF process. We were able to use a drug that didn’t introduce more oestrogen to my body. The timing of the egg harvest also worked well with my cycle, so it was a two-week delay before I could start chemotherapy. When we knew the timing, the medical oncologist was positive about it.

"They can’t say how successful the IVF process is going to be – unfortunately, for me, they could only harvest one mature egg.

"At this point, my partner and I had to decide: do we freeze my egg or a combination of the two of us in an embryo? We needed to consider what would happen if we don’t stay together for the long term. You know, it takes a lot of courage to acknowledge these difficult questions.

"We decided to freeze an embryo, because the success rates of having a live birth from embryo were slightly better than a frozen egg. We feel now that we will be together for a very long time, so hopefully the embryo will give us the best chance possible when we do want to have a baby."

Tell your cancer story.

Other treatments

Some other common cancer treatments include bone marrow or stem cell transplants, immune therapies, vaccines and biological response modifiers.

Stem cell transplants often require high doses of chemotherapy and possibly radiotherapy. This is given before transplantation to destroy cancer cells in the body and weaken the immune system so that it will not attack a donor’s cells during the transplant. This may affect your fertility.

The effects of some newer treatments on fertility and pregnancy are not yet known. It is important to discuss your fertility options with your cancer or fertility specialist.  

Ovarian failure and menopause

Premature ovarian failure

After cancer treatment, you may go through premature ovarian failure. This is when the hormones required for the ovaries to function properly decrease and stop producing mature eggs.

This can happen during treatment and for some time afterwards. This is known as temporary ovarian failure. You will experience occasional or no periods, and symptoms similar to menopause (see below).

If you have temporary ovarian failure, you are at risk of permanent ovarian failure or early menopause. It can be difficult to predict whether it will be temporary or permanent. However, if you have been in ovarian failure for a number of years, the chances of your ovaries functioning normally again decreases.

Early menopause

Early menopause (premature permanent ovarian failure) is when you stop having menstrual periods because you have no eggs left. The eggs may have been destroyed or damaged by treatment.

Experiencing menopause means you don’t ovulate and can no longer bear children. Symptoms of early menopause may include:

  • a dry vagina
  • pain during intercourse
  • a loss/reduction of interest in sex (low libido)
  • hot flushes and night sweats
  • sleep disturbance
  • mood changes.

Some women have mild symptoms, but others are more severely affected because the menopause didn’t occur gradually.  

"It feels like menopause is discussed as a treatment side effect, not as this massive impact on who you are as a person. It makes me feel like I’ve been fast-tracked into my mother ... I’m facing menopause 20 years earlier than my friends." – Denise

If your menopausal symptoms are severe, your doctor may prescribe hormone replacement therapy (HRT). This replaces the hormones usually produced by the ovaries, and can be taken in the form of tablets, creams or skin patches. However, some women are advised not to take HRT – it may be risky depending on the type of cancer you had.

There are also effective non-hormonal treatments available. Discuss your situation with your doctor.

Your feelings about menopause

Many women feel emotional when going through early menopause as a result of cancer treatment.

Menopause may make you feel a sense of loss, sadness or isolation. You may feel that your family and friends aren’t interested in hearing what you are going through. People may be relieved that you’ve finished cancer treatment, but unaware of how challenging it is for you to cope with the symptoms and side effects of early menopause.

You may find it difficult to start new intimate relationships after going through menopause. The relationships and sexuality section may provide some helpful information about support.

Menopause isn’t always a traumatic experience, though. Going through menopause might give you a sense of release from monthly menstruation and fertility issues. This may lead to a newfound sense of freedom, confidence or control.

Key points

  • You will probably be advised to avoid falling pregnant during cancer treatment.
  • Treatments may cause premature ovarian failure and/or early menopause. This could be permanent.
  • Chemotherapy is drug treatment that can damage the ovaries and age them.
  • Radiotherapy, given externally or internally, may damage the reproductive organs and cause infertility or future miscarriage.
  • Surgery could remove the reproductive organs or cause scarring that impacts fertility.
  • Other treatments, including hormone treatment, can also impact your fertility.

Reviewed by: 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 Jun, 2014