Hormones are substances produced naturally in the body. Hormones control many body functions, including how you grow, develop and reproduce.

• Oestrogen and progesterone, often called female sex hormones, are produced in the ovaries. These hormones control the growth and release of eggs (ova), and the timing of menstruation (periods).
• Androgens are often called male sex hormones. The major androgen is testosterone, which is produced mainly in the testicles and helps the body make sperm. Most people produce some testosterone, although generally men make more.

Each month, from puberty (sexual maturation) to menopause (when periods stop), one of the ovaries releases an egg. This is called ovulation.

The egg travels from the ovary into the fallopian tube. Here it can be fertilised by a sperm. Once the egg is fertilised, it implants itself into the lining of the uterus and grows into a baby. After the egg is fertilised by the sperm, it’s called an embryo.

As females get older, hormone levels fall to a level where the ovaries stop releasing eggs and periods stop. This is known as menopause. This is the natural end of the female reproductive years and it usually happens between the ages of 45 and 55.

• ovaries – two small, walnut-shaped organs in the lower part of the abdomen (belly). They contain follicles that hold immature eggs (ova), which eventually become mature eggs, and make hormones including oestrogen and progesterone.
• fallopian tubes  – two long, thin tubes that extend from the uterus and open near the ovaries. They carry sperm to the eggs, and eggs from the ovaries to the uterus.
• uterus (womb)  – a hollow muscular organ where a fertilised egg (ovum) is nourished to develop into a baby. The inner lining of the uterus is known as the endometrium; each month if an egg is not fertilised, some of the lining is shed and flows out of the body (menstruation or monthly period). It is joined to the vagina by the cervix.
• cervix (neck of the uterus)  – the lower, cylinder-shaped entrance to the uterus. It produces moisture to lubricate the vagina, holds a developing baby in the uterus during pregnancy and widens during childbirth.
• vagina (birth canal)  – a muscular tube or canal that extends from the opening of the uterus (the cervix) to the vulva. It is the passageway through which menstrual blood flows out of the body, penetrative sex (such as intercourse) occurs and a baby is born.
• vulva – the external sex organs; includes the labia.

• testicles (testes) – two small, egg-shaped glands which make and store sperm. They also make the hormone testosterone.
• scrotum – the loose pouch of skin at the base of the penis that holds the testicles.
• epididymis – a tightly coiled tube attached to the outer surface of each testicle. Sperm travel from the testicles through the epididymis to the spermatic cord.
• spermatic cord and vas deferens – tube running from each testicle to the penis. It contains blood vessels, nerves and lymph vessels and carries sperm towards the penis.
• seminal vesicles – a pair of glands that lie close to the prostate. They produce fluids that make up part of semen.
• prostate – a small gland about the size of a walnut. It produces fluids that form part of semen, and is located near the nerves, blood vessels and muscles that control bladder function and erections.
• penis – the main external sex organ. Urine and semen pass out of the body through the penis. Semen is made up of sperm and fluids, and is ejaculated from the penis.

Infertility is defined as a condition where a person or couple is unable to conceive. This may result from female or male factors, or a combination of both, or the reasons may be unknown.

For females under 35, the term usually refers to trying unsuccessfully to conceive for 12 months. If a female is 35 or older, the term is used after six months of trying.

Cancer and its treatment may affect your fertility, depending on the type of cancer and treatment you have.

Chemotherapy and radiation therapy can damage reproductive organs involved in creating or carrying an unborn baby, such as the ovaries, cervix, uterus or testicles.

Sometimes these organs are damaged or removed during surgery, which can harm or destroy eggs or sperm, or make it difficult to carry a pregnancy to term.

Fertility problems after treatment may only last months to years or they may be permanent.

Age is one of the most important factors in how cancer treatment affects fertility.

Female age and fertility

Females are born with all the eggs they will have in their lifetime. From the age of 30, fertility starts to decline and this decline speeds up after 35.

It then becomes harder to conceive and the risk of chromosomal conditions (e.g. Down syndrome) increases.

From your early 40s, although you may still have regular periods, it is usually difficult to conceive a child because of lower egg quality. After menopause, it won’t be possible to conceive a child naturally.

How cancer treatments affect fertility will vary. Before and after puberty, the effect of chemotherapy and radiation therapy on fertility depends on the drugs used or the dose.

Before puberty, high doses of drugs or radiation to the pelvis may cause enough damage to the ovaries that both puberty and future fertility are affected.

After puberty, treatment to the ovaries can cause periods to stop permanently. Even if periods return after treatment, some women may experience medically induced menopause.

Male age and fertility

The quality and quantity of sperm decreases with age. This means it may take longer for an older man to conceive with his partner.

Before and after puberty, some chemotherapy and radiation therapy may affect sperm production and may cause infertility. The impact of radiation will depend on the dose and what organs are affected by the radiation.

This describes the procedures that can help preserve your fertility, for example, freezing eggs, embryos or sperm, or using injections that cause a temporary state of menopause to preserve your ovaries.

Other procedures include freezing ovarian or testicular tissue. If a cancer treatment may affect your fertility, fertility preservation procedures are usually done before treatment begins.

Your fertility may also be protected during treatment – for example, with ovarian transposition or radiation shielding.

Timing of pregnancy and when to use contraception is an important discussion to have with your cancer specialist. Some cancer specialists advise waiting between six months and two years after treatment ends.

This may be to allow your sperm or eggs to recover, and to ensure you remain in good health.

If you have a hormone-sensitive cancer and are taking anti-oestrogen drugs, you will need to wait for nine months after you finish taking these drugs before getting pregnant.

Research shows that for most types of cancers, pregnancy does not increase the chances of cancer coming back. Research is continuing, so discuss this issue with your specialist.

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

This is a very personal decision. Many people who have had cancer do go on to have children. Others decide not to have children. Having cancer may change the way you feel about having a child.

Having a family is very important to many cancer survivors and with advice from specialists, this can be safe and successful. If you have a partner, discuss your family plans with each other and with your treatment team.

Worrying about cancer coming back may make it hard for you to make plans, including having a child. Fertility clinics often have counsellors who can talk through your situation.

Ask to be referred to a counsellor who has experience in both cancer and fertility.

Studies show that if one or both parents have a history of cancer, their child has the same risk of getting cancer as anyone else.

About 5% of some cancers are caused by an inherited gene fault from either parent. This is known as familial cancer. If you inherit a gene fault from either of your parents, this will increase the risk of you developing cancer.

You may also pass on this gene fault to your children. If your diagnosis is linked to an inherited gene fault, you may consider having preimplantation genetic testing (PGT) as part of in-vitro fertilisation (IVF).

This involves testing embryos for genetic conditions. Only unaffected embryos are implanted into the uterus. This reduces the chance of the gene being passed on to the child. A fertility clinic can provide more information.

Fertility is an important part of health for everyone. But your doctor may not discuss whether you want children in the future if they make assumptions based on:

• your age, sexual orientation, gender
• whether you have children or not, or
• if they are focused on starting treatment immediately.

If fertility matters to you, let your health professional know before treatment begins.

Ask your cancer specialist about the chances of your treatment causing fertility problems and what you can do now if you want to have a child later (e.g. freezing eggs, or ovarian, sperm or testicular tissue).

Ask to be referred to a fertility clinic or oncofertility specialist, or if it is possible to plan treatment in ways that protect or limit damage to reproductive organs to reduce the chances of infertility after treatment.

Tell the fertility clinic or oncofertility specialist that you are having treatment for cancer so that they can arrange an appointment for you as soon as possible.

Your cancer care team may also be able to help you get an appointment quickly. The fertility clinic can give you information about: 

• how your age and cancer treatment might affect fertility 
• the options available to you 
• how likely it is that each option will lead to pregnancy 
• costs of the different options 
• using donor eggs or sperm in the future
• any counselling you might need.

If you have a partner, try to attend appointments together and include them in the decision-making process. You may also wish to bring a family member or friend for support.

There are several people who can help with fertility concerns.

• cancer specialist – might be a medical oncologist, radiation oncologist, gynaecological oncologist, surgeon or haematologist
• fertility specialist – diagnoses, treats and manages infertility and reproductive hormonal disorders; may be an obstetrician, reproductive endocrinologist or urologist
• oncofertility specialist – specialises in fertility care of adults or children with cancer
• cancer care coordinator – a nurse specialist who coordinates your care throughout diagnosis and treatment and works closely with other members of your health care team
• fertility counsellor – provides support and advice for people with fertility concerns
• genetic counsellor – provides advice for people with a strong family history of cancer or a genetic condition linked to cancer
• gynaecological oncologist – diagnoses and treats cancers of the female reproductive system (e.g. ovarian, cervical)
• urologist, andrologist – diagnose and treat diseases of the urinary system and the male reproductive system

Fertility preservation can be expensive, and this may influence your decision-making.

The cost of fertility treatment varies – you may be able to have treatment at a fertility unit in a public hospital or a private clinic.

Ask your fertility specialist for a written estimate of their fees and any Medicare rebates. Ask your private health fund (if you belong to one) what costs they will cover and what you’ll have to pay.

Depending on the treatment you have, costs may include:

• fertility specialist appointments – ask if they offer a discount for people diagnosed with cancer
• medicines and blood tests 
• fees for procedures (e.g. the different steps in the IVF cycle for egg or sperm collection, preimplantation genetic testing, and implantation of embryos after treatment) 
• day surgery, operating theatre and anaesthetist fees 
• egg, sperm and embryo storage (cryopreservation) – ask your clinic about up-front payments, instalment payments and ongoing fees.

If you need in-vitro fertilisation (IVF) to have a baby in the future (e.g. by using your frozen sperm, eggs or embryos), private fertility clinics will usually charge their standard fees.

Medicare will cover the cost to see a specialist only if you have a referral. The referral should list both you and your partner so you can claim the maximum benefit.

See Cancer and your finances for more information.

Being diagnosed with cancer during pregnancy is uncommon – it is estimated that 1 in every 1000 pregnant females are diagnosed with cancer.

Call Cancer Council 13 11 20 for more information about pregnancy and cancer.

• Treatment during pregnancy – This may be possible, but you need to discuss the potential risks and benefits to you and the baby with your oncologist before treatment begins. In some cases, treatment can be delayed until after the baby’s birth. For some cancers, chemotherapy may be safely used after the first trimester (12 weeks), usually with a break of a few weeks before the birth.
• Termination – Some people diagnosed with cancer in the early weeks of pregnancy decide to terminate the pregnancy so they can start treatment immediately.
• Change in birth plan – If you are diagnosed later in the pregnancy, you may be able to have the baby before the due date.
• Breastfeeding – You will be advised not to breastfeed while having chemotherapy, targeted therapy, or immunotherapy as drugs can be passed to the baby through the breastmilk. If you are having radiation therapy, talk with your doctor about whether it is safe to continue breastfeeding during treatment.

Asking your doctor questions will help you make an informed choice. You may want to include some of the questions below in your own list.

Before cancer treatment

• Will cancer or its treatment affect my fertility? Will this be temporary or permanent?
• Will any delay while I preserve my fertility affect the success of the cancer treatment?
• How long do I have to make a decision?
• Can you refer me to a fertility specialist? Are there ways to protect my fertility before treatment starts?
• What are the pros and cons of each fertility option?
• What are the chances of success of each fertility option? 
• What are the risks and possible side effects of each fertility treatment?
• Which fertility option should I avoid and why?
• Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it? 
• Do I need to pay up-front before treatment begins?
• How can I find a counsellor or psychologist?

After cancer treatment

• What fertility options do I have after treatment?
• I want to try and get pregnant. When can I start trying?
• When should I have tests to check my fertility?

Questions for reflection

• Has cancer changed my life goals, including having a child?
• If I decide not to have a child, what has led me to this decision? Are there benefits to not having a child?
• If I have a child, is it important to me that they are biologically related to me?
• What does my partner think?
• Which fertility option appeals to me and why?