Some chemotherapy drugs can stop the ovaries from working properly and releasing eggs (ovulation). If chemotherapy destroys or damages eggs, your body won’t be able to replace them.

Chemotherapy drugs can cause your periods to become irregular or even stop for a while. Depending on your age, number of eggs and the amount of chemotherapy you’ve had, your periods may return within a year of finishing treatment.

If your periods do not return, the ovaries may have stopped working permanently, causing premature or medically induced menopause.

The effects of chemotherapy on the sperm you make may be temporary or permanent if the cells in the testicles are too damaged to produce healthy, mature sperm.

Some chemotherapy drugs can affect your heart and lungs. If this causes long-term damage, it may make a future pregnancy and birth more difficult. Your specialist will talk to you about what precautions to take during pregnancy.

Heart health and cancer

This can stop the ovaries producing hormones and eggs permanently.

If you need radiation therapy near the ovaries, one or both may be surgically moved higher in the abdomen and out of the field of radiation. This is called ovarian transposition (oophoropexy).

This can stop the ovaries producing hormones, and cause permanent menopause. Radiation therapy can also permanently damage the uterus, which means you cannot carry a baby.

This can lower the number of sperm and affect the sperm’s ability to work normally.

This may cause erectile dysfunction, which means not being able to get and keep an erection firm enough for penetrative sex.

This may damage the pituitary gland, which releases hormones that control reproduction. It tells the ovaries to release an egg each month and the testicles to make sperm.

This is known as total body irradiation (TBI), and may be given before a stem or bone marrow cell transplant to treat blood cancers.

Complications such as miscarriage, premature birth and low birth weight are more common with pregnancies after TBI.

If one ovary is removed, the other ovary should continue to release eggs and produce hormones. If you still have a uterus, you may still have periods and be able to become pregnant.

If both ovaries are removed (bilateral oophorectomy), you will experience immediate medically induced menopause. You will no longer have periods or be able to become pregnant naturally.

This type of surgery may be used to treat cancer of the cervix, ovary, uterus and, sometimes, cancer of the vagina. After a hysterectomy, there is nowhere for a baby to develop and your periods will stop.

Sometimes the ovaries will also be removed. If your ovaries are left in place and continue to work, you may be able to fertilise your eggs through IVF and use a surrogate to carry the pregnancy.

Treatment for testicular cancer usually involves removing one testicle. If you have had one testicle removed, you can go on to have children naturally. However, men with testicular cancer have lower fertility rates than the general population.

The urologist may advise you to store sperm at a sperm banking facility before the surgery, just in case you have fertility problems in the future.

In some rare cases, both testicles are removed (bilateral orchidectomy). This causes permanent infertility because you will no longer produce sperm. You will still be able to get an erection.

Surgery for prostate cancer usually involves removing the prostate and seminal vesicles, and sealing the tubes from the testicles (vas deferens).

This causes permanent infertility because you will not be able to ejaculate semen during orgasm. This is known as a dry orgasm.

Part or all of the penis may be removed to treat cancer of the penis. The part of the penis that remains may still get erect with arousal and may be long enough for penetration.

It is sometimes possible to have a penis reconstructed after surgery, but this is still considered experimental and would require another major operation.

This may damage the nerves used for getting and keeping an erection (called erectile dysfunction or impotence). Erectile dysfunction may last for a short time or be permanent.

It may be possible for the surgeon to use a nerve-sparing technique to protect the nerves that control erections. This works best for younger men who had strong erections before the surgery.

However, problems with erections are common even with nerve-sparing surgery.

If a cancer is growing in response to the hormones oestrogen or progesterone, the cancer cells will have hormone receptors. These are proteins found on the surface of the cancer cell.

Cancer cells with oestrogen or progesterone hormone receptors on them are called hormone receptor positive or hormone-sensitive cancers. They are more likely to respond to hormone therapy.

Anti-oestrogen drugs (such as tamoxifen) are used to reduce the risk of oestrogen-sensitive breast cancers coming back. Many anti-oestrogen drugs are taken for 5–10 years.

Pregnancy should be avoided while taking the drugs and for nine months afterwards, as there is a risk the drugs could harm an unborn child. These drugs can cause menopause symptoms, although they don’t bring on menopause.

Although hormone treatments for breast cancer are used for many years, ask your doctor if it is possible to take a break from the drugs to try for a baby.

Anti-oestrogen drugs do not damage the ovaries or eggs. Some anti-oestrogen drugs are of benefit during fertility treatment and keep your oestrogen levels low.

Males with breast cancer who are taking the drug tamoxifen may experience increased sperm production.

Some cancers of the uterus grow in response to oestrogen. Hormone therapy may be given if the cancer has spread or if the cancer has come back, particularly if it is a low-grade cancer.

The hormone testosterone helps prostate cancer to grow. Hormone therapy may reduce how much testosterone your body makes and help slow the growth of the cancer or even shrink the cancer, but it may also cause infertility.

While you’re having chemotherapy and radiation therapy, and for some time afterwards, the ovaries often stop producing hormones. This is known as acute ovarian dysfunction.

You will have occasional or no periods, and symptoms similar to menopause, before regular periods return. If you have no periods for several years, your ovaries may not work normally again.

Menopause is the end of menstruation (having periods). It usually happens between the ages of 45 and 55.

Menopause before the age of 40 is known as premature menopause or premature ovarian insufficiency (POI), and before the age of 45 it is called early menopause.

A permanent end to your periods may occur immediately or many years after treatment depending on your age, type of treatment and the dose of any drugs you received.

If the ovaries are surgically removed or too many eggs are damaged during treatment, menopause is permanent.

While premature menopause means you won’t ovulate, it may be possible to carry a baby if you have a uterus and have not had radiation therapy and use stored eggs or donor eggs.

After spontaneous POI there is a small chance (5–10%) of becoming pregnant naturally because a remaining egg may mature and be fertilised by a sperm. The likelihood of getting pregnant after POI caused by cancer treatment is not known.

Most menopause symptoms are related to a drop in your body’s oestrogen levels and might be more severe when menopause starts suddenly.

Common symptoms may include a dry vagina, hot flushes and night sweats, aching joints, changes in mood and difficulty sleeping.

MHT was previously known as hormone replacement therapy or HRT. It may help treat menopause symptoms. MHT replaces the hormones that the ovaries stop making, and can be taken as tablets, creams or skin patches.

Taking MHT may increase the risk of some diseases. If you were diagnosed with hormonesensitive cancers such as breast cancer, you are advised not to take MHT, but there are other non-hormonal drugs available that can help.

Vaginal moisturisers and lubricants can help with vaginal discomfort and dryness. They are available over the counter from a pharmacy.

In some cases, after some surgeries or treatment, the nerves involved in ejaculation are damaged. During orgasm, semen may go back towards the bladder instead of forward into the penis. This is called retrograde ejaculation.

If this happens, you may be given medicine to help the semen move out of the penis as normal. This may make it possible for you to conceive naturally.

Your fertility specialist can also collect some ejaculated sperm from the urine, which can be used to fertilise eggs during IVF.

Sometimes surgery damages the nerves that help control erections and causes erectile dysfunction. This is often a temporary problem.

The ability to have erections firm enough for penetration can continue to improve for up to three years after treatment has finished. Some people may not get strong erections again.

There are several medical options you can try. These include prescription medicine and erectile aids, which may make it possible for you to conceive naturally.

If you are not able to have penetrative sex, you may be able to have testicular sperm extraction to help you conceive.