Assessing your fertility

Sunday 1 May, 2016

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On this page: Fertility tests for women | Fertility tests for men

After cancer treatment, you may want to do some tests to see how your fertility has been affected. 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 – this may be months or even years later. 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 there are no tests that can reliably predict whether you will be able to fall pregnant and if the pregnancy will be successful.

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 of the menstrual cycle – usually the first couple of 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)

A transvaginal ultrasound can be used to view the ovaries and follicles, and measure how many eggs you have. This test is done early in the menstrual cycle.

Anti-Müllerian hormone (AMH)

This blood test measures AMH, which is a hormone secreted by the developing egg sacs (follicles). The level of AMH in a woman’s blood is an estimate of the number of eggs left in the ovaries.

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 achieve ejaculation, but this doesn’t necessarily mean you are fertile.

Semen analysis (sperm count)

This 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 whether you are likely to need assistance to conceive.

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

If cancer genes are present

A small number of people have a greater risk of developing certain cancers, such as breast, ovarian or bowel cancer, because they carry a changed gene. You can discuss the risk of your future children inheriting a predisposition to cancer with your doctor or a genetic counsellor.

If you have a faulty gene, you may want to consider having a pre-implantation genetic diagnosis (PGD) test.

In PGD, a woman goes through the IVF cycle. While the embryos are developing in the laboratory, a few cells are removed from each embryo and tested for genetic conditions. Only unaffected embryos are implanted into the woman’s uterus, increasing the chance of the faulty gene not being passed onto the child. You can discuss this option with your fertility specialist.

If you are concerned about your family history of cancer, visit a familial cancer centre for advice about the possibility of genetic testing. Usually these centres do not need a doctor’s referral and can be found in most major public hospitals.

To find a familial cancer clinic, visit the Cancer Council Australia website.

Reviewers: 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.

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