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Fertility


Fertility after cancer treatment


After cancer treatment, you may want to do some tests to see how your fertility has been affected. The results will help your specialist recommend the best options for having a child after cancer treatment.

If you weren’t able to preserve your fertility before starting cancer treatment, you may still be able to do this after treatment. In this case, it is better to have any fertility tests soon after cancer treatment ends.

Otherwise, 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 females

Your fertility specialist or reproductive endocrinologist can organise a number of tests to assess your likely fertility status after treatment.

Types of fertility tests for females

  • Follicle-stimulating hormone (FSH) – a blood test can measure the hormone FSH, which may indicate how close to menopause you are. This hormone is produced in the pituitary gland, and stimulates the follicles in the ovaries, which will in turn release eggs. 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 uses echoes from soundwaves to create a picture of the cervix, uterus, fallopian tubes and ovaries. A technician will insert an ultrasound wand into the vagina.
  • Antral follicle count (AFC) – an ultrasound wand is inserted into the vagina to show the number of follicles in the ovaries. Each follicle contains a single immature egg.
  • Ovarian size – an ultrasound probe is inserted into the vagina to show the size of the ovaries. Smaller ovaries usually contain fewer eggs, which may make it more challenging to become pregnant.
  • 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 the blood is only an estimate of the number of eggs left in the ovaries. It does not reflect egg quality or the ability to have a baby. AMH is usually low after cancer treatment but sometimes increases after you’ve recovered from chemotherapy.
  • Oestrogen (oestradiol) – this is produced mainly in the ovaries. The level of oestradiol rises and falls throughout the menstrual cycle so a single measurement does not give good information about fertility.
  • Luteinising hormone (LH) – a blood test can measure LH levels. This hormone helps the ovaries release an egg. High levels of LH may be a sign that your ovaries have stopped working (premature ovarian insufficiency).

 

Fertility tests for males

After treatment, you may be able to have an erection and ejaculate, but this doesn’t necessarily mean you are fertile. If you stored sperm in a sperm bank before cancer treatment, your doctor can compare this sample to your sperm sample after treatment.

Types of fertility tests for males

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 help to conceive.

Follicle-stimulating hormone (FSH) – a blood test can measure FSH. This hormone is produced in the pituitary gland. In males, FSH encourages sperm production. If FSH levels are higher than normal, this is a sign that fewer sperm are being produced.

If FSH levels are lower than normal, this indicates that the pituitary gland is damaged. This will affect the number of sperm produced. This does not necessarily mean that sperm production is too low for a pregnancy but it is a sign of whether or not fertility has been affected.

Luteinising hormone (LH) and testosterone – a blood test can measure LH and testosterone levels. LH is important in fertility, because it maintains the amount of testosterone that is produced by the testicles. This also helps with sperm production, muscle strength and general sexual health including sex drive (libido).

Like many hormones in the body, LH and testosterone levels are different at different times of the day. They are highest in the morning, so the test is done earlier in the day. It is important to tell your doctor whether or not you’ve been using marijuana, as this will lower LH and testosterone levels. 

 

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. 

If your cancer specialist has identified a gene that may have contributed to the growth of the cancer, you may consider having a pre-implantation genetic diagnosis (PGD) test as part of IVF. While the embryos are developing in the laboratory, a few cells are removed from each embryo and tested for genetic conditions.

Embryos that are PGD-tested will be frozen until the results are available. Only unaffected embryos are implanted into the uterus, reducing the chance of the faulty gene being passed onto the child. You can discuss this option with your fertility specialist.

Learn more about genetics and risk

Other paths to parenthood

Giving birth yourself or having your partner become pregnant aren’t the only ways to become a parent.

Surrogacy

Surrogacy may be an option if you are unable or do not wish to carry a pregnancy.

In Australia, a surrogate is a healthy female who carries a donated embryo to term. The surrogate cannot use her own eggs. The embryo can be created from the egg and sperm from the intended parents or a donor. The embryos are implanted into the surrogate’s uterus through IVF.

In Australia, it is illegal to advertise for someone to act as a surrogate or to pay a surrogate for her services. Non-commercial or altruistic surrogacy is legal. It’s common for people to ask someone they know to be the surrogate. You may need to cover the surrogate’s medical costs and other reasonable expenses.

Surrogacy is a complex process for everyone involved. The fertility clinic organising it ensures that both the donor and surrogate go through counselling and psychiatric testing before the process begins. An ethics committee may also have to approve your case. The Victorian Assisted Reproductive Treatment Authority provides a lot of useful information about surrogacy, including a helpful domestic surrogacy arrangement legal checklist.

Paid surrogacy is legal in some countries overseas. However, in some Australian states and territories it is a criminal offence for residents to enter into commercial surrogacy arrangements overseas – you will need to check that it is legal in your state or territory. It is also important to seek independent legal advice about parentage, citizenship and any conditions you and the surrogate have to meet.

Adoption and fostering

Adoption involves becoming the legal parent of a child who is not biologically yours and looking after them permanently. Although the number of adoptions in Australia each year is low, you may be able to adopt a child within Australia or from an overseas country.

Fostering (foster care) means taking responsibility for a child without becoming the legal parent. Types of foster care include emergency, respite, short-term and long-term care. In Australia, there are more opportunities to foster than to adopt.

Most adoption and fostering agencies say they do not rule out adoption or fostering for cancer survivors on the basis of their medical history. However, all applicants must declare their health status. The agency may also speak directly with your doctor and require you to have a medical examination. The intention is to determine the risk of the cancer returning and your capacity to raise a child.

The agency from your state or territory may send a representative to assess your home, and you will have a criminal record (background) check.

Not having a child

If fertility treatment is not successful, you may come to accept that you won’t have a child. You might feel like you ran out of time, money or energy to keep trying to have a child.

Not being able to have a child after cancer treatment may cause a range of emotions, including:

  • sadness or emptiness
  • a sense of grief or loss
  • anger that cancer and its treatment caused changes to your body
  • relief, contentment or happiness
  • empowerment, if you chose not to pursue the goal of having children.

You may feel a sense of loss for the life you thought you would have. It can take time to accept that you won’t have a child and learn to enjoy the benefits of being child-free – more time to follow other aspects of your life, focus on your relationships, advance your career or afford a different lifestyle.

Many people have happy and fulfilling lives without children, or gain satisfaction from other types of nurturing. Your feelings may change over time. They may also depend on if you have a partner and how they feel.

If you want support, a counsellor, social worker or psychologist can talk to you about being child-free and help you deal with challenging situations (for example, if your partner feels differently to you).

 

The emotional impact

How people respond to infertility varies. Common reactions include:

  • shock at the diagnosis and its impact on fertility
  • grief and loss of future plans
  • anger or depression from disruption of life plans
  • uncertainty about the future
  • loss of control over life direction
  • worry about the potential effects of early menopause.

These feelings may be intensified by the physical and emotional process of infertility treatment, and by not knowing if it will work. People who didn’t get a chance to think about their fertility until treatment was over say the emotions can be especially strong. 

Learn more about emotions

Coping strategies

Learning that cancer treatment has affected your ability to have children can be challenging. There is no right or wrong way of coping.

The strategies may help you feel a greater sense of control and confidence:

  • find support from family and friends – your loved ones may not know how to communicate with you or they may make unhelpful comments. You may need to remind people that you aren’t asking for advice or solutions, and that you simply want them to listen as you express your feelings.
  • gather information – the impact of cancer on your fertility may change your future plans or make them unpredictable. Knowing your options for building a family may help you deal with feelings of uncertainty.
  • explore peer support  talking to people who have been in a similar situation to you may make you feel less isolated and provide you with practical strategies to help you cope.
  • consider counselling – a professional counsellor can help you discuss the impact of cancer and infertility on your relationships, ethical concerns, coping with fertility treatments, and your emotions about other people’s pregnancies, births and babies. Most fertility units have a fertility counsellor.
  • try relaxation and meditation exercises – both of these strategies can help reduce stress and anxiety.

When you don't want to talk about it

There may be times when you don't want to talk about the impact of cancer treatment on your fertility. This may be because you think you don’t have the words to describe how you feel, you are afraid of breaking down, or you find it too overwhelming or confronting.

You may find it easier to withdraw from family members and friends to give yourself time to make sense of what’s going on. If you are a private person, this might be the best way for you to process your feelings. Exploring your thoughts by writing in a journal or expressing yourself creatively can be helpful.

You may want to avoid being a burden to others or fear appearing as if you are not coping. You may be specifically avoiding friends or family members who are pregnant or have children because it brings up painful emotions. It’s okay to decline invitations to baby-focused events until you feel able to cope.

Over time and with support, you may come to terms with what you are going through and be able to open up to others. The pain of seeing your friends or family members with children will lessen.

Fertility and Cancer

Download our Fertility and Cancer booklet to learn more and find support

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Expert content reviewers:

Dr Ying Li, Gynaecologist and Fertility Specialist, RPA Fertility Unit, Royal Prince Alfred Hospital, NSW; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s Hospital and Prince of Wales Hospital, NSW, and Lead Clinician for Youth Cancer NSW/ACT; Paul Baden, Consumer; Dawn Bedwell, 13 11 20 Consultant, Cancer Council Queensland; Maurice Edwards, Special Counsel, Watts McCray Lawyers, NSW; Helena Green, Clinical Sexologist and Counsellor, InSync for Life, WA; Dr Michelle Peate, Program Leader, Psychosocial Health and Wellbeing Research (emPoWeR) Unit, Department of Obstetrics and Gynaecology, Royal Women’s Hospital, The University of Melbourne, VIC; A/Prof Kate Stern, Gynaecologist and Reproductive Endocrinologist and Head, Fertility Preservation Service, Royal Women’s Hospital Melbourne, The University of Melbourne, VIC; Prof Jane Ussher, Chair, Women’s Health Psychology, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, NSW; Renee Van Den Bosch, Consumer.

Page last updated:

The information on this webpage was adapted from Fertility and Cancer - A guide for people with cancer, their families and friends (2020 edition). This webpage was last updated in March 2022.  

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