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Assessing fertility after treatment

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

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

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 probe is inserted into the vagina to examine the structure of the reproductive organs, such as the cervix, uterus, fallopian tubes and ovaries.

Antral follicle count (AFC)

An ultrasound probe is inserted into the vagina to count the number of follicles in the ovaries. Each follicle contains a single immature egg.

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

An ultrasound probe is inserted into the vagina to show the volume of the ovaries. Usually the combined volume is about 10 mL. Women with an ovarian volume of less than 4 mL often find it challenging to become pregnant.

Oestrogen (oestradiol)

This is produced mainly in the ovary. The level of oestradiol in a women is a sign of ovulation.

Luteinising hormone (LH)

A blood test can measure LH levels. This hormone helps a woman's ovaries release an egg. High levels of LH may be a sign of premature ovarian insufficiency.

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.

Follicle-stimulating hormone (FSH)

A blood test can measure FSH. This hormone is produced in the pituitary gland. In males, FSH stimulates sperm production. The level of FSH goes up during puberty, and varies throughout the day.

If FSH levels are high, this is a sign that fewer sperm are being produced. If FSH levels are low, 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 smoking marijuana, as this will lower LH and testosterone levels.

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 compare this sample to your sperm sample after treatment.

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 any 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. During a 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. To find a familial cancer clinic, visit the Cancer Council Australia website at cancer.org.au and search for "family cancer clinics".

Expert content reviewers:

Dr Yasmin Jayasinghe, Paediatric Gynaecologist, Royal Children's Hospital Melbourne, Co-chair Fertility Preservation Taskforce, Melbourne, and Senior Lecturer, Department of Obstetrics and Gynaecology, University of Melbourne, VIC; Dr Peter Downie, Head, Paediatric Haematology-Oncology and Director, Children's Cancer Centre, Monash Children's Hospital, and Director, Victorian Paediatric Integrated Cancer Service, VIC; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Aaron Lewis, Consumer; Pampa Ray, Consumer; Dr Sally Reid, Gynaecologist, Fertility SA and Advanced Gynaecological Surgery Centre, Visiting Consultant, Women's and Children's Hospital, and Clinical Senior Lecturer, School of Paediatrics and Reproductive Health, The University of Adelaide, SA; A/Prof Kate Stern, Head, Fertility Preservation Service, The Royal Women's Hospital and Melbourne IVF and Head, Endocrine/Metabolic Clinic, Royal Women's Hospital, and Co-chair, AYA cancer fertility preservation guidance working group, VIC.

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