It’s best to talk about ways to preserve or protect your fertility before cancer treatment begins. Fertility is something your treatment team should raise, but you can also bring up the topic yourself.
What to consider when making decisions
After a cancer diagnosis, you may need to make several decisions about your fertility. It can be difficult to decide what to do, particularly if you have options to consider. You may feel that everything is happening too fast.
Seeing a fertility specialist
Most people find it helpful to receive information and advice about their fertility options. Ask your cancer specialist whether you should see a fertility specialist. You can also get a referral from your general practitioner (GP). As well as explaining your fertility options, a fertility specialist can help with contraception and hormone management during cancer treatment.
Generally, people make decisions they are comfortable with – and have fewer regrets later – if they gather information and think about the possible outcomes. Ask your health professionals to explain each fertility option, including risks, benefits, side effects, costs and success rates. You may find it helpful to take notes during the discussion.
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:
- 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?
- What fertility options do I have 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 treatment?
- Which fertility option should I avoid and why?
- What options do I have after treatment?
- How long after treatment should I wait before trying to conceive?
- 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?
Thinking about and reflecting on your answers to these questions below may also help your decision-making. There are no right or wrong answers.
- 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 that it is biologically related to me?
- What does my partner think?
- Which fertility option appeals to me and why?
It’s your decision
You may feel too overwhelmed by the amount of cancer information you are given at diagnosis to think about fertility. Or you may be asked to make fertility decisions before you’ve given much thought to whether you want to have a child in the future.
Even if you think that you don't want kids or your family is complete, a fertility specialist or counsellor will probably encourage you to consider as many fertility options as possible to keep your choices open for the future. These decisions are personal, and no decision is right or wrong.
A decision aid can help you focus on what matters most to you. Your health professional may be able to recommend a decision aid or give you a booklet setting out the options. For example Breast Cancer Network Australia's resource to help younger women with breast cancer make fertility-related decisions.
Talk it over
Discuss the options with people close to you (such as your partner, a friend or family member) or with an infertility counsellor or psychologist. Research shows that couples who make fertility decisions together are happier with the outcome, whatever it is.
It’s common to feel unsure when making tough decisions. Keeping a journal or blog about your experience may help you come to a decision and reflect on your feelings.
Fertility treatment costs
Fertility treatments can be expensive and this may be a factor in your decision-making. Costs of specialists and private clinics vary across Australia. You may also be able to have treatment at a fertility unit in a public hospital or a clinic that provides discounted fertility treatment for cancer patients.
Depending on the treatment you have, costs may include:
- fertility specialist consultations – ask if they have special fees for people diagnosed with cancer, as sometimes this is the case
- medicines and blood tests
- fees for procedures (for example, the different steps in the IVF cycle from egg or sperm collection to 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 annual fees.
If you are a private patient, there may be Medicare rebates for some of these costs. Ask your private health fund (if you belong to one) what costs they will cover and what you’ll have to pay – some funds only pay benefits for services at certain hospitals.
Relationships and sexuality
A cancer diagnosis, treatment side effects and living with the uncertainty of infertility may affect your feelings towards your relationships and your sexuality.
Whether or not you have a partner, it may be a good idea to find out your fertility status as soon as you feel ready. This way, you can reflect on what you want and, if you have a partner, start talking with them about what the future may hold.
The effect on partners
Cancer, infertility and changes to your sexuality can put pressure on your relationship with a partner. How your relationship is affected may depend on how long you have been together, the strength of your relationship before cancer and infertility, and how well you communicate.
Everyone copes with infertility in their own way. Your partner will also experience a range of emotions, which may include helplessness, frustration, fear, anger and sadness. Some partners are very supportive, while others avoid talking about it. Fertility issues may become a source of unspoken tension between partners.
If your partner is unwilling to talk about fertility, you might feel like you’re coping alone or making all the decisions. It can also be challenging if you and your partner disagree about what to do and focus on different outcomes. Seeing a fertility counsellor can help you cope with and talk about these issues.
Starting a new relationship
Many people deal with a cancer diagnosis without the support of a partner. If you wish to start a new relationship, you may find explaining fertility issues to a potential or new partner difficult. You might worry that they won’t be interested in you because you’ve had cancer, or because you may not be able to have children or have chosen not to.
While the timing will be different for each person, it can be helpful to wait until you and your new partner have developed a mutual level of trust and caring. Start the conversation when you feel ready. You may want to talk through the scenario with a friend, family member or health professional to practise what to say and think about answers to questions your partner may ask.
If you're a young person
During and after cancer treatment, young people want to continue living life as normally as possible. This may include having a boyfriend or girlfriend. You may feel confused about how much to share about having cancer and the impact on your fertility.
Canteen offers counselling to young people aged 12–25 who have been affected by cancer. This can be in person or by phone, email or instant messaging. It also runs online forums and camps.
Sexuality and intimacy
Being able to conceive a child may be part of your sexual identity and infertility may change your attitude and feelings about sex. You may feel that sex is linked with the stress of infertility and you may lose interest in intimacy and sex (low libido).
Some cancer treatments may cause physical problems, such as pain during penetrative sex or trouble getting and keeping an erection. These problems may be difficult for you and your partner, if you have one. Fertility issues cause some people to have a negative body image.
It will take time to accept any physical and emotional changes. If you feel you need further support, consider talking to a counsellor or sex therapist.
Fertility and Cancer
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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.
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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 January 2022.