• 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).

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. 

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 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.

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).