While cancer treatments may improve diagnosis and future health, some cancer treatments may interfere with women’s ability to have children. As a result, some women may choose to consider fertility preservation. If you are considering options to preserve fertility before starting cancer treatment, it is crucial to talk with an expert as soon as possible, as some fertility preservation is time sensitive in relation to your treatment start. 

Cancer treatments that damage the ovaries include: 

• Chemotherapy, especially at high doses and including alkylating drugs such as chlorambucil, cyclophosphamide, thiotepa, and busulfan 

• Radiation to the pelvic area aimed at or near the ovaries and uterus 

• Surgery that removes both ovaries and/or the uterus  

Predicting Your Fertility after Cancer Treatment  

There are many factors that contribute to future fertility, including:  

• Baseline fertility 

• Age at time of cancer treatment 

• Type of cancer and treatment 

• The amount of treatment 

• The duration of treatment 

• The amount of time since treatment ended 

• *Keep in mind that each woman’s ovarian egg supply is also unique and varies from person to person.  

Your personal fertility can be estimated with a combination of tests:  

• A blood test for the hormone FSH (follicle-stimulating hormone) 

• Blood test for the hormone AMH (anti-müllerian hormone) 

• An ultrasound image of your ovaries to measure their size and to count the number of egg-containing follicles that are developing 

Options to Preserve Fertility Before Cancer Treatment 

Women who are interested in having children in the future should take some time to consider their fertility preservation options before beginning certain cancer treatments. Understanding your options is crucial in giving yourself the best chance to make a comfortable decision. It may be helpful to meet with a fertility specialist to discuss next steps that will best support your own personal situation.     

• Some women may safely choose a cancer treatment less damaging to fertility. Limited surgery can be safely used to treat very early-stage cancer of the cervix or some ovarian cancers. Women with early-stage cancer of the uterus can sometimes have treatment with the hormone, progesterone, and delay hysterectomy until after having a pregnancy and birth. 

• Women who need radiation to the pelvic area can have their ovaries moved upwards, so they remain outside of the direct target area. 

• Other women may freeze and store ovarian tissue, unfertilized eggs, or fertilized embryos for future tries at getting pregnant. 

• Some women may benefit from taking hormones to shut down their ovaries and create a temporary menopause during cancer treatment, but the results of this option remain controversial. 

• It may be possible to have treatment for infertility after cancer, but success rates are higher if you preserve eggs, embryos, or ovarian tissue before your cancer treatment damages fertility. 

Fertility preservation is not always covered by insurance, but many clinics offer reduced fees to cancer patients. Some charitable organizations also provide funds to patients who cannot afford fertility preservation.  

Getting Pregnant after Cancer  

• Women often worry about whether getting pregnant after cancer treatment is safe, but many young women give birth to healthy babies after finishing cancer treatment. 

• Studies have not shown that pregnancy increases the risk of cancer returning after successful treatment of breast cancer. 

• Unfortunately, some women cannot carry a pregnancy because cancer treatment damaged their fertility, removed their ovaries or uterus, or caused radiation damage to the uterus. 

• Before trying to get pregnant, cancer survivors should see a doctor, ideally an obstetrician who works with high-risk pregnancies, and have exams not only to check the uterus, but to look for any damage to the heart or lungs from cancer treatment. Sometimes the damage is silent but becomes a problem during the physical stress of a pregnancy. 

• Some women need infertility treatment to get pregnant. Success rates for treatments like in vitro fertilization vary greatly; a woman’s age and menopause play a large role in chances of a successful pregnancy. 

For women who can no longer carry a pregnancy, paths to motherhood include adopting a baby or child, “adopting” an embryo, using eggs from a donor to create an embryo, or having another woman (surrogate or gestational carrier) get pregnant with one of your frozen embryos or from artificial insemination from your partner, and give birth to a child for you. Some women also have no desire to be mothers, and their feelings need to be respected and honored. 

Are There Health Risks for Children Born to a Mother Treated for Cancer? 

Women who have children conceived during or after cancer treatment may worry about the risk of birth defects or the child’s lifetime risk of cancer.  

Research on birth defects is mostly reassuring. Some chemotherapy or targeted therapy drugs are known to cause birth defects, especially if a fetus is exposed during the first trimester (13 weeks) of pregnancy when organs are forming. If a woman is known to be pregnant, oncologists are careful about the type of treatments used.  

Some mothers carry a mutated gene that could increase a child’s lifetime risk of a particular type of cancer, a much higher risk than normal of getting certain cancers. Family members who carry the damaged gene typically get cancer at an earlier age than usual. If you see a cancer pattern in your family or if you have a known gene mutation, ask your oncologist about having genetic counseling and testing. You may be able to have a child who does not carry the mutation if you are willing to use genetic testing of an embryo or fetus. 

Resources for Help with Cancer-Related Infertility 

• The Alliance for Fertility Preservation (https://www.allianceforfertilitypreservation.org/) is a nonprofit organization that provides a comprehensive directory of US programs offering fertility services to cancer patients (Fertility Scout), a list of states that mandate insurance coverage for fertility preservation, and links to all programs that help cancer patients with the costs of fertility preservation 

Finding expert help for fertility