Women's fertility and chemotherapy
This page contains information on fertility and chemotherapy for women. It includes
Chemotherapy can stop your ovaries from working. This may be temporary or permanent. Your doctors can tell you if the drugs you are having are likely to make you permanently infertile. This is more likely with high doses of chemotherapy and if you are older (nearer your menopause).
It can be difficult to learn that you can no longer have children. Our coping emotionally section has information about who you can contact to help you cope.
If the infertility is temporary, your periods may become irregular or stop during treatment. But they will go back to normal once your treatment is over. This usually takes 6 months to a year.
If you are permanently infertile, you are likely to have menopausal symptoms. These can include hot flushes, mood swings, tiredness, vaginal dryness, and loss of interest in sex. You may be able to take hormone replacement therapy, although this is not recommended with some types of cancer. Talk to your doctor or nurse.
Being pregnant when you are diagnosed
If you were pregnant when your cancer was diagnosed, you will need to discuss your options with your doctor. These depend on the type of cancer you have, the extent of the cancer, the treatment you need and how long you have been pregnant.
Ways to preserve your fertility
It is not as easy for women to preserve their fertility as it is for men, but there are ways of doing it including freezing embryos. Whether this is possible depends on the type of cancer you have and how quickly you need to have chemotherapy. Talk to your doctor about your options.
Getting pregnant after treatment
Most doctors will advise women that it is best to wait for 2 years after chemotherapy treatment before becoming pregnant.
Other fertility options after treatment
There are some other options women might consider if their fertility has been affected. These include using donor eggs or sperm. There are lots of complex issues to think about with these methods. So you need an opportunity to discuss them with a fertility expert or counsellor.
You can view and print the quick guides for all the pages in the fertility and chemotherapy section.
Chemotherapy can stop your ovaries from working for a while, or possibly permanently. Whether your infertility is temporary or permanent depends partly on the drugs and doses that you have. Some chemotherapy drugs are more likely than others to cause infertility. You can ask your doctors if the drugs you are having are likely to make you infertile.
Permanent infertility is more likely if you have higher doses of the drugs. It is also more likely in older women than young women, especially if you are getting close to the age where you would naturally have a menopause.
Some chemotherapy drugs can be very damaging to the eggs in your ovaries, so that none are left after treatment. If this happens, you can no longer get pregnant and you may have symptoms of the menopause. For some women, although their periods stop during chemotherapy, they may still be producing eggs and could still get pregnant. So it is best to continue using reliable contraception even if your periods do stop. If you do get pregnant chemotherapy drugs could harm the baby. Your doctor should discuss this with you.
If the infertility is temporary, your periods may become irregular or stop during treatment. But they will go back to normal once your treatment is over. This happens in about a third of all women whose periods stop because of chemotherapy. It takes about 6 months to a year for your periods to go back to normal after your chemotherapy has finished.
You may have an early menopause. Your periods become irregular and then stop completely. You may also have
- Hot flushes
- Dry skin
- Vaginal dryness
- Loss of energy
- Less interest in sex
- Mood swings or feeling low
Depending on the type of cancer you have, your doctor may prescribe hormone replacement therapy (HRT) to reduce menopausal symptoms. HRT is started after the chemotherapy and helps to prevent the symptoms of the menopause. But the hormones don't mean you start producing eggs again. They cannot stop the infertility.
You may want to someone about permanent infertility. It can be very difficult to learn that you may no longer be able to have children. If you would like to talk to someone outside your own friends and family, look at the counselling organisations page. There is also more information about what counselling is in the counselling section.
You may also want to speak to a fertility expert to explore whether there are any options for preserving your fertility. And you can also ask about other fertility options, such as egg donation. You can read more about these options further down the page.
You could contact a support group or ask your doctor about speaking to another woman who has had chemotherapy which caused infertility. It can help to talk with someone who understands what you are going through.
If you became pregnant before your cancer was diagnosed and before your chemotherapy, you will need to talk about this with your doctor. Your doctor can discuss with you all the options that you have.
You can sometimes delay starting chemotherapy until your baby is born, but this is not always possible. Sometimes chemotherapy can be given in the very last months of pregnancy, but this is very rare. It depends on
- The type of cancer you have
- The extent of the disease
- The drugs you will be having
Sometimes, there is a need to start chemotherapy quickly to control the cancer and in this situation your doctor may feel that it is best to end the pregnancy. In early pregnancy, a termination may be necessary, and in later pregnancy the baby may be delivered early. These are obviously very big decisions and you will need help and support to decide what is the best thing for you to do.
It may be possible to have chemotherapy after the first trimester with some types of cancer, including breast cancer. You can read more about breast cancer and pregnancy in the breast cancer section. Talk to your doctor openly about your pregnancy. Make sure you completely understand all the risks and choices you have before you make any decisions.
It is not as easy for women to preserve their fertility as it is for men but there are ways of doing it, such as
These techniques are done before the chemotherapy starts. To freeze embryos and eggs you have drugs to stimulate your ovaries so the doctor can collect eggs. There are 2 possible problems with this. Firstly, it may be more difficult to have this type of treatment with some types of cancer. If you have a hormone dependent breast cancer for example, your specialist will need to discuss what fertility drugs you can have .
Secondly, it can take a few weeks to stimulate your ovaries and collect the eggs. Your specialist may not want you to wait to start your chemotherapy for that long. Depending on when you had your last period, it may take as little as 2 weeks, so it is definitely worth asking if this is possible for you.
The approach to infertility treatment that has been used the longest is in vitro fertilisation (IVF). You have fertility drugs to stimulate your ovaries to produce eggs. These are then collected (harvested) and fertilised with your partner's sperm. The embryos that are created are then frozen until you want to have a baby. This process is quite complicated and it is not successful for everyone. It is also important to understand that the embryos are the joint property of you and your partner. Both of you will need to agree to use them later.
The success rate depends on your age. National statistics from the Human Fertilisation and Embryology Authority (HFEA) show that on average around a quarter of women (25%) having IVF for whatever reason, had a baby in 2012. For women under 35, about a third had a baby. The success rate after embryo freezing is about 22 out of every 100 (22%) women of all ages.
Not everyone has a partner. It is now possible to have just your eggs frozen, in the same way that a man can freeze sperm. The process is much the same as for IVF. You have drugs to stimulate your ovaries to make eggs. These are then collected and frozen before being fertilised. National statistics from the Human Fertilisation and Embryology Authority (HFEA) show that up to December 2012, only 20 babies have been born in the UK after treatment using the woman's own frozen eggs. Newer methods of storing eggs may help to improve the success rate. But it is unclear at the moment how successful this approach is for women with cancer.
Some research is looking into removing ovarian tissue and freezing it before chemotherapy starts. The idea is that after treatment, the ovarian tissue can be put back. If the ovarian tissue then starts working normally, eggs may be produced and so fertility is preserved. Around 40 babies have been born worldwide after having this treatment. It is still too early to tell if this will work well enough to be made more widely available. But, so far, the results look promising. At the moment there are only a few centres in the UK offering this service. Talk to your doctor if you want to know more about this.
Most doctors will advise women that it is best to wait for 2 years after chemotherapy treatment before becoming pregnant. But this is not because the pregnancy could affect the cancer. They recommend this because, if your cancer is going to come back, it is most likely to recur within the first 2 years after your diagnosis. If the cancer came back, you'd need more treatment. As you might expect, this could be very difficult if you were either pregnant or had a young baby.
There are some other options that women might consider if their fertility has been affected by cancer and treatment. There are lots of complex issues to think about with these methods, and some options may not be straight forward. For example, some of these options are not always funded by the NHS and there is also a shortage of donors.
Women may consider
- Using donor eggs
- Using donated sperm so they can freeze embryos rather than eggs
- Using donated embryos
- Surrogacy (when another woman carries the baby for you)
Some women who cannot use their own eggs chose to use donated eggs. And some women without a partner may choose to use donor sperm to fertilise their own eggs, so they can freeze embryos. Women may also consider using donated embryos. Embryos are sometimes donated by couples who have completed their family after fertility treatment.
You can read more about these fertility treatments on the the Human Fertilisation and Embryology Authority (HFEA) website. And you can discuss these options with your fertility expert. Many people find it helpful talking to a counsellor about all of the issues involved with these treatments.
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