Women's fertility and chemotherapy

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 permanently stop the ovaries from producing eggs. 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 speak with 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 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. 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

• Freezing embryos
• Freezing eggs
• Freezing ovarian tissue

These techniques are done before the chemotherapy starts and involve having some eggs collected. There are two possible problems with this. Firstly, it is not possible to have this type of treatment with some types of cancer. If you have a hormone dependent breast cancer for example, your specialist may advise against it.

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. The actual time depends on where you are in your menstrual cycle when the process starts. 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 the test tube baby technique - 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. The success rate depends on your age. National statistics from the Human Fertilisation and Embryology Authority (HFEA) show that around 25 out of every 100 women (25%), under the age of 38 having IVF for whatever reason, had a baby in 2006. The success rate after embryo freezing is about 16 out of every 100 (16%).

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. The early research shows that the number of babies born from frozen eggs is between 2 and 4 out of  every 100 (2 to 4%). These figures are based on research and techniques are constantly improving so the numbers may be slightly higher than this now. There are different ways of freezing the eggs and the newer technique of injecting a single sperm into a single egg. This procedure is called intracytoplasmic sperm injection (ICSI), and appears to be most successful. We need more research to develop the techniques and find the best way of freezing eggs.

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. There have been reports of at least 4 women giving birth 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. 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 is no evidence that pregnancy increases the risk of breast cancer or melanoma coming back – two of the types of cancer that women are often told can be affected by pregnancy hormones.