This information is about fertility (the ability to have children) and how it can sometimes be affected by cancer treatment. It is written for women with cancer, and their partners. We have a separate section on fertility for men with cancer.

Being told that you have cancer and that treatment may make you infertile is very difficult to come to terms with. The prospect of losing your fertility can be overwhelming no matter whether or not you already have children, or have considered having them before.

Your doctor will talk to you about the risk of infertility before your treatment starts. It may also be helpful to discuss whether there is anything that can be done to lessen the effects of treatment on your fertility.

Before your treatment starts, it is important to know if your fertility is likely to be affected. You can then decide whether you want to look at options that may be available to you, such as storing embryos (fertilised eggs) or eggs for future use. If you have a partner, it might be helpful for you both to be present during these discussions.

Don't be afraid to ask your doctor or specialist nurse any questions that you have.

It is advisable to avoid getting pregnant during treatment with chemotherapy or radiotherapy. This is because these treatments can damage your eggs, and could possibly harm a baby conceived at this time.

There is no evidence that cancer treatments can harm children that you have after treatment. But doctors usually advise that you should avoid getting pregnant for about a year after your treatment.

If you have breast cancer, you are advised not to take the contraceptive pill. There is a possible risk that the hormones in the pill (oestrogen and progesterone) could stimulate breast cancer cells.

If you become pregnant during treatment let your doctor or nurse know straightaway, as there may be some risk of harm to the baby.

For women, fertility is the ability to get pregnant and it depends on a supply of eggs from the ovaries. You are born with a large number of eggs and as you get older the number decreases. When there are very few left, you go through the menopause (change of life).

To have a child, one of your eggs needs to be fertilised by a sperm from a man. Once a month, from puberty to menopause, one of your ovaries produces and releases an egg. The egg moves along your fallopian tube to your womb, ready to be fertilised.

If the egg is fertilised by a sperm, the resulting embryo may bury itself in the lining of your womb and grow to form a baby. Hormones (the body's chemical messengers) are produced by the ovaries. They prepare the lining of the womb for the fertilised egg.

If the egg is not fertilised, the woman will have a period.

Treatment for cancer can affect your fertility in different ways. Some cancer treatments can:

• cause an early menopause by damaging the ovaries (reducing the number of eggs)
• stop you from producing hormones
• involve losing your womb
• damage the womb lining (making it difficult to get pregnant or keep a pregnancy).

There are four main treatments for cancer and they can all affect fertility:

• chemotherapy
• radiotherapy
• hormonal therapy
• surgery.

Chemotherapy can often cause infertility. This is usually temporary, but in some cases it will be permanent. The effect that chemotherapy has on fertility and whether it is temporary or permanent will depend on:

• the chemotherapy drugs used – some are more likely than others to cause a problem
• the dose of the drug used – higher doses, particularly with stem cell transplants, are more likely to affect fertility
• whether a combination of chemotherapy drugs is given – a combination of drugs may be more likely to affect your fertility
• your age – the younger you are, the more likely you are to keep your fertility.

What may help

Your doctor will explain how different chemotherapy treatments are likely to affect your fertility. In some circumstances it may be possible to choose a chemotherapy treatment that is less likely to affect fertility.

If you are a young woman, chemotherapy may mean that you will start your menopause earlier than normal.  

Studies are trying to find out if giving hormonal therapy, to stop the ovaries from working during chemotherapy, helps protects them. The hormonal therapy that is used is usually a drug called Zoladex, which is given by injection.

Most types of radiotherapy for cancer won't affect your ability to get pregnant. But others may mean that you will be unable to have a child.

Pelvic radiotherapy

Radiotherapy to the pelvis can stop the ovaries from working. It can lead to infertility which can be temporary or permanent. Radiotherapy given directly to the ovaries and womb (usually given for cancer of the cervix and womb cancer) will cause permanent infertility.

Radiotherapy can also affect the womb. Sometimes it leads to infertility, or it can increase the risk of miscarriage and premature birth.

The risk of infertility is generally related to the dose of radiotherapy given, and risk increases if it is given in combination with chemotherapy. The risk of permanent infertility also increases with the age at which the person has treatment.

Total body irradiation (TBI)

TBI is sometimes given to women with cancers like leukaemia or lymphoma, and usually causes permanent infertility. Only a small number of people who have this treatment will be able to have children afterwards.

Radiotherapy to the brain

Radiotherapy to the brain that includes the pituitary gland (which is at the base of the brain) can sometimes affect fertility. The pituitary gland controls the hormones that stimulate the ovaries to produce the female hormones oestrogen and progesterone.

What may help

In some situations, your ovaries can be protected with a lead shield to minimise the dose of radiotherapy they receive. This is usually when radiotherapy is being given close to the ovaries – but not directly to them.

Occasionally, in some circumstances, it may be possible for the ovaries to be surgically moved out of the way to protect them from radiotherapy.

Hormonal therapy is often used to treat breast cancer and occasionally some other cancers. It can affect your fertility, but this is usually temporary.

The drugs that are commonly used for breast cancer are Tamoxifen and Zoladex. Zoladex will stop your periods but they will come back within six months of coming off the drug. Tamoxifen sometimes causes your periods to stop but they will usually start again a few months after you finish taking it.

The side effects of hormonal therapy are similar to the effects of menopause. Some women may go through their natural menopause, without knowing it, while they're taking hormonal therapy.

It is important to avoid getting pregnant while you are taking hormonal therapy. Women are usually advised to take tamoxifen for five years. This may be an issue for older women who still want children. If this is the case for you it is important to talk it over with your specialist.

Most operations for cancer do not affect your ability to get pregnant. But some operations will mean that you will be unable to have a child. These are:

• having your womb removed (a hysterectomy)
• having both your ovaries removed (a bilateral oophorectomy)
• some types of surgery to the cervix, vulva and vagina.

What may help

If you have a very early cancer of the cervix, you may be able to have an operation which only removes the upper vagina and cervix. The womb is left so that you may still be able to have children. This is a specialist operation called a trachelectomy and is only done in a few hospitals in the UK.

A permanent stitch is put in the bottom of the womb to close it. This means that any babies you have will be born by Caesarean section. Women who have this operation have an increased risk of miscarriage or premature birth. This is because the cervix may not be able to support the weight of the baby as it grows. But healthy babies have been born to women who have had this operation.

If your periods stop or you have an early menopause as a result of cancer treatment you may be offered hormone replacement therapy (HRT). You won't be given HRT if you have breast cancer or any cancer that is dependent on hormones to grow. Your doctor can talk this over with you.

HRT is given to prevent problems associated with an early menopause, such as thinning of the bones (osteoporosis) and heart disease. HRT does not help your fertility to come back.

Some women regain their fertility a while after stopping their cancer treatment (they may be on HRT when this happens). It is important to use contraception if you don't want to get pregnant. Or, you can take the oral contraceptive pill (unless you have breast cancer) instead of HRT. Some types of contraceptive pill will replace your hormones (oestrogen and progesterone) as well as preventing pregnancy. Again, you can discuss this in more detail with your specialist.

It can be difficult to predict whether your fertility will be affected or if it will return to normal when your cancer treatment is over. Before your treatment starts, your doctor can refer you and your partner (if you have one) to a fertility clinic.

At the clinic you will be given information and counselling about possible fertility treatments and their rates of success. Fertility treatments can be time-consuming and take up a lot of emotional and physical energy. This can be difficult when you're already coping with cancer. They can also be expensive. Some women may feel that the chances of success are too low, especially when they balance this with the demands of the treatment. Other women feel that anything that could improve their chances of having a child in the future is worthwhile.

You may be able to store embryos (fertilised eggs), or to have your eggs frozen and stored for future use. Ovarian tissue which contains eggs can be removed for future use, but this is still a very experimental technique.

Embryo storage may be available on the NHS, but you often have to pay privately for other treatments.

Egg collection

Freezing and storing embryos or your eggs means that you need to have your eggs collected. This has to be done before treatment starts. Some women need to start their cancer treatment immediately. In this situation it is not usually possible to delay treatment to have the ovaries stimulated to produce eggs (ovarian stimulation).

The whole process of egg collection takes 4–6 weeks. Hormones are given by injection to stimulate the ovaries to produce more eggs than normal. To increase the chances of achieving a pregnancy, as many eggs as possible are collected (usually at least six).

If you have breast cancer (or any hormone dependent cancer) there is a possible risk that the hormones used to stimulate the ovaries may make the cancer grow. For this reason, it may not be advisable to have ovarian stimulation in these situations. Your doctors will discuss this with you. It may be possible to collect one or two eggs without stimulation. But having only one or two eggs reduces the chances of a successful pregnancy.

Eggs are normally collected using an ultrasound-guided needle which is passed through the wall of the vagina. This is usually done by giving you a sedative to relax you or under a local or general anaesthetic.

Storing embryos

To make an embryo, sperm is needed to fertilise the eggs. If the sperm is your partner's, both of you must sign a consent form and neither can use the embryo to start a pregnancy without the other's permission. If you have no partner, sperm from a donor can be used. As there is a shortage of sperm donors in the UK, this may be difficult.

Once the eggs have been collected they can be fertilised using IVF (in-vitro fertilisation) and embryos can then be frozen. IVF involves putting your eggs together with sperm in a test-tube for fertilisation to occur and to produce embryos.

Storing unfertilised eggs

This is a newer, more experimental technique which is very much less successful than freezing embryos. The eggs are frozen until needed. When they are later thawed they may be fertilised by a sperm (from your partner or a donor) using a new technique called ICSI, which is explained later.

Storing ovarian tissue

A new and experimental technique is to take and store samples of ovarian tissue that contain some eggs. The ovarian tissue can be put back into the body at a later date. This technique is at a very early stage of development and has not been widely used.

Using donated eggs and sperm

It may be possible to use donated sperm if you are able to collect eggs and want to store embryos, but don't have a partner. There is a shortage of sperm donors in the UK, so this may not be straightforward.

If the cancer treatment has caused permanent infertility and you were unable to collect some of your eggs before treatment, you may consider using donated eggs.

Everyone who donates eggs or sperm is carefully selected. Usually an egg donor will be matched as closely as possible so that the eye and hair colour, physical build and ethnic origin are the same as the woman who can no longer produce eggs. Sperm donors will also be closely matched. The donor has to be fit and healthy with no medical problems and will be tested for various infectious diseases.

Choosing to use donated eggs or sperm can be a difficult decision and will often need very careful consideration. It isn't going to suit everyone. Your doctor or nurse at the fertility clinic can discuss this with you further.

If you have had previous cancer treatment (but no egg or embryo storage) and are having difficulty getting pregnant, you will be referred to a fertility clinic. You can usually be referred quite quickly. If you already have embryos or eggs stored you can go back to the fertility clinic.

Using stored embryos

When the embryos are needed, they are thawed and placed in the womb (not more than two at a time) to see if they will implant and develop. Pregnancy rates using frozen embryos are generally lower than when an embryo is implanted immediately after IVF, but even so healthy babies have been born in this way.

Using stored eggs and ICSI

When the eggs are thawed they are fertilised by injecting a sperm directly into an egg. This is known as ICSI (intracytoplasmic sperm injection) and is a very delicate procedure. If any eggs are successfully fertilised, the resulting embryo or embryos are placed in the womb to see if they will implant and develop. Egg storage and ICSI is much less likely to result in pregnancy than embryo storage, but techniques are improving all the time.

Using stored ovarian tissue

It might be possible to remove immature eggs from the stored tissue or to implant it back into the ovary. The tissue may eventually start to produce eggs which could then be removed and fertilised. This technique is very experimental and not widely available. Very few embryos have been produced in this way.

Are there any risks?

The use of stored embryos has been carried out for many years and it appears not to cause any increased risk of harm to the child. Newer techniques, such as freezing eggs and ICSI have been used less and the long-term risks to the children conceived using these methods is not fully known. At the moment the best information suggests the risks of harm are very small. Storing ovarian tissue is still too experimental for us to know about any long-term risks.

If you are concerned about the possible risks, talk it over with your doctor or nurse at the fertility clinic.

Other options

Some women may consider adoption or surrogacy (a woman carries a pregnancy for a couple). If you have had your womb removed, or radiotherapy directly to the womb, then adoption or surrogacy are the only possible options.

Other women choose not to have fertility treatment, adoption or surrogacy and go on to enjoy life without children. Many women develop close, nurturing relationships with their relatives' or friends' children. Everyone is different.

Being told you have cancer and that treatment may affect your fertility can be very difficult. Your fertility may not be uppermost in your mind – dealing with the cancer is often the priority. But some women find the threat of losing their fertility as difficult to accept as the diagnosis of cancer. There is no right or wrong way to react or to feel.

The uncertainty surrounding fertility, and whether the steps you have taken to protect it will work, can make a very difficult time even harder. Everyone has their own way of coping with difficult situations and some people find it helpful to discuss how they are feeling with a close friend or relative, or a counsellor.

Many hospitals have specialist nurses who may be able to help you. Some hospitals and fertility clinics also have fertility counsellors that you could talk to. You could also contact a support organisation.

This section has been compiled using information from a number of reliable sources, including:

• Sexuality and Fertility After Cancer. Schover. Wiley. 1997.
• Oxford Textbook of Oncology (2nd edition). Souhami et al. Oxford University Press. 2002.
• The HFEA website: www.hfea.gov.uk (June 2007).

For further references, please see the general bibliography.