If you’ve been diagnosed with cancer and are trying to get pregnant (or know you’ll want to one day), you’re probably wondering how cancer might affect your fertility. There are many different types of cancer and just as many treatments, so the answer really depends on a lot of factors. Below, we’ll take an in-depth look at how one common type of cancer treatment — chemotherapy — works, how it can affect fertility, and how you can protect yourself and your future child.
Can cancer cause infertility?
It’s a big question and one that’s important to ask. Some cancers can directly cause infertility, such as uterine cancer, cervical cancer, or testicular cancer. Since these cancers begin in the reproductive organs, it only makes sense.
Cancers of the reproductive organs aside, it’s usually the cancer treatments that hurt fertility the most. There are many different options for fighting cancer and all carry some level of risk to your fertility. These cancer treatments include (but aren’t limited to):
- Radiation therapy
- Surgery to remove cancer
- Hormone therapy
- Stem cell transplant
If you’re diagnosed with cancer before you’ve had children, you’ll want to talk to your doctor about finding a treatment that is both effective and poses minimal risk to your fertility. There are also options for preserving your fertility before undergoing treatment for cancer, which we’ll look at in more detail below.
What is chemotherapy, and how does it work?
Chemotherapy is a type of cancer treatment that uses cancer drugs to either fight and cure cancer or to reduce symptoms and prolong life. Chemo is typically given intravenously, though some chemotherapy drugs come in pill form or as an injection (like a shot). Many people use chemotherapy and another form of treatment to fight cancer.
Chemotherapy drugs work by targeting cells, like cancer cells, that divide and spread quickly. According to the American Cancer Society, chemotherapy can be used for many different reasons, including:
- To make cancer grow slower
- To keep cancer from spreading (metastasizing) to other parts of the body
- To kill cancer cells that have already spread
- To help control side effects of cancer
How does chemotherapy affect fertility in women?
Your age, the type of chemotherapy drug(s) used, and the dosage amount are all factors that play into if — and how — chemo can cause infertility. If cancer-related infertility occurs, it can usually be attributed to one of the following:
- Damage to the eggs
- Ovarian damage or failure (also called premature menopause)
Your age at the time of chemo can have a significant impact on whether your fertility is affected and to what extent. Women who are younger have more eggs in their ovaries, giving them a higher chance of conceiving later in life even if some of them are damaged or gone completely.
Women who are treated for cancer after age 35 will likely experience the most difficulty getting pregnant. This can be in the form of either permanent infertility or temporary infertility. Permanent infertility happens when there are no eggs left after chemotherapy. If this is the case, you may enter menopause, no matter your age. Some women experience temporary infertility — when your periods are irregular or stop during treatment but return once treatment has finished.
The drugs used for chemotherapy are the primary cause of these infertility issues and can take a toll, regardless of age. Let’s take a look at which drugs have the most and least impact on egg quality.
Which chemo drugs are most likely to cause infertility?
According to the American Cancer Society, there are several drugs that research has found to be directly harmful to a woman’s eggs. After taking any of these chemo drugs, there’s a good chance that a woman will not be able to have children, even years later.
- Carmustine (BCNU)
- Cyclophosphamide (Cytoxan ®)
- Doxorubicin (Adriamycin®)
- Lomustine (CCNU)
Which chemo drugs are least likely to damage a woman’s eggs?
On the other hand, there are chemotherapy drugs that carry a lower risk. These include:
- 5-fluorouracil (5-FU)
How does chemotherapy affect fertility in men?
Like women, men can also experience chemo-related infertility. The main concern is that the drugs can cause sperm production to slow down or stop entirely. Typically, the higher the dose of the drug, the more likely this is to happen. It can also hurt the sperm’s ability to fertilize an egg.
Since men are constantly producing sperm (unlike women who are born with all of the eggs they’ll ever have), there’s potentially good news. Sperm production usually returns within 1 to 4 years after chemo but can take up to 10 years. However, if it hasn’t started back up after 4 years, it probably won’t. The following lists are courtesy of the American Cancer Society.
Which chemo drugs have the worst impact on male fertility?
- Actinomycin D
- Cyclophosphamide (Cytoxan®)
- Nitrogen mustard (mechlorethamine)
Which chemo drugs come with a lower risk of infertility for men?
- 5-fluorouracil (5-FU)
- 6-Mercaptopurine (6-MP)
- Cytarabine (Cytosar®)
- Daunorubicin (Daunomycin®)
- Doxorubicin (Adriamycin®)
- Etoposide (VP-16)
- Thioguanine (6-TG)
- Vinblastine (Velban®)
- Vincristine (Oncovin®)
Surprisingly, research has found that men are warned about the risks of infertility due to chemo more often than women are. Make sure you ask your doctor about all of the potential risks, as well as all possible options for preserving your fertility during chemotherapy.
Is it safe to get pregnant during or after chemo?
Chemotherapy has the potential to damage fertility in a number of ways — including damaging the quality of eggs and sperm. By that logic, it makes sense that getting pregnant during chemo is a bad idea. There is a heightened risk of preterm birth and birth defects, not to mention health risk to you. Your doctor will advise you to use some type of protection during intercourse — something other than hormonal birth control, which can interfere with your chemo.
After chemotherapy is complete, most experts recommend waiting at least 6 months before getting pregnant. This can feel like a long time if you were struggling with infertility before you were diagnosed with cancer but if the chemo damaged your eggs (or his sperm), the embryo could miscarry or turn into a baby with birth defects. There’s not nearly enough research on this topic but it’s smart to hold off, just to be safe.
How can I protect my fertility if I need chemotherapy?
If your doctor tells you that, in order to fight a cancer diagnosis, you’ll need to have chemo, it’s a good idea to be proactive about your fertility. Thankfully, advanced medicine and technology give you more options than ever. These include:
- Freezing your eggs — In order to freeze your eggs, you’ll be given about 2 weeks worth of hormone injections that stimulate your ovaries to produce and mature eggs faster than they normally would. Then, those eggs are extracted and frozen at subzero temperatures until you’re ready to use them later.
- Freezing embryos — An embryo (a fertilized egg) can be frozen, much in the same way eggs are. Your eggs will be extracted after going through the same hormone injections to stimulate their growth. They are then fertilized with your partner’s sperm (or a donor’s sperm) and frozen until you want to use them.
- Sperm banking — If he’s the one going through chemo, freezing his sperm (called sperm banking) is a great option. The sperm will be frozen and available to use later on.
While choosing any of these can certainly help keep doors open, there’s no guarantee of a pregnancy down the road. These fertility preservation methods also tend to be expensive, as do the methods of insemination needed to attempt a pregnancy with them. Typically, in vitro fertilization (IVF) or intrauterine insemination (IUI) are the most common methods used. Of course, an at-home insemination method like the Stork OTC is also an option and is far more affordable than a fertility clinic.
If you’ve been diagnosed with cancer, there are some organizations that offer assistance in both preserving fertility before treatment and receiving fertility treatments after: