Life After Cancer: Changes in a Woman’s Fertility
Cancer can affect a woman’s ability to have children (fertility). A woman is considered infertile if she cannot get pregnant or carry a pregnancy after a year of unprotected sex.
You are considered infertile if one or more of these happen:
Your eggs are permanently damaged or destroyed
Your ovaries can’t make eggs become mature and send them out
An egg can’t reach the uterus because parts of your reproductive system are damaged
An egg can’t be fertilized
A fertilized egg can’t attach to the uterus
A fertilized egg can’t grow in the uterus because the uterus is damaged
Doctors are still learning how cancer treatments affect fertility. Medicines, surgery, radiation, and other treatments can cause problems. Fertility problems also depend on:
The type of cancer and where it was in your body
The kinds of treatment you had
How long treatment lasted
Your age when you had treatment
How long it has been since treatment ended
Your overall health
Talking with your healthcare team before treatment
Your healthcare team can tell you about how treatments may change your ability to get or stay pregnant. Talk about this before you start treatment.
You may choose to have eggs or embryos frozen. Or you may choose a type of treatment that may help protect your fertility. Talk with your team about your options.
Fertility after chemotherapy
Chemotherapy (chemo) can damage the eggs that are in your ovaries. You are born with all of the eggs you will ever have. Some medicines are more likely than others to harm a woman’s eggs. The effects may depend on the medicines you get, the dose, and how long you were treated. Talk with your healthcare team about the medicines you took, and the risks of each on fertility. Most healthcare providers say to wait at least 6 months after your last chemo treatment to try for a pregnancy. Eggs maturing in the ovaries can be damaged by chemo medicines.
Fertility after targeted or immune (biologic) therapy
Researchers are still learning how these types of medicines affect a woman’s fertility. They don’t work the same as chemo. Some may cause the ovaries to shut down or other problems. Ask your healthcare team what effects your medicines may have on your fertility.
Fertility after radiation therapy
Radiation to the belly (abdomen), vagina, or uterus can cause infertility. Radiation to these areas can also damage the ovaries. This can destroy eggs in the ovaries, or cause the ovaries to stop working. Radiation to the pituitary gland can also make the ovaries stop working. Radiation can also cause scar tissue to form in the uterus. This can keep the uterus from stretching to hold a growing baby. And this can cause problems in a later pregnancy, such as miscarriage or preterm birth. Your healthcare team can tell you the effects you may have from your radiation treatment.
Fertility after surgery
Surgery can change your fertility if you had your uterus or ovaries removed. Fertility can also be affected by scar tissue after surgery. Scar tissue may block the fallopian tubes and prevent an egg from reaching the uterus. If you still have your uterus and have one ovary, you may be able to get pregnant. Your healthcare team can tell you what to expect.
Working with your healthcare team after treatment
After treatment, your healthcare team can help you manage the effects on your fertility. If you plan to get pregnant after your cancer treatment is done, talk with your team first. Ask how long you should wait after treatment. Some kinds of treatment used while eggs are maturing in the ovaries may raise the risk for birth defects. You may need to wait 6 months or more. They can give you information to help you make decisions, help you find a specialist, and let you know when it’s OK to start trying for a pregnancy. They may also be able to help direct you to adoption or surrogate resources.
Ask your healthcare team:
How does my type of treatment affect fertility in women?
Am I healthy enough for pregnancy, using my egg or a donor egg?
Am I healthy enough for fertility treatment?
When can I start trying to get pregnant?
Do I need to see a fertility specialist? Can you refer me to one?
Working with a fertility specialist
After treatment, it may take a while for your menstrual periods to start again. But getting your period may not mean that your fertility is restored. You may want to work with a fertility doctor. He or she can do tests to check fertility hormone levels, see how many eggs are in your ovaries, and look for other signs that you can have a baby.
If your fertility has changed because of cancer treatment, a fertility doctor can help you use eggs or embryos frozen before cancer treatment, or eggs or embryos from a donor. He or she will help you understand your options and what may work best for you.
It’s important to know that working with a fertility specialist may not be covered by health insurance. Fertility treatments can cost thousands of dollars, and in many cases more than one treatment is needed. Talk with the fertility specialist and your insurance company to learn what your out-of-pocket costs will be.
Fertility changes can be very stressful and upsetting. You and your partner may want to talk with a counselor. Ask your healthcare team for referral to counseling. They can also help you find a nearby support group or other resources.
March 21, 2017
Ovarian failure due to anticancer drugs and radiation. UpToDate., Overview of infertility and pregnancy outcome in cancer survivors. UpToDate.
Cunningham, Louise, RN,Stump-Sutliff, Kim, RN, MSN, AOCNS