Women's fertility and chemotherapy

Some chemotherapy drugs are more likely than others to cause infertility. Infertility means you can’t get pregnant.

There might be ways to preserve your fertility. Ask your doctor, they may refer you to a fertility expert. You can also ask about other fertility options, such as donor eggs. 

Sometimes, your periods stop during chemotherapy, but you are still producing eggs. This means that you could still get pregnant. Chemotherapy drugs could harm the baby, so you should use reliable contraception. Your doctor should discuss this with you. 

Temporary and permanent infertility

Whether your infertility is temporary or permanent depends partly on the drugs you have and the dose. You can ask your doctors if the drugs you’re having are likely to make you infertile. It might not be possible for them to give you a definite answer. This uncertainty can be difficult to cope with.

Temporary infertility

With temporary infertility, your periods may become irregular or stop during treatment. But they’ll go back to normal once your treatment is over. This is more likely in younger women.

It might take a few years for your periods to go back to normal, but you could still get pregnant. Ask your healthcare team about contraception and how long you should use this for. 

Permanent infertility

Permanent infertility is more likely if you have higher doses of chemotherapy. It’s also more likely in older women who are getting close to the age where you’d naturally have the menopause.

Some chemotherapy drugs can damage the eggs in your ovaries. If this happens, you can no longer get pregnant and you might have symptoms of the menopause.

Early menopause

You may have an early menopause. Your periods become irregular and then stop completely. You may also have some of these symptoms:

• hot flushes

• dry skin

• vaginal dryness

• loss of energy

• less interest in sex

• mood swings

• feeling low

There are a range of treatments and things you can do to help cope with the effects of a menopause. You may need to try different things before you find something that works for you.

Depending on your type of cancer, your doctor may prescribe hormone replacement therapy (HRT). HRT can begin after chemotherapy and helps to reduce symptoms of the menopause. The HRT can't make you start producing eggs again, so it can't stop the infertility.

Ways to preserve your fertility

There are options available to preserve your fertility. Your healthcare team should discuss this with you. They can refer you to the fertility clinic or assisted conception unit. 

The possible options for preserving fertility include:

• freezing embryos
• freezing eggs
• freezing ovarian tissue
• ovarian suppression

If you choose to, you need to have fertility preservation before starting chemotherapy. These methods are not always successful or suitable for everyone. 

Freezing embryos

You have fertility drugs to stimulate your ovaries to produce eggs. This is called ovarian stimulation. Doctors then collect (harvest) the eggs. They use your partner’s sperm or donor sperm to fertilise them in a laboratory, creating embryos. They freeze the embryos until you want to have a baby, when the embryo is returned to your womb to grow there. This is called in vitro fertilisation (IVF).

It is 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. 

Freezing eggs

You might choose to have your eggs frozen until you’re ready to have a baby.

The process is similar to IVF. You have drugs to stimulate your ovaries to make eggs. Doctors then collect and freeze them until you are ready for them to be fertilised. When you are ready to use them, they are injected with sperm to create an embryo. The embryo is then returned to your womb.

Possible risks of ovarian stimulation

Ovarian stimulation is not suitable for everyone. It takes at least 2 weeks to stimulate the ovaries. If you need to start chemotherapy straight away, there may not be time for you to have it. 

The drugs you have to stimulate the ovaries increase the levels of the hormone oestrogen. Oestrogen may encourage some cancers to grow, such as breast cancer. 

Your specialist will talk through your options and explain any risks. 

Freezing ovarian tissue

You can have a small operation to remove one of your ovaries, which is then frozen. This is called ovarian tissue cryopreservation. The tissue is put back once your cancer treatment has finished.

If the ovary then starts working, it may produce eggs and so you remain fertile.

Ask your specialist if this is suitable for you and whether they can refer you to one of these services.

Ovarian suppression

Your doctor may suggest an injection of a gonadotropin-releasing hormone (GnRH) agonist, such as Zoladex. This is a hormone drug that stops the ovaries from working and makes a woman go into the menopause for a short time. This is called ovarian suppression.

You start the hormone drug at least a week before chemotherapy starts, and have it every 3 to 4 weeks. It may protect your ovaries from the harmful effects of chemotherapy and help preserve your fertility.

You might experience menopausal symptoms such as hot flushes. This treatment is not suitable for everyone and is not always successful.

Other fertility options

There are other options you could consider if cancer has affected your fertility:

• using donor eggs
• using donated sperm so doctors can freeze embryos rather than eggs
• using donated embryos
• surrogacy (when another woman carries the baby for you)
• adoption

These are difficult decisions and some options may not be straightforward. For example, some of them aren’t always funded by the NHS. There is also a shortage of donors. 

You can discuss these options with your fertility expert. Many people find it helpful talking to a counsellor about all the issues involved.

You can read more about these treatments on the Human Fertilisation and Embryology Authority (HFEA) website.  

Getting pregnant after chemotherapy

Most doctors will advise you to wait for some time after chemotherapy before becoming pregnant. The amount of time will depend on:

• your type of cancer
• the type of chemotherapy you have
• the dose of chemotherapy you have
• any other treatments you need

Speak to your healthcare team about when it is safe to try.

Coping with infertility

It can be very difficult to learn that you may no longer be able to have children. There is support available to help you cope.

Other support

Cancer, Fertility and Me is a website. It is for people with cancer who are having treatment that may affect their fertility, or chances of becoming pregnant in the future. 

It is written by fertility doctors, specialist nurses, psychologists and other professionals.

It aims to help people think about the treatments which may help to preserve their fertility. It also aims to help you prepare to talk with your healthcare team, partner, family and friends about fertility preservation before cancer treatment starts. 

That Cancer Conversation

That Cancer Conversation is Cancer Research UK's podcast. In the episode exploring infertility and cancer, we chat with people whose cancer journey has had an impact on their fertility.

It also features Professor Richard Anderson, Deputy Director of the University of Edinburgh’s Centre for Reproductive Health. We explore options that are available and what the future of fertility medicine could look like.