A Women’s Risk of Infertility After Childhood Cancer Treatment

Author: OncoLink Team
Last Reviewed: June 22, 2020

Fertility is the ability to get pregnant. Fertility after cancer therapy is a very complex topic. Whether or not a woman will remain fertile after treatment is related to:

  • The doses and types of medications you received (certain medications, higher doses or longer treatments are more likely to cause infertility).
  • If you also got radiation to the abdomen, pelvis, or brain.
  • Your age at the time of treatment.
  • The number of oocytes (eggs) present when therapy started. This number drops as women age and as the number of eggs drops, it is harder to get pregnant.
  • Treatment that removes both ovaries or the uterus has a major effect on fertility.

Certain treatments are more strongly tied to infertility, including:

  • Certain anti-cancer medications: alkylating agents (Cytoxan, busulfan, melphalan, BCNU), procarbazine, bevacizumab, cisplatin, and some FOLFOX regimens.
  • We do not know how many of the newer treatments will affect long term fertility.
  • Both total body irradiation and bone marrow transplant have a high risk for infertility.
  • Radiation fields that include a woman’s pelvis or brain can affect fertility. Learn more about the risks related to radiation

Evaluating Fertility

It is very hard to predict if a woman will remain fertile after treatment. If a woman’s periods return after treatment, she is still at risk of going into menopause earlier than her peers. There is no way of knowing when this will happen. This is something to think about when deciding when to start a family.

It can be very helpful for a survivor who wants to become pregnant to be seen by a fertility specialist who works with cancer survivors. This specialty is often called "oncofertility." Testing can be done to evaluate fertility, including certain hormone levels and a follicle count (a measure of a woman’s remaining egg supply). 

Finding a Fertility Specialist and Other Resources

LiveSTRONG and The OncoFertility Consortium websites can help you find a fertility specialist. LiveSTRONG offers financial assistance to cancer survivors for fertility care. The OncoFertility Consortium and The National Infertility Association’s website, Resolve, offers information on fertility treatments and testing, adoption, and deciding to not have children. Resolve also offers information on individual state laws about fertility coverage by insurers. If you underwent fertility preservation prior to treatment, you will need to work with a fertility specialist to get pregnant using your stored eggs or embryos.

Should I be followed by a high-risk doctor for my pregnancy?

Women who have had cancer treatment may be at higher risk for issues during pregnancy and should consider seeing a high-risk obstetrician. This is important if you received radiation to the abdomen or pelvis area, had surgery involving female reproductive organs, or if you received chemotherapy that can cause heart damage.

Preventing Unwanted Pregnancy

Even if your periods stop during treatment, you may still be able to get pregnant. While your provider does their best to predict if you will be able to get pregnant, this is not a guarantee. The use of effective birth control during and after cancer treatment is important even when you think you cannot get pregnant.

Whether or not a woman is able to have a baby after cancer treatment is not easy to predict. It is a common concern for women who have been treated for childhood cancers. Discussing your concerns with your healthcare team and seeing an Oncofertility specialist can help you in reaching your goals for a family.

References

Long-Term Follow Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. Version 5.0, 2018. Accessed at: http://www.survivorshipguidelines.org/pdf/2018/COG_LTFU_Guidelines_v5.pdf

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