Sometimes cancer treatment can affect fertility. Then it becomes more difficult or impossible to use your eggs or sperm in a pregnancy. There are methods that can sometimes be used to preserve fertility.
Thus, various cancer treatments affect fertility
The most common treatments for cancer are cytostatics, radiation, and surgery. Everyone can make it harder to have children.
Cytostatic treatment affects fertility
Cytostatics is a collective name for several different drugs. They stop cancer cells from growing and spreading. Healthy cells can also be affected, such as egg cells and sperm, which are also called sperm.
Several things affect the risk of cytostatic drugs affecting fertility, such as the drugs you receive and the doses you receive. Most often, an increased dose means that the risk increases.
Age may also matter if you have ovaries. They become more sensitive over the years as the eggs become less and less. Therefore, it may be more difficult for you than for a younger person to have children after treatment with cytostatic drugs, even though you have been given the same dose of the same drug.
Radiation therapy to the ovaries, testes or brain
Radiation treatment affects fertility if the rays are directed at the genitals.
Radiation to the brain can also affect fertility. In the brain is the pituitary gland that produces the hormones needed for the eggs and sperm to mature and function.
There are drugs that replace the hormones after radiation therapy so that it is still possible to have children later in life.
Radiation to the uterus
Radiation therapy to the uterus can make it more difficult or impossible to get pregnant or to carry a pregnancy.
Surgery of the uterus, ovaries or fallopian tubes
The ability to have children can be affected if you have surgery in the uterine mucosa, ovaries or fallopian tubes. You can be operated on in a way that reduces the risk if you have cancer that is at an early stage.
You can no longer get pregnant if the uterus is removed.
Other gastric operations
An operation in the abdomen can cause scars called fissures. It is unusual, but sometimes ovulation can affect, for example, a fallopian tube so that it becomes too narrow for an egg to pass through it.
Operation of a testicle
The sick testicle is usually removed if you have testicular cancer. The second testicle may have reduced the production of sperm.
Other cancer treatments can also affect fertility
Immunotherapy and targeted therapy are quite new ways to treat some cancers. Then drugs have used that work in a different way than cytostatic drugs. It will take several years for sure answers to how these drugs affect fertility.
Other than the cancer treatment can affect
Sometimes the disease causes fertility to be reduced, for example in testicular cancer.
Fertility may have been reduced even before you got cancer. Every seventh to every ten people in Europe have problems with impaired fertility.
Methods to protect eggs or ovaries
There are a few different methods to try to preserve fertility. You are offered to do so if you are under 40 and treatment can affect your fertility.
The ovaries can be moved
The ovaries can be protected with surgery if you are to receive radiation treatment. Then they are moved to the upper part of the stomach where they end up outside the area to be radiation treated.
An ovary can be removed and saved
An ovary or part of an ovary can be operated out and frozen. It can be an alternative to getting eggs to freeze if it is urgent to start with the cancer treatment. The frozen ovary or ovarian part is thawed and put back into the body when you want to try to get pregnant.
Eggs can be frozen fertilized or unfertilized
Your eggs can be picked out and saved in the same way as with test tube fertilization, also called IVF treatment.
The eggs can be frozen without fertilization or fertilization, also called embryos. It does not matter to the chance of having a child. You can only use embryos if you have the same partner you wanted to have children with when you became ill.
Sometimes it is too urgent to start with the cancer treatment to catch up with the hormone stimulation required before the eggs can be removed.
You will receive anti-estrogen in addition to the hormone stimulation if you have a breast cancer tumor that needs hormones to grow. Then there is very little risk of tumor growth due to the hormone stimulation.
If you are pregnant when you get cancer
Pregnancy may need to be terminated if it is at an early stage and you develop cancer. Even then, it can be helpful to get pregnant again when cancer treatment is complete.
Methods to protect sperm and testes
You are offered to freeze your sperm before the cancer treatment if you are under 55 and the treatment can affect your fertility. It is common to have sperm delivered on several occasions.
The sperm can be thawed and used in a test tube fertilization treatment, also called IVF treatment.
Sperm can be taken directly from the testicle
Sometimes there is no sperm in the semen. Then you can place a tissue sample from one testicle instead. Sperm may be frozen in the tissue sample.
Protection if you should receive radiotherapy
You get protection over the testicles if you are to receive radiation treatment. The cover is of lead that blocks the radiation. Radiation can also be shielded if it needs to be administered near the testes.
Methods for children to receive cancer treatment
So far, there are no established methods to preserve the future fertility of children who are before puberty when they need cancer treatment.
All or part of an ovary or testicle can be operated out and frozen.
The ovaries can later be thawed and put back in a new operation. The hope is that the eggs will be developed so that they can get pregnant.
The testicle is more difficult to get started in similar ways. This is because the testicle contains no sperm since it was operated out before the child’s puberty.
The methods are still experimental, but much research is underway.
Talk to your child’s doctor for more information.
The chance of pregnancy
The chance of having children is about 30 percent if frozen and thawed eggs or sperm are used in an IVF treatment.
How do I know if I am fertile after cancer treatment?
It can be difficult to know if cancer treatment has affected your ability to have children. Some suffer from some time after treatment. Others get pregnant even though the doctor has considered that the possibility is small.
Surveys and supportive treatment if you have ovaries
It may take several months for the period to return if it ceased while receiving cancer treatment.
You can get pregnant despite missing menstruation, or have menstruation even though you can no longer get pregnant.
A gynecologist can help you if you want to get an assessment of your ability to have children. The gynecologist examines your ovaries with ultrasound. You may also be given a blood test to measure hormone levels, which may be a sign that there are eggs left.
Surveys and supportive treatment if you have testicles
Talk to your doctor if you want to submit sperm samples after your cancer treatment. The test is examined to see if there are live sperm and how they move. These sperm can be screened out if they are few and used in an IVF treatment.
The doctor can also measure the level of the testosterone hormone needed to form sperm. The level is measured in a blood sample that you are allowed to leave. You can get artificial testosterone treatment if you need to.
Sperm production can sometimes recover without treatment. It can happen after a long time, sometimes several years.
The future fertility of children who have had cancer
A child who has had cancer should be checked several times during his or her upbringing. Then the child can receive hormone therapy if it is needed to reach puberty, or if fertility is low or about to cease. For example, irregular menstruation may be a sign that fertility is about to cease completely for a young person who has had cancer as a child.
Children with testicles usually come into puberty as usual. Cancer treatment may still have damaged sperm production. Sperm tests later in life can show whether there is sperm or not.
You who have had cancer as a child should be offered a referral to a fertility hospital when you turn 18 so that you can receive continued help.
Avoid pregnancy when receiving cancer treatment
Use contraception as long as the cancer treatment is in progress and for a while afterward. There is a risk of pregnancy even if you receive treatment that may affect fertility. Treatment can be harmful to a fetus.
Talk to your doctor about what kind of birth control you can use, and when it might be advisable to try to get pregnant after the cancer treatment. It is common to have to wait six months to one year, but some may have to wait longer.
Can pregnancy affect the risk of me or the child getting sick?
The risk is very small for the child or you to be affected by having had cancer.
The risk to the child
It is only if you have had a cancer disease that is hereditary that there is a risk that the child also gets cancer.
There is no or only a very small risk that your child will have any malformation because you have had cancer.
The risk of relapse if you are pregnant or breastfeeding
Breast cancer is sometimes dependent on the same hormones needed if you are pregnant or breastfeeding. But pregnancy or breastfeeding does not seem to increase the risk of cancer coming back.
Adoption or donated germ cells
There may be other opportunities to have children if your fertility has stopped.
You can get donated eggs or sperm
Donated eggs or sperm can be used for IVF treatment.
Adoption according to individual assessment
You can apply to adopt a child. Then an inquiry is made to find out if you are suitable. Your health and illness history is part of the investigation.
You can get adopted even if you have had cancer. There are many cancers where most people get rid of the disease and have a good life after treatment.
Often, a specialist physician needs to write a certificate of how long it has been since the cancer treatment and how great the risk is that the disease will return. Then the social services make an individual assessment.
You can apply again
You can reapply if you have been rejected for being sick. The National Board of Health and Welfare’s legal advice and social services can make a new assessment if you are no longer on sick leave and you have little risk of getting cancer back.
Different rules for different countries
You can be assessed differently if you want to adopt from another country. It depends on which country you are applying to adopt from. You can read more in the text on adoption.
Thoughts and feelings about trying to have children
There may be many issues that you feel you need to think about if you are considering trying to have children. Some questions have no given answers about what is right or wrong. It can feel extra difficult if you have or have had a serious illness:
- What if you have relapses and don’t feel like a good parent when you get treatment again – or die?
- What if you refrain from trying to have children for fear of relapse and then live a long and healthy life, but without children?
The risk of recurrence can be estimated at about, but only by comparing with other people who have had the same type of cancer as you. It is a statistical figure that says nothing about how it will be for you.
You can also think about your situation in general: Are there people in your vicinity who could be supportive of you and the child?
Ask questions and ask for help if not offered
Your doctor or other healthcare professional should tell you if cancer treatment can affect your fertility. You will also need to know what alternatives are available and get the support you need to make decisions about how you want to do.
Talk to your contact nurse or your doctor if you are not offered a referral to a fertility clinic at a university hospital.
You have the right to support to be able to make decisions about your child’s fertility
Deciding on your child’s fertility can be difficult. Concerns about the child’s cancer can make the question of fertility feel unimportant. You may want to save the child treatment with which the child himself has difficulty understanding the benefit.
You and the child should have the opportunity to talk about risks and opportunities with a person who is a specialist infertility.
The information should be adapted to the child’s age. Children at puberty have the right to talk to a specialist without you as a custodian.
Both you and the child can be supported by, for example, a curator.
In the text Help with thoughts and feelings about cancer, there are tips on other people who can be supportive if you need to talk.
Sometimes cancer treatment can affect fertility. Then it becomes more difficult or impossible to use your eggs or sperm in a pregnancy. There are methods that can sometimes be used to preserve fertility.
Thus, various cancer treatments affect fertility
The most common treatments for cancer are cytostatics, radiation, and surgery. Everyone can make it harder to have children.
Cytostatic treatment affects fertility
Cytostatics is a collective name for several different drugs. They stop cancer cells from growing and spreading. Healthy cells can also be affected, such as egg cells and sperm, which are also called sperm.
Several things affect the risk of cytostatic drugs affecting fertility, such as the drugs you receive and the doses you receive. Most often, an increased dose means that the risk increases.
Age may also matter if you have ovaries. They become more sensitive over the years as the eggs become less and less. Therefore, it may be more difficult for you than for a younger person to have children after treatment with cytostatic drugs, even though you have been given the same dose of the same drug.
Radiation therapy to the ovaries, testes or brain
Radiation treatment affects fertility if the rays are directed at the genitals.
Radiation to the brain can also affect fertility. In the brain is the pituitary gland that produces the hormones needed for the eggs and sperm to mature and function.
There are drugs that replace the hormones after radiation therapy so that it is still possible to have children later in life.
Radiation to the uterus
Radiation therapy to the uterus can make it more difficult or impossible to get pregnant or to carry a pregnancy.
Surgery of the uterus, ovaries or fallopian tubes
The ability to have children can be affected if you have surgery in the uterine mucosa, ovaries or fallopian tubes. You can be operated on in a way that reduces the risk if you have cancer that is at an early stage.
You can no longer get pregnant if the uterus is removed.
Other gastric operations
An operation in the abdomen can cause scars called fissures. It is unusual, but sometimes ovulation can affect, for example, a fallopian tube so that it becomes too narrow for an egg to pass through it.
Operation of a testicle
The sick testicle is usually removed if you have testicular cancer. The second testicle may have reduced the production of sperm.
Other cancer treatments can also affect fertility
Immunotherapy and targeted therapy are quite new ways to treat some cancers. Then drugs have used that work in a different way than cytostatic drugs. It will take several years for sure answers to how these drugs affect fertility.
Other than the cancer treatment can affect
Sometimes the disease causes fertility to be reduced, for example in testicular cancer.
Fertility may have been reduced even before you got cancer. Every seventh to every ten people in Europe have problems with impaired fertility. Read more in the article on involuntary childlessness.
Methods to protect eggs or ovaries
There are a few different methods to try to preserve fertility. You are offered to do so if you are under 40 and treatment can affect your fertility.
The ovaries can be moved
The ovaries can be protected with surgery if you are to receive radiation treatment. Then they are moved to the upper part of the stomach where they end up outside the area to be radiation treated.
An ovary can be removed and saved
An ovary or part of an ovary can be operated out and frozen. It can be an alternative to getting eggs to freeze if it is urgent to start with the cancer treatment. The frozen ovary or ovarian part is thawed and put back into the body when you want to try to get pregnant.
Eggs can be frozen fertilized or unfertilized
Your eggs can be picked out and saved in the same way as with test tube fertilization, also called IVF treatment.
The eggs can be frozen without fertilization or fertilization, also called embryos. It does not matter to the chance of having a child. You can only use embryos if you have the same partner you wanted to have children with when you became ill.
Sometimes it is too urgent to start with the cancer treatment to catch up with the hormone stimulation required before the eggs can be removed.
You will receive anti-estrogen in addition to the hormone stimulation if you have a breast cancer tumor that needs hormones to grow. Then there is very little risk of tumor growth due to the hormone stimulation.
If you are pregnant when you get cancer
Pregnancy may need to be terminated if it is at an early stage and you develop cancer. Even then, it can be helpful to get pregnant again when cancer treatment is complete.
Methods to protect sperm and testes
You are offered to freeze your sperm before the cancer treatment if you are under 55 and the treatment can affect your fertility. It is common to have sperm delivered on several occasions.
The sperm can be thawed and used in a test tube fertilization treatment, also called IVF treatment.
Sperm can be taken directly from the testicle
Sometimes there is no sperm in the semen. Then you can place a tissue sample from one testicle instead. Sperm may be frozen in the tissue sample.
Protection if you should receive radiotherapy
You get protection over the testicles if you are to receive radiation treatment. The cover is of lead that blocks the radiation. Radiation can also be shielded if it needs to be administered near the testes.
Methods for children to receive cancer treatment
So far, there are no established methods to preserve the future fertility of children who are before puberty when they need cancer treatment.
All or part of an ovary or testicle can be operated out and frozen.
The ovaries can later be thawed and put back in a new operation. The hope is that the eggs will be developed so that they can get pregnant.
The testicle is more difficult to get started in similar ways. This is because the testicle contains no sperm since it was operated out before the child’s puberty.
The methods are still experimental, but much research is underway.
Talk to your child’s doctor for more information.
The chance of pregnancy
The chance of having children is about 30 percent if frozen and thawed eggs or sperm are used in an IVF treatment.
How do I know if I am fertile after cancer treatment?
It can be difficult to know if cancer treatment has affected your ability to have children. Some suffer from some time after treatment. Others get pregnant even though the doctor has considered that the possibility is small.
Surveys and supportive treatment if you have ovaries
It may take several months for the period to return if it ceased while receiving cancer treatment.
You can get pregnant despite missing menstruation, or have menstruation even though you can no longer get pregnant.
A gynecologist can help you if you want to get an assessment of your ability to have children. The gynecologist examines your ovaries with ultrasound. You may also be given a blood test to measure hormone levels, which may be a sign that there are eggs left.
Surveys and supportive treatment if you have testicles
Talk to your doctor if you want to submit sperm samples after your cancer treatment. The test is examined to see if there are live sperm and how they move. These sperm can be screened out if they are few and used in an IVF treatment.
The doctor can also measure the level of the testosterone hormone needed to form sperm. The level is measured in a blood sample that you are allowed to leave. You can get artificial testosterone treatment if you need to.
Sperm production can sometimes recover without treatment. It can happen after a long time, sometimes several years.
The future fertility of children who have had cancer
A child who has had cancer should be checked several times during his or her upbringing. Then the child can receive hormone therapy if it is needed to reach puberty, or if fertility is low or about to cease. For example, irregular menstruation may be a sign that fertility is about to cease completely for a young person who has had cancer as a child.
Children with testicles usually come into puberty as usual. Cancer treatment may still have damaged sperm production. Sperm tests later in life can show whether there is sperm or not.
You who have had cancer as a child should be offered a referral to a fertility hospital when you turn 18 so that you can receive continued help.
Avoid pregnancy when receiving cancer treatment
Use contraception as long as the cancer treatment is in progress and for a while afterward. There is a risk of pregnancy even if you receive treatment that may affect fertility. Treatment can be harmful to a fetus.
Talk to your doctor about what kind of birth control you can use, and when it might be advisable to try to get pregnant after the cancer treatment. It is common to have to wait six months to one year, but some may have to wait longer.
Can pregnancy affect the risk of me or the child getting sick?
The risk is very small for the child or you to be affected by having had cancer.
The risk to the child
It is only if you have had a cancer disease that is hereditary that there is a risk that the child also gets cancer.
There is no or only a very small risk that your child will have any malformation because you have had cancer.
The risk of relapse if you are pregnant or breastfeeding
Breast cancer is sometimes dependent on the same hormones needed if you are pregnant or breastfeeding. But pregnancy or breastfeeding does not seem to increase the risk of cancer coming back.
Adoption or donated germ cells
There may be other opportunities to have children if your fertility has stopped.
You can get donated eggs or sperm
Donated eggs or sperm can be used for IVF treatment.
Adoption according to individual assessment
You can apply to adopt a child. Then an inquiry is made to find out if you are suitable. Your health and illness history is part of the investigation.
You can get adopted even if you have had cancer. There are many cancers where most people get rid of the disease and have a good life after treatment.
Often, a specialist physician needs to write a certificate of how long it has been since the cancer treatment and how great the risk is that the disease will return. Then the social services make an individual assessment.
You can reapply if you have been rejected for being sick. The National Board of Health and Welfare’s legal advice and social services can make a new assessment if you are no longer on sick leave and you have little risk of getting cancer back.
Different rules for different countries
You can be assessed differently if you want to adopt from another country. It depends on which country you are applying to adopt from. You can read more in the text on adoption.
Thoughts and feelings about trying to have children
There may be many issues that you feel you need to think about if you are considering trying to have children. Some questions have no given answers about what is right or wrong. It can feel extra difficult if you have or have had a serious illness:
What if you have relapses and don’t feel like a good parent when you get treatment again – or die?
What if you refrain from trying to have children for fear of relapse and then live a long and healthy life, but without children?
The risk of recurrence can be estimated at about, but only by comparing with other people who have had the same type of cancer as you. It is a statistical figure that says nothing about how it will be for you.
You can also think about your situation in general: Are there people in your vicinity who could be supportive of you and the child?
Ask questions and ask for help if not offered
Your doctor or other healthcare professional should tell you if cancer treatment can affect your fertility. You will also need to know what alternatives are available and get the support you need to make decisions about how you want to do.
Talk to your contact nurse or your doctor if you are not offered a referral to a fertility clinic at a university hospital.
You have the right to support to be able to make decisions about your child’s fertility
Deciding on your child’s fertility can be difficult. Concerns about the child’s cancer can make the question of fertility feel unimportant. You may want to save the child treatment with which the child himself has difficulty understanding the benefit.
You and the child should have the opportunity to talk about risks and opportunities with a person who is a specialist infertility.
The information should be adapted to the child’s age. Children at puberty have the right to talk to a specialist without you as a custodian.
Both you and the child can be supported by, for example, a curator.
In the text Help with thoughts and feelings about cancer, there are tips on other people who can be supportive if you need to talk.