Life After Cancer: Changes in a Woman’s Fertility 

Cancer can affect a woman’s ability to get pregnant (her fertility). Infertility means a woman is not able to get pregnant through normal sexual activity, or she is unable to carry a baby through pregnancy. A woman is thought to be infertile if she can't get pregnant after a year of regular, unprotected sex, or after 6 months if she is over age 35.

Infertility can be caused by:

• Early menopause

• Damaged or destroyed eggs

• Hormone changes that affect the way your eggs mature and leave the ovaries

• An egg that can’t reach the uterus

• An egg that can’t be fertilized

• A fertilized egg that can’t attach inside the uterus

• A fertilized egg that can’t grow in the uterus 

Healthcare providers are still learning how cancer care affects a woman's fertility. Fertility problems depend on:

• The type of treatment(s) you had

• The type of cancer and where it was in your body

• How long treatment lasted

• Treatment doses

• Your age when you had treatment

• How long it has been since treatment ended

• Your overall health  

Don't assume that you can't get pregnant after cancer treatment. Cancer survivors are 3 times more likely to have unplanned pregnancies than the general population. So it's also important to talk to your treatment team about birth control if you don't want to become pregnant.

Before treatment 

It's important to talk with your healthcare team about fertility before you start treatment. You may have to bring it up.

Your team can tell you about how treatment may change your ability to get or stay pregnant. Talk with your team about your options. You may choose to have eggs or embryos frozen. Or you may choose a type of treatment that may help protect your fertility.  

If you want to get pregnant after treatment, ask your team about seeing a fertility specialist before treatment starts.

If you had chemotherapy 

Chemotherapy (chemo) can damage the eggs that are in your ovaries. You're born with all the eggs you will ever have. Some chemo medicines are more likely to cause infertility than others. It depends on which medicines you get, the dose, and length of treatment. Talk with your healthcare team about the chemo you had and the risks of each medicine on fertility.

You may need to wait at least 6 months after your last chemo treatment to try for a pregnancy. This is because eggs maturing in the ovaries can be damaged by chemo. And getting pregnant too soon after chemo might cause birth defects or miscarriage.

If you had 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. Some are linked to a high risk of birth defects. Or they may cause other problems. Ask your healthcare team what effects your medicines may have on your fertility. 

If you had radiation therapy

Radiation can cause infertility in different ways, such as: 

• Radiation to the belly, vagina, or uterus can harm the ovaries. It can destroy eggs in the ovaries. Or it can cause the ovaries to stop working.

• Radiation to the brain can damage the pituitary gland. It can affect hormones that control ovulation (the release of eggs from the ovaries) and cause infertility.

• Radiation can also cause scar tissue to form in the uterus. This can keep the uterus from stretching to hold a baby. And it can cause problems in a later pregnancy. It may cause miscarriage or early birth.

Your healthcare team can tell you what effects you might have from your treatment.

If you had surgery

Surgery to your reproductive organs or other organs in your belly or pelvis can change your fertility. For instance:

• Surgery to other organs around your reproductive organs can lead to scarring that causes infertility. For instance, scar tissue may block the fallopian tubes. It can stop an egg from reaching the uterus.

• If you had your uterus removed (hysterectomy), you will not be able to carry a pregnancy.

• If you had both of your ovaries removed (oophorectomy), you will not be able to get pregnant without medical help. (If you still have your uterus and have 1 ovary, you may be able to get pregnant.)

Your healthcare team can tell you what to expect.

After treatment 

After treatment, your healthcare team can help you manage changes to your fertility. If you plan to get pregnant after your treatment is done, talk with your team first. Ask how long you should wait after treatment. Some kinds of treatment can harm the eggs that are maturing in the ovaries. This can raise the risk for birth defects. You may need to wait 6 months or more. Your team can give you information to help you make decisions. They can also help you find a specialist. And they'll let you know when it’s OK to start trying for a pregnancy. They may be able to help you find adoption or surrogate resources, too. 

Ask your healthcare team:

• How does the treatment I had affect fertility in women?

• Am I healthy enough for pregnancy?

• Can I use my egg or do I need 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? 

Seeing a fertility specialist 

After treatment, it may take a while for your menstrual periods to start again. But getting your period doesn't always mean that your fertility is okay. You may want to work with a fertility specialist. They can:  

• Do tests to check your fertility hormone levels

• See how many eggs are in your ovaries

• Look for other signs that you can have a baby

• Help you use eggs or embryos frozen before cancer treatment

• Help you use eggs or embryos from a donor

The specialist 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. In many cases, more than 1 treatment is needed. Talk with the fertility specialist and your health insurer to find out what your own costs will be. 

Getting support 

Fertility changes can be very stressful and upsetting. You and your partner may want to talk with a counselor to work through fertility-related decisions. Ask your healthcare team for a referral. They can also help you find a nearby support group or other resources.