Fertility after cancer treatment

Fertility after cancer is one of the areas where people are most often left without information. Some treatments cause temporary changes, some cause permanent ones, and the difference is not always known at the outset. What is clear is that this should be assessed rather than assumed, and that a specialist referral is a reasonable thing to ask for at any point.

• Alkylating chemotherapy (for example cyclophosphamide) carries the highest risk of lasting damage to ovaries and testes.
• Radiotherapy to the pelvis, abdomen or whole body affects the ovaries and testes directly; radiotherapy to the brain can affect the hormones that drive reproduction.
• Surgery to reproductive organs has direct effects.
• Hormone therapy — for example tamoxifen for five to ten years — does not necessarily damage fertility but delays trying, which matters because ovarian reserve declines with age.
• Age at treatment is one of the strongest factors for ovarian function: the same treatment has different consequences at 25 and at 40.
• Immunotherapy and targeted therapies — effects are less well established, so ask specifically about the drugs you had.

International guidance recommends that fertility is discussed with everyone of reproductive age before treatment, and that people are referred to a specialist. If that did not happen for you — which is common — you can still ask for referral now.

• Ask your oncology team how long to wait. Advice varies by cancer and treatment, and is often around six months to two years — partly because of drug effects and partly because of when recurrence risk is highest.
• If you are on hormone therapy, discuss the timing carefully: pausing treatment to try for a pregnancy is a real conversation in some situations, and one to have with your oncologist rather than to decide alone.
• Being pregnant after cancer is not generally believed to increase recurrence risk for most cancers, but this depends on the diagnosis — ask specifically.
• Use effective contraception until you are deliberately trying: fertility can return unpredictably, and pregnancy during or shortly after some treatments carries risks.
• Ask about preconception review, folic acid, and whether your treatment history affects pregnancy care — for example anthracyclines or chest radiotherapy and heart function during pregnancy.

• Stored eggs, sperm or embryos, if preservation happened before treatment.
• Ovarian tissue that was frozen and can be re-implanted, available in some centres.
• Donor eggs, donor sperm or donor embryos.
• Surrogacy, where legally available.
• Adoption and fostering — policies on medical history vary, and having had cancer does not automatically exclude you.
• Choosing not to pursue parenthood, which deserves the same support and is a legitimate outcome.