Female Fertility and Cancer Treatment

Cancer treatments may affect your fertility by harming reproductive organs and endocrine glands that control fertility. Changes to your fertility may be temporary or permanent. Treatments such as chemotherapy, radiation therapy, and hormone therapy can cause primary ovarian insufficiency, as explained in the section Primary ovarian insufficiency (POI) and cancer treatment.

Chemotherapy and fertility

Chemotherapy destroys cancer cells but can also harm healthy cells, such as those in the ovarian follicles, which contain oocytes (egg cells). Some types of chemotherapy pose a high risk to your fertility. For example, alkylating agents present a high risk to your fertility because they can cause the ovaries to stop developing mature eggs and producing estrogen. This can lead to primary ovarian insufficiency. You may be at greater risk of infertility if you receive high doses of chemotherapy or several chemotherapy drugs at the same time.

Pausing Therapy for Early-Stage Breast Cancer to Get Pregnant

In a new study, temporarily stopping hormone therapy did not raise the risk of a recurrence.

Hormone therapy and fertility

Hormone therapy, also called endocrine therapy, adds, blocks, or removes hormones (estrogen and progesterone). It may be used to stop or slow the growth of cancer that uses hormones to grow. This can cause primary ovarian insufficiency. Fertility-related side effects depend on the specific type of hormone therapy and may include symptoms such as those listed in the section Primary ovarian insufficiency (POI) and cancer treatment.

Research has found that some women being treated for breast cancer can stop hormone therapy while trying to become pregnant without raising the risk of recurrence in the short-term, according to initial results from the POSITIVE clinical trial.

Immunotherapy and fertility

Immunotherapy stimulates or suppresses your immune system to fight cancer. Immune checkpoint inhibitors are a type of immunotherapy drug used to treat some types of cancer. The effects of immunotherapy on fertility and pregnancy are still being studied. If your doctor recommends immunotherapy, ask what is known about the type of immunotherapy you will be receiving and how it may affect your fertility.

Radiation therapy and fertility

Radiation therapy destroys cancer cells or slows their growth. Radiation to your reproductive organs, pelvic region, or central nervous system can affect your fertility. The dose of radiation, the part of your body that received radiation, and your age all play a role in whether your fertility is affected. The type of radiation therapy used is also a factor. For example, proton beam radiation therapy and intensity-modulated radiation therapy may have less of an effect on your fertility than standard radiation therapy.

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Pelvic region: Radiation therapy to or near reproductive organs (such as your cervix, fallopian tubes, ovaries, uterus, vagina, and vulva) in your pelvic region can damage ovaries or destroy eggs and may cause primary ovarian insufficiency. Radiation therapy near the uterus can affect the blood flow or cause scarring, which may cause infertility or increase the risk of pregnancy-related complications.

Central nervous system: Radiation therapy to your brain may affect glands that send signals to the ovaries to make the hormones estrogen and progesterone that are needed for ovulation. Learn about procedures that can help protect your fertility during radiation therapy in the section Fertility preservation methods for females.

Stem cell transplant and fertility

Before having a stem cell transplant, also called a bone marrow transplant or hematopoietic cell transplant, you may receive high doses of chemotherapy, radiation therapy, or both. Because these treatments can damage the ovaries, they may cause primary ovarian insufficiency or infertility. Researchers are studying reduced-intensity conditioning regimens to determine if they can lower the risk of primary ovarian insufficiency or infertility.

Surgery and fertility

The type, size, and location of the tumor are important factors in whether surgery affects your fertility. Some cancers may require surgeries that could affect your fertility:

• Gynecologic cancers (cancers of the female reproductive system). Cervical, ovarian, and uterine cancers may require hysterectomy, which is surgery to remove the uterus. You may no longer be able to carry a pregnancy. An oophorectomy, which is surgery to remove one or both ovaries, may cause infertility if both ovaries are removed.
• Cancers in the abdomen or pelvis. Anal, bladder, colon, and rectal cancers may require surgery that can harm nearby organs. These surgeries may cause adhesions, which are scar-like tissues that form between organs and tissues. Adhesions can prevent eggs from travelling from the fallopian tubes to the uterus or prevent implantation. Surgeries, such as a radical cystectomy, also sometimes remove reproductive organs, which can cause infertility.

Talk with your doctor to learn whether the advised surgery may affect your fertility.

Targeted therapy and fertility

Targeted therapy uses drugs or other substances to block proteins or other molecules that control how cancer cells grow, divide, and spread. While the effects of targeted therapies on fertility and pregnancy are still being studied, some studies have found that tyrosine kinase inhibitors (TKIs) may affect fertility. Research has also found that targeted therapy may affect organs in the endocrine system, such as the thyroid, which may lower your fertility. If targeted therapy is recommended, talk with your doctor about how the specific type of targeted therapy may affect your fertility.