How Cancer and Cancer Treatment Can Affect Fertility in Women

Some cancers and cancer treatments can cause changes in your body that affect your fertility (your ability to have children). This could include hormone changes or damage to certain parts of your body.

Learn more about how cancer and its treatment can affect fertility in women and how to find help with fertility issues.

Hysterectomy

A hysterectomy is surgery done to remove your uterus and cervix. Without a uterus you can’t conceive and carry a child. A hysterectomy might be done for uterine (endometrial) cancer, cervical cancer, or other cancers that affect the reproductive organs.

You might hear people refer to a "simple" or "radical" hysterectomy. A simple hysterectomy usually means removing only the uterus and the cervix. A radical hysterectomy means removing the uterus, cervix, upper part of the vagina, and tissues around the uterus. The ovaries are not always removed during these surgeries.

Some women at high risk for breast, uterine, and ovarian cancers, or women who have a hereditary cancer syndrome, might choose to have a hysterectomy and have their ovaries and fallopian tubes removed to help prevent the cancers from starting.

Oophorectomy

An oophorectomy is surgery to remove your ovaries. One or both fallopian tubes are often removed at the same time. This surgery is done for ovarian cancer and other cancers that affect the reproductive system. It might be done at the same time as a hysterectomy, or it might be done separately if your uterus isn’t affected.

Since your ovaries hold your eggs, you can’t get pregnant through sexual intercourse without them. If possible, and if there is a low risk that the cancer will come back, the surgeon might try to save one ovary to preserve eggs. In this case, you might be able to get pregnant at a later time. Keeping at least one ovary also preserves the hormones that help prevent menopause symptoms, like hot flashes and vaginal dryness.

Some women at high risk for breast, uterine, and ovarian cancers choose to have an oophorectomy as a way to help prevent the cancers from starting.

Trachelectomy

Trachelectomy is surgery to remove your cervix (the lower part of your uterus) and the upper part of your vagina. The uterus is kept so you have the chance to carry a pregnancy later.

Adhesions

Other types of cancer surgery for tumors in your abdomen or pelvis can sometimes cause scarring (adhesions) around your reproductive organs. This scarring might block your ovaries, fallopian tubes, or uterus, preventing your eggs from being fertilized and implanting in your uterus. This could prevent a pregnancy or not allow it to go full term.

Radiation therapy

Radiation therapy can affect your fertility if the radiation is aimed at or around your reproductive organs or certain parts of your brain.

Radiation to the abdomen (belly) and pelvis

Radiation to your abdomen (belly) and pelvis can affect your uterus and ovaries. How much of an affect it has will depend on the method of radiation used, the total dose given, and your age and stage of development.

Ovaries: Radiation aimed at or near your ovaries might damage them enough to affect their function. Both external and internal radiation therapy can expose your ovaries to radiation.

Whether or not you become infertile depends on the amount of radiation absorbed by your ovaries. High doses might destroy some or all of the eggs in your ovaries and cause infertility and early menopause. This is more likely to happen if you are older, because the number of eggs in your ovaries decreases over time.

Some eggs might survive if your ovaries can be moved away from the radiation target area in a minor surgery. This could help preserve some eggs and give you a greater chance at keeping your fertility. Or, it could increase the chance that your fertility returns after you finish treatment.  

Uterus: Radiation to the uterus can sometimes damage the muscles and blood supply. These problems can limit the growth and expansion of your uterus during pregnancy. Women who had radiation to the uterus have an increased risk of miscarriage, low-birth weight infants, and premature births.

These problems are most likely to happen in women who had radiation during childhood, before the uterus began to grow during puberty. But older women might also be impacted.

Radiation to the brain

Radiation to the brain can sometimes affect your pituitary gland. Your pituitary gland makes hormones that signal your ovaries to start the ovulation process (release of eggs). This may or may not affect your fertility. It depends on the focus and dose of the radiation.

Radiation and pregnancy

Radiation can harm a developing fetus. If there is a chance you’ll remain fertile after radiation, it's important to ask your health care team how long you should wait before having unprotected sex or trying for a pregnancy. They will be able to consider your circumstances and give you specific information.

Chemotherapy

Chemotherapy (chemo) works by killing cells in your body that divide quickly. This includes cancer cells, but also the cells of your ovaries (oocytes).

The oocytes make hormones like estrogen. Your body needs these hormones to release eggs from your ovaries each month and prepare your uterus for pregnancy. Loss of these hormones can affect your fertility. You might go into premature or early menopause. This can be temporary or permanent.

Some chemo medicines can also lower the number of eggs in your ovaries, making it harder to get pregnant after treatment. 

Whether or not you are fertile after chemo depends on your age and stage in life, such as if you’ve gone through puberty or are nearing menopause. Other factors include your hormone levels after chemo, the type of cancer you have, and the type and dose of chemo you get.  

Chemo medicines that are most likely to cause infertility in women are:

• Busulfan
• Carmustine
• Chlorambucil
• Cyclophosphamide
• Doxorubicin (Adriamycin)
• Lomustine
• Mechlorethamine (Mustargen)
• Melphalan
• Procarbazine

Other chemo medicines can also affect fertility.

Higher doses of chemo are more likely to cause fertility changes that don’t get better. The same is true if you get more than one of these medicines. Ongoing infertility is also more likely when you are treated with both chemo and radiation therapy to the belly (abdomen) or pelvis.

Talk to your cancer care team about the chemo medicines you will get and your risk of  infertility from them.

Chemo and pregnancy

It's very important to not get pregnant during chemo. Many chemo medicines can harm an unborn baby. This can lead to birth defects and miscarriage. If there is a chance you could get pregnant during treatment, it’s important to use effective birth control. Talk to your cancer care team about your best options.

Some women can get pregnant even when their periods have stopped, so it’s important to use birth control whether or not you have periods. Talk to your cancer care team about what's best for you.

If you want to get pregnant after treatment ends, be sure you know how long you should wait before trying. You can learn more about this in Having a Baby After Cancer (Pregnancy).

Hormone therapy

Hormone therapy works by lowering the level of certain hormones or by keeping them from working the way they should.

Since your body needs these hormones to conceive and carry a pregnancy, not having enough of them might make it hard to become pregnant or to carry a baby to full term. Some of these medicines might also cause birth defects.

Some hormone therapies can put you into an early menopause. This may be temporary or permanent, depending on your age and the type and length of your treatment.

Targeted therapy and immunotherapy  

There haven’t been enough studies done to fully understand which targeted therapies and immunotherapies can cause infertility or pregnancy problems. But here is what’s known so far:

Many targeted therapy medicines interfere with functions your body needs for healthy ovaries and fertility. Because of this, these medicines might increase your chances of infertility after treatment.  For example, bevacizumab (Avastin) has been linked to ovarian failure, which can be permanent.

Some immunotherapy medicines have also been shown to interfere with fertility, and with having a healthy pregnancy after treatment. For example, the targeted medicines thalidomide and lenalidomide carry a high danger of causing birth defects. Women who are given these medicines are asked to use two effective types of birth control while taking them.

In addition, studies show that some immune checkpoint inhibitors (another type of immunotherapy medicine) might increase the risk of pregnancy complications such as birth defects.

More studies are taking place. In the meantime, talk with your doctor or cancer care team about your risk of infertility and what can be done to help preserve it.

Bone marrow or stem cell transplant

Having a bone marrow or stem cell transplant often means you will get high doses of chemo and sometimes radiation to your whole body to prepare for the transplant. This treatment might permanently stop your ovaries from working normally, causing infertility. Talk with your doctor or cancer care team about this risk before starting treatment.

Evaluating menstruation and fertility after cancer treatment

If you have regular menstrual periods after cancer treatment, your chances of being fertile are higher. But having your period doesn’t always mean you’ll be able to have a baby.

For some women, cancer treatment stops menstrual periods permanently. This is called early menopause. It causes permanent infertility.

For other women, menstrual periods stop during treatment but return later. Women who have periods after cancer treatment may still be less fertile. Even if you menstruate during treatment and remain fertile afterward, you might still have trouble conceiving a child.

Older women and women who had higher doses of radiation therapy or chemo are less likely to restart their periods after treatment. If their period does start again, it may take longer to come back.

Children and younger women have a larger ovarian reserve (more ovaries left in their bodies). They are less likely to go through menopause or become infertile. But some younger women might still lose their fertility. Radiation therapy to the pelvis and abdomen (belly) and higher doses of chemo may cause even young girls to go through menopause.

Your doctor can refer you for ovarian reserve testing. This is done by using sensitive hormonal tests, such as the anti-Müllerian hormone. Results of these tests might help your doctor determine how likely you are to get pregnant or if you will need fertility assistance.

How to find help with fertility issues

If you have trouble getting pregnant after cancer treatment, think about meeting with a reproductive endocrinologist. This is a doctor who specializes in fertility issues. Some reproductive endocrinologists specialize in cancer-related fertility.

For partners

Partners often share the same concerns about fertility as the person with cancer. If your partner is going through treatment, it’s important for both of you to get the support you need.

Depending on the situation and your desire for having children, you can work together to find possible options for preserving fertility or for having a child once treatment ends. This can help reassure both you and your partner. It can help you both cope with the changes that are happening and challenges that lie ahead.

Going with your partner to treatment, follow-up visits, and check-ups might be a good idea, too. You can also ask for a referral to a counselor, therapist, or fertility specialist.

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