Fertility Issues for Women After Cancer Treatment

From the DFCI/NCCN Survivorship Information ^TM  

Cancer treatment saves the lives of many women, but it may affect their ability to bear children later on. This is often because of the way the treatments affect the ovaries.

The ovaries hold ovum, or eggs, which are released once a month after a girl reaches puberty. Eggs cannot grow or be replaced; when a girl is born, her ovaries contain all the eggs she will ever have. The ovaries must work properly for normal growth, sexual development, and fertility.

The ovaries are sensitive to radiation and chemotherapy. If they are harmed during treatment, it can cause problems with ovulation, menstruation, and pregnancy. The uterus or cervix can also be affected by cancer treatment. This can lead to challenges with carrying a baby and can cause miscarriage or premature delivery.

Most female childhood cancer survivors will be able to have children. However, those who received the following treatments will have a higher risk of fertility issues:

• radiation to the lower abdomen, pelvis, or lower back (the higher the dose of radiation, the higher the risk of infertility)
• total body irradiation with a bone marrow transplant
• chemotherapy – specifically, high doses of alkylating agents such as:
  • cyclophosphamide (Cytoxan)
  • ifosfamide
  • procarbazine
  • melphalan
• surgery to the ovaries or uterus
• high-dose radiation or surgery to the brain (excluding leukemia)

Pregnancy Possibilities

Because each woman is different, no one can know for certain how your cancer treatment will affect your chances of having a baby. Talk to your health care provider about blood tests that can evaluate the health of your ovaries.

Menopause/Premature Ovarian Failure

Natural menopause happens when the ovaries make smaller amounts of sex hormones and menstrual periods go away. At this point, the eggs are gone, and a woman is no longer able to have a baby. Natural menopause usually happens at about age 51 in women who have not had treatment for cancer. Women who go through menopause before the age of 40 have what is called premature ovarian failure.

Some women who have had treatment with chemotherapy (especially alkylating agents) may have early menopause, because of damage to the ovaries. However, some are still able to become pregnant with fertility treatments. If a woman is at risk for early menopause and hopes to have children, it is wise not to wait too long. Your health care provider can give you a referral to a doctor who specializes in fertility therapies.

If you have a baby, there is no evidence that your cancer or the cancer treatment you had will put him or her at risk of cancer or birth defects.