Fertility
How do I know if I am fertile (able to have children)?
- Attempt pregnancy: The best way to predict fertility after cancer is to try to become pregnant.
- Monitor menstrual bleeding (periods)
- Having monthly periods is a sign that the ovaries are working but does not always mean you are fertile.
- Common types of chemotherapy can decrease the number of eggs in the ovaries. This interrupts ovulation and results in temporary or permanent loss of periods.
- Many women who stop getting their periods will see them return within 6 months of finishing chemotherapy, but it may take
- Those women who do not stop getting periods or who get them back after chemotherapy may still have a smaller number of eggs. This could result in infertility and menopause at a younger
- Women over age 40 and who receive chemotherapy will have a higher risk of permanent loss of periods (menopause).
- Medicines called gonadotropin releasing hormone agonists (GnRHa, such as Lupron and Zoladex) can suppress ovulation (egg release during the menstrual cycle) and temporarily stop periods. Many women will get their periods back within 6 months of stopping GnRHa, but it can take longer.
- In women with no history of cancer treatment, menopause happens between age 40 and 60 (average age 51) after having no periods for 12 months.
- A fertility specialist can monitor your ovarian reserve
- Ovarian reserve is the number and quality of eggs that remain in your ovaries. Cancer therapy can reduce the number and quality of eggs in your ovaries.
- Ovarian Reserve Testing can help measure a woman’s fertility potential. While test results are helpful in gaining a better understanding of your fertility potential, they are not able to determine whether or not you will be able to conceive.
- Common tests to measure Ovarian Reserve include: (1) blood tests to measure hormones that regulate your menstrual cycle such as, follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH), and (2) tests using an ultrasound (an imaging test that uses sound waves to make pictures of organs and tissues inside your body) of antral follicle count (AFC).
- FSH is best tested with estradiol between days 3 and 5 of your menstrual cycle, while AMH and AFC can be tested at any time.
- As your age increases and fertility potential decreases, FSH levels ↑ and AMH and AFC levels ↓. This reflects decreasing ovarian reserve.
- Similarly to aging, chemotherapy can lower the number and quality of eggs in your ovaries, resulting in ↑ FSH and AMH and AFC↓. However, these levels can fluctuate (rapidly change) after treatment.
Next steps if you want to have children in the future:
DISCUSS
your desire to have children
with an oncologist
GET REFERRED
to a fertility
specialist
DISCUSS
family building options
with fertility specialist
CHOOSE
the best family building
option for you
Helpful questions to take to your doctor:
- How will my cancer treatment affect my fertility?
- Can I have my own biological children after cancer?
- Am I at risk for temporary or permanent infertility following my cancer treatment?
- Can I have ovarian reserve tested (FSH, estradiol, AMH, AFC)?
- I stopped having my period. Could I still get pregnant?
- What are my fertility options?
- Should I consider fertility preservation after treatment completion? What if I cannot freeze my eggs or embryos?
- When can I get pregnant after cancer treatment?
Glossary
- Anti-Mullerian hormone (AMH): Anti-Mullerian hormone is produced by ovarian follicles. Blood tests for AMH help gauge how many eggs remain in the ovary.
- Antral follicle count (AFC): Antral follicle count is the number of ovarian follicles from both ovaries measured by vaginal ultrasound. AFC helps to gauge how many eggs remain in the ovary.
- Cancer treatment summary: A document that lists the types of cancer treatments you had. It should include any surgeries, chemotherapy, radiation therapy, or other types of therapy you received.
- Estradiol: A sex hormone that plays an important role in the female reproductive cycle.
- Follicle stimulating hormone (FSH): Follicle stimulating hormone is produced by the pituitary gland. FSH helps control the menstrual cycle, regulate the production of eggs in the ovaries, and gauge how many eggs remain in the ovaries.
- Gonadotropin releasing hormone agonists (GnRHa): A type of medication that can suppress spontaneous ovulation.
- Menstrual cycle: A series of changes in the female reproductive system that occurs monthly, starting with the first day of the last period and ending with the first day of the next period.
- Ovarian follicles: Structures in the ovaries that enclose human eggs.
- Ovulation: The release of an egg from the ovary, which usually happens once a month, about two weeks before the next period.
- Ultrasound: An imaging test that uses sound waves to make pictures of organs, tissues, and other structures in your body.
Pregnancy
Baby's Health
Is my baby’s health at risk?
- Babies who are born too soon, or premature, can have problems with their breathing, feeding, immune system and growth. They often need to stay in the hospital for a longer time after they are born.
- Babies who are born to mothers who have had cancer are not at an increased risk of developing cancer, chromosomal abnormalities or birth defects.
- It is a good idea to meet with a genetics counselor if you want to become pregnant after your cancer treatment. They can help you understand your baby’s risk for inherited cancers. You will need to provide them with your family’s medical history. This could include parents, grandparents, and other members of your family that are related to you. The genetics counselor can also help you decide if you need further testing to understand any additional genetic risks.
Can I breastfeed?
- You may be able to breastfeed even if you have had cancer.
- It is important to talk with your health care team, including your obstetrician or pediatrician, before you breastfeed. Some medications are not safe to use while you breastfeed.
What should I do if I want to get pregnant soon?
- You should contact your cancer team to request a treatment summary. You should take your treatment summary with you and show it to your pregnancy care team.
- If you received anthracyclines, you may need to see a cardiologist (heart doctor) before pregnancy
- If you received pelvic radiation, you may need to see a high-risk obstetrician (pregnancy doctor)
- If you have a concern for inherited cancer, you may need to see a genetics counselor
This is custom heading element
CONTACT
your oncologist
and request a treatment summary
REVIEW
possible pregnancy risks
with your oncologist.
NOTIFY
your obstetrician about your
history and treatment exposure
Helpful questions to ask your healthcare team
- Is my health at risk during pregnancy because I have had cancer?
- Should I see a cardiologist before deciding if I want to get pregnant?
- Is my baby’s health at risk because I have had cancer?
- Will I be able to breastfeed in the future?
Glossary
- Birth defects: Birth defects are problems with the way a baby’s body forms that happen before they are born. Some birth defects are not very serious and do not need any treatment. Others can be very serious and need special care. An example of a birth defect is a cleft lip, where the baby’s lip does not form correctly.
- Chromosomal abnormalities: Chromosomes are structures that are inside of our cells. Chromosomes act like tiny instruction manuals that tell our bodies how to grow and work. Sometimes these instruction manuals can have too many or too few copies, which can cause problems in our bodies. One example of a chromosomal abnormality is Turner Syndrome. Girls with Turner Syndrome have only one X chromosome.
- Inherited cancers: A cancer someone gets because of a change in their genes they got from their parents. Genes are like messages that tell our cells how to grow and work. Sometimes, these genes can have mistakesin them. This mistake might make the cells grow out of control and become cancer. Only about 5% to 10% of all cancers are inherited.
- Premature baby, or premature birth: Occurs when a baby is born more than three weeks before a baby is due. It typically happens before the 37th week of pregnancy.