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How Cancer Treatments Impact Fertility: What You Need to Know

Authored and medically reviewed by Dr. Eli Reshef

Dr. Eli Reshef is a reproductive endocrinologist and fertility specialist who sees patients in Chicago and the greater Chicagoland area.

A cancer diagnosis can bring many concerns, including the potential impact on fertility. Many cancer treatments can affect reproductive health, but advances in oncofertility—a specialized field that bridges oncology and reproductive medicine—are helping patients explore options to retain their ability to have children after cancer treatment. Understanding these potential effects and available fertility preservation strategies can empower patients to make informed decisions before starting treatment.

How Cancer Treatments Affect Fertility

1. Chemotherapy

Chemotherapy drugs target rapidly dividing cells, which includes both cancer cells and reproductive cells. In women, chemotherapy can damage eggs and lead to premature ovarian failure (POF), also known as premature ovarian insufficiency (POI) or early menopause. In men, it can reduce sperm production, sometimes permanently. The extent of fertility damage depends on the type of drug, dosage, and patient’s age.

2. Radiation Therapy

Radiation can impact fertility depending on the area being treated. Direct radiation to the pelvic area can damage the ovaries, uterus, or testes, leading to decreased egg or sperm production or damage to the uterus. Whole-body radiation, often used before bone marrow transplants, has a high risk of causing infertility.

3. Surgery

Surgical removal of reproductive organs, such as the ovaries, uterus, or testes, can result in permanent infertility, which refers to the inability to conceive a child naturally or through assisted reproductive technologies (ART) in the long term. Even surgeries that don’t directly remove reproductive organs may cause scarring or complications that make conception difficult.

4. Hormone Therapy

Certain cancers, like breast and prostate cancer, are treated with hormone-blocking medications. These drugs disrupt reproductive hormone levels, affecting ovulation and sperm production. While some effects are temporary, long-term use may lead to irreversible fertility challenges.

5. Bone Marrow or Stem Cell Transplants

These treatments require high doses of chemotherapy and radiation, which can significantly impact fertility. Many patients who undergo these procedures experience permanent infertility.

What is Oncofertility?

Oncofertility (a type of fertility preservation) is a medical field dedicated to helping cancer patients understand and manage the effects of treatment on their fertility and assist in future pregnancy after cancer treatment. It combines oncology with reproductive health to provide fertility preservation options before, during, and after cancer treatment. Working with an oncofertility specialist can help patients explore the best strategies to protect their reproductive potential.

Fertility Preservation Options Before and During Treatment

For people of reproductive age facing a cancer diagnosis, fertility preservation is an essential consideration. Several options are available, depending on the patient’s age, treatment timeline, and personal preferences:

• Egg or Embryo Freezing (Cryopreservation): Women can undergo ovarian stimulation to retrieve eggs, which can be frozen for future use or fertilized with sperm to create embryos for later implantation.

• Ovarian Tissue Freezing: A portion of ovarian tissue is surgically removed and frozen. This tissue can later be reimplanted to restore fertility.

• Ovarian Suppression: Hormonal treatments, such as GnRH agonists, may help protect ovarian function during chemotherapy.

• Sperm Banking: Men can preserve sperm samples before starting cancer treatment for future use in assisted reproductive technologies.

• Testicular Tissue Freezing: An experimental option where testicular tissue is removed and stored for potential future use.

• Experimental Options for Young Patients: Young patients who have not gone through puberty may consider experimental tissue freezing. 

Fertility Preservation Options After Treatment

For those unable to conceive naturally post-treatment, there are still options for family-building, including many assisted reproductive technologies: 

• In Vitro Fertilization (IVF): If a patient has frozen eggs, sperm, or embryos before treatment, IVF can be used to achieve pregnancy by fertilizing eggs in a lab and transferring an embryo to the uterus.

• Use of Donor Eggs, Sperm, or Embryos: If fertility is significantly impacted, patients can use donated eggs, sperm, or embryos to conceive with the help of assisted reproductive technology.

• Gestational Surrogacy: Patients who cannot carry a pregnancy due to medical reasons may choose gestational surrogacy, where an embryo is implanted into a surrogate who carries the pregnancy.

• Adoption: For those unable to conceive biologically, adoption can be a fulfilling option to grow a family and provide a child with a loving home.

The Importance of Early Planning

A cancer diagnosis can be overwhelming, but understanding the impact of treatment on fertility and exploring oncofertility options can provide hope and empower patients to make informed decisions.

The best time to explore fertility preservation options is before starting cancer treatment. Consulting with a fertility specialist early allows for a personalized approach, ensuring patients have the best chance of preserving their ability to have biological children in the future.

If you or a loved one is facing cancer and concerned about fertility, schedule a consultation with one of our fertility specialists to discuss preservation strategies tailored to your needs.

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