Chemotherapy side effects: fertility and pregnancy
Chemotherapy may affect sexual organs or functions in various ways.
Possible side effect: changes in your fertility.
When symptoms may occur: during and following treatment.
- Early menopause (women)
- Inability to conceive or father a child (men and women)
- Some drugs can damage the DNA development of a foetus
What you should do:
- Men can consider sperm banking (if appropriate)
- Women can consider freezing embryos, freezing unfertilised eggs (oocytes), freezing ovarian tissue or drugs to protect the ovaries
- Men and women should use effective contraception
Some chemotherapy drugs can damage the ovary or testis, leading to an increased risk of infertility (inability to have a child) and also, in women, early menopause. If this is an important issue for you, make sure you discuss it fully with your doctor before treatment starts.
You may experience changes in your desires or desired level of sexual activity, or you may notice no difference. Loss of libido (sex drive) is not uncommon in both women and men. However, chemotherapy in itself doesn’t usually affect sexual performance or cause impotence. The stress of your illness or the treatment schedule may make you feel more tired than usual. If fatigue is a problem you may want to set aside time for physical intimacy after a period of rest.
Although your sexual needs and desires are highly individual, the following advice may be helpful:
- Try to find out as much as possible about how your treatment may affect you
- Share your worries and feelings with people who care for you
Feel free to discuss any concerns you may have with your doctor or nurse. Even if they are unable to help you, they can refer you to someone who can.
Chemotherapy may affect your ability to conceive a child which may be temporary or permanent, depending on your age and your treatment. If you are concerned about this you may want to discuss it with your doctor before starting treatment.
Women having certain chemotherapy treatment plans may notice changes in their menstrual cycle. If you are still having periods then it is quite possible that these will gradually stop while you are on chemotherapy. This is less likely if you are in your twenties or thirties. If you are in your forties, your periods may not return and menopausal symptoms may begin.
Hormonal changes may cause hot flushes and vaginal dryness. If you suffer from any menopausal symptoms, talk to your doctor who may prescribe something to help relieve them.
If you are concerned about preserving your fertility, your specialist cancer doctor may want to refer you to a fertility clinic where you can discuss what options may be available. However, not all of the following options will be suitable for every woman and it may also depend on whether you can safely delay treatment.
The options include freezing fertilised or unfertilised eggs, or ovarian tissue:
- Freezing embryos (in vitro fertilisation or IVF): collecting and freezing embryos for later implantation.
- Freezing unfertilised eggs (oocytes): a procedure that may be considered by women who do not currently have a partner and do not wish to use a sperm donor. This is a fairly new and experimental technique.
- Freezing ovarian tissue: ovarian tissue contains hundreds of immature eggs that could potentially be saved and used to start a future pregnancy. This is still at a very early and experimental stage.
- Drugs to protect the ovaries: there is some evidence that drugs which induce a temporary menopause, for example, Zoladex, may protect the ovaries during treatment from long-term chemotherapy damage. This approach is experimental.
It may be possible to become pregnant during the time you are having chemotherapy, but it isn’t advisable to do so. Some chemotherapy drugs can damage an unborn child.
During treatment and for about one year afterwards, sperm and eggs may not be formed normally, if they are produced at all. Your doctor will be happy to discuss this further with you.
You or your partner should use a barrier method of contraception during treatment, not only to prevent pregnancy but also to prevent any possible contamination with chemotherapy. Non-barrier methods should be fine after treatment is finished but they need to be used for one year after completion of chemotherapy. If you know you are pregnant before starting treatment or become pregnant during treatment, you must tell your doctor immediately.
We are aware that some women may be diagnosed with cancer during pregnancy. If you are in this situation, your specialist doctor will discuss with you the benefits and risks of having chemotherapy.
There may be a risk of harm to a child who is being breast-fed since the drug may be concentrated in the milk. It is very important that you check with your doctor first if you wish to breast-feed while receiving chemotherapy.
Some chemotherapy drugs can damage the testis and this may affect your ability to father a child. Although sterility (failure of sperm production) isn’t associated with many drugs, chemotherapy may reduce the number of sperm or their motility (movement). After treatment, some men remain infertile while in others, the sperm count returns to normal.
If sterility is likely to be a permanent side effect, you may be offered the opportunity to bank sperm before starting treatment (sperm is frozen for artificial insemination at a future date). Before sperm banking takes place, you will be asked to have a blood test for HIV antibodies, hepatitis B and hepatitis C. This is routine practice to ensure that healthy sperm are banked.
During treatment and for about one year afterwards, it isn’t advisable for you to father a child because sperm may not be formed normally. You or your partner should use effective contraception.