Fertility and cancer treatment

How cancer treatment can affect fertility

Each cancer treatment can affect fertility in different ways. For example, treatment may damage or affect:

the pituitary gland and hormone levels
sperm production and quality
the ability to have an erection or ejaculate
the eggs in the ovaries
the womb or cervix.

Cancer and its treatment can also change how you feel about sex. It is common to have problems with sexual well-being during cancer treatment and after. Talking about this can be difficult and sometimes embarrassing, but your healthcare team is there to support you.

The effect of cancer treatment on your fertility can be difficult to deal with, and you may have lots of different emotions. Talking to other people in a similar position may help you feel less isolated. Macmillan’s Online Community is a good place to start. You can also talk things over with our cancer support specialists free on 0800 808 0000.

Related pages

Sex and cancer

Chemotherapy and fertility

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

Does chemotherapy affect sperm?
Chemotherapy can reduce or stop sperm production. This is usually temporary, but sometimes it can be permanent. It may depend on:

the drugs you have – some chemotherapy drugs affect sperm production more than others

the combination of drugs – having different drugs together may be more likely to reduce sperm production than having a single drug

the dose of the drug – higher doses of chemotherapy are more likely to affect sperm production, especially if you have it before a stem cell transplant.

Sometimes it is possible to choose a chemotherapy treatment that is less likely to affect your fertility. Your cancer doctor can tell you whether this is an option for you.
Does chemotherapy affect the ovaries?
Chemotherapy can reduce the number of eggs stored in the ovaries. It can also make the ovaries release fewer or no eggs. You may have a temporary or permanent early menopause. Unfortunately, if the menopause is permanent, you will be infertile.

Your risk of infertility may depend on:

your age when you have chemotherapy – the closer you are to a natural menopause, the higher the risk of infertility

the drugs you have – some chemotherapy drugs affect the ovaries more than others

the combination of drugs – having different drugs together may be more likely to affect the ovaries than having a single drug

the dose of the drug – higher doses of chemotherapy are more likely to affect the ovaries, especially if you have it before a stem cell transplant.

Chemotherapy can reduce the number of eggs you have. This may cause the menopause to start 5 to 10 years earlier than it would naturally. This means you have a shorter time to try to get pregnant.

Sometimes it is possible to choose a chemotherapy treatment that is less likely to affect your fertility. Or your cancer doctor may give you another drug during chemotherapy to try to protect the ovaries. They will tell you whether these are options for you.

Tell your cancer doctor if you are taking masculinising hormones as a gender-affirming treatment. Some masculinising hormones work by ‘switching off’ or suppressing the ovaries. This may help protect the ovaries from some damage during chemotherapy. You may still have the option to start a pregnancy or have fertility preservation after chemotherapy. Your doctor or nurse can explain more about this.

After chemotherapy

Sperm and fertility after chemotherapy

After chemotherapy, you can have tests to check whether you are producing healthy sperm.

If you are producing sperm, you may be able to try to start a pregnancy by having vaginal sex or using fertility treatments such as IUI or IVF.

If you stored sperm before cancer treatment, you may decide to use it with fertility treatments such as IUI or IVF. Or you may decide to find out about using a sperm donor.
Ovaries and fertility after chemotherapy

After chemotherapy, you can have tests to help find out how your fertility has been affected.

If your fertility recovers, you may be able to try to start a pregnancy by having vaginal sex or using fertility treatments such as IUI or IVF.

If you stored eggs, embryos or ovarian tissue before cancer treatment, you may decide to use these with fertility treatments. Or you may decide to find out about using an egg donor.

Radiotherapy and fertility

Radiotherapy uses high-energy rays to destroy cancer cells. It is given to an area of the body as precisely and carefully as possible. This means it usually only affects fertility if the treatment area includes part of the reproductive system, or the pituitary gland. For example, your fertility may be affected if you have the following treatment:

Pelvic radiotherapy – this is radiotherapy to the area between your hips and below your belly button. It might affect parts of the reproductive system, depending on the exact treatment area.
Radiotherapy to the brain – if the pituitary gland is in the treatment area, this can affect the hormones your body uses to control the reproductive system.
Total body irradiation (TBI) – this is radiotherapy to the whole body before a donor stem cell or bone marrow transplant. It usually causes permanent infertility.

It is sometimes possible to protect the testicles or ovaries during pelvic radiotherapy. Your cancer doctor can explain whether the following are suitable for you:

To protect the testicles – the radiographer may use shielding cups to cover and protect the testicles during treatment. Or they may use intensity-modulated radiotherapy (IMRT). This shapes the radiotherapy beams to fit the outline of tumours more precisely. It causes less damage to areas near the tumour.
To protect the ovaries – the radiographer may use a lead shield to protect the ovaries during treatment. Or you may have keyhole surgery before radiotherapy starts, to move the ovaries away from the area being treated. This is called ovarian transposition.

Does radiotherapy affect sperm?

Radiotherapy to the pelvis can reduce the amount and quality of sperm you produce. This may be temporary or permanent. It may depend on the type and amount of radiotherapy you have.

Radiotherapy to the pelvis may also affect how much semen your body makes. When you ejaculate, you may notice that only a small amount of fluid comes out. Or you may notice that no fluid comes out. This means you have stopped producing semen. It is called dry ejaculation.

If you have radiotherapy directly to the testicles or total body irradiation (TBI), it will cause permanent infertility. You may still produce semen when you ejaculate, but it will not contain sperm.

Radiotherapy to the brain can affect how the pituitary gland releases hormones called gonadotrophins. These hormones stimulate the testicles to produce testosterone and sperm. The pituitary gland may stop producing gonadotrophins months or years after this type of radiotherapy treatment.
Does radiotherapy affect erections?

Radiotherapy to the pelvis or pituitary gland may reduce how much testosterone you produce. This can affect your sex drive and ability to get an erection. You can have testosterone replacement therapy (TRT) to help with erections and sex drive. But TRT does not make the testicles produce sperm.

Radiotherapy to the pelvis can also damage nerves or blood vessels to the penis. Your body may still produce sperm and semen. But you may have problems getting erections or ejaculating.

It can be difficult to talk about problems like this. Try not to let embarrassment stop you from asking for help. If you are worried, your healthcare team is always a good place to start. There may be advice, support or treatments that can help improve some problems. This can depend on the underlying cause, so it is important to get the right advice for your situation.
Does radiotherapy affect the ovaries and womb?
Radiotherapy to the pelvic area can affect how the ovaries and womb work. Sometimes this improves after treatment, and it does not always affect fertility. But unfortunately for some people it may mean they cannot get pregnant in the future.

Radiotherapy directly to the ovaries and womb causes an early menopause and permanent infertility. Radiotherapy to other areas of the pelvis may affect the ovaries or womb indirectly. The ovaries may stop working for a short time or permanently. If they recover after treatment, you may be able to get pregnant.

If radiotherapy affects the womb, you may be able to get pregnant. But there will be a higher risk of miscarriage or premature birth.

Your risk of infertility after pelvic radiotherapy depends on:

the dose of radiotherapy you have

your age – the risk increases as you get older

whether you also have chemotherapy – there is a higher risk of infertility when you have chemotherapy with radiotherapy (chemoradiation).

Radiotherapy to the brain can affect how the pituitary gland releases hormones called gonadotrophins. These hormones stimulate the ovaries.

The pituitary gland may stop producing gonadotrophins months or years after this type of radiotherapy. If this happens, the ovaries still contain eggs. But they may stop releasing them.
Does radiotherapy affect the vagina?

Radiotherapy to the pelvis sometimes makes the vagina narrower, drier or less stretchy. This may make vaginal sex difficult or painful.

It can be difficult to talk about problems like this. Try not to let embarrassment stop you from asking for help. If you are worried, your healthcare team is always a good place to start. There may be advice, support or treatments that can help.

After radiotherapy

Sperm and fertility after radiotherapy

After pelvic radiotherapy, you can have tests to check whether you are producing healthy sperm. After pituitary radiotherapy, you can also have tests to check your hormone levels.

If you are producing sperm, you may be able to try to start a pregnancy by having vaginal sex or using fertility treatments such as IUI or IVF.

If you stored sperm before cancer treatment, you may decide to use it with fertility treatments.

If you have dry ejaculation, you may be able to have sperm collected by sperm extraction. The sperm can then be used with ICSI treatment.

After pituitary gland radiotherapy, you may have gonadotrophin-replacement injections. These may help you produce sperm to start a pregnancy – by having vaginal sex or with fertility treatments such as IUI or IVF.

Or you may decide to find out about using a sperm donor.
Erections and fertility after radiotherapy

If you stored sperm before cancer treatment, you may decide to use it with fertility treatments such as IUI or IVF. Or you may decide to find out about using a sperm donor.

If you have erection or ejaculation problems, you may be able to have sperm collected by sperm extraction and use it with ICSI.
The ovaries, womb and fertility after radiotherapy

After pelvic radiotherapy, you can have tests to help find out if and how your fertility has been affected. After pituitary gland radiotherapy, you can have tests to check your hormone levels.

If your fertility recovers, you may be able to try to start a pregnancy by having vaginal sex or using fertility treatments.

If you stored eggs, embryos or ovarian tissue before cancer treatment, you may decide to use these with fertility treatments. Or you may decide to find out about using an egg donor.

If radiotherapy has affected the womb, or there is another reason you cannot get pregnant or give birth, you may decide to find out about using a surrogate.

After pituitary gland radiotherapy, you may have gonadotrophin-replacement injections. These can stimulate the ovaries to release an egg. You may then be able to get pregnant by having vaginal sex or using fertility treatments.
Vaginal changes and fertility after radiotherapy

If vaginal sex is not possible, you may be able to try for a pregnancy using IUI or IVF. Or you may decide to find out about using an egg donor.

Your healthcare team can support you and tell you more about your options.

Surgery and fertility

Surgery is a common treatment for cancer. It only usually affects fertility if the operation involves part of the reproductive system, or the pituitary gland.

Surgery to the testicles

Testicular cancer is usually diagnosed and treated with surgery.

Removing 1 testicle should not affect your fertility, as long as the other testicle is healthy.

Rarely, both testicles have to be removed. This will cause permanent infertility.
Surgery to the prostate gland

You may have surgery to treat prostate cancer. If the prostate gland is removed, you will still make sperm, but not semen. This means that nothing will come out during ejaculation. It is called dry ejaculation.

Prostate surgery and other prostate cancer treatments usually affect erections or sex drive. It can be difficult to talk about problems like this. Try not to let embarrassment stop you from asking for help.

If you are worried, your healthcare team is always a good place to start. There may be advice, support or treatments that can help improve some problems. This can depend on what is causing the problem, so it is important to get the right advice for your situation.
Other surgery and erection or ejaculation problems

If you have testicular cancer, you may need an operation to remove lymph nodes in the tummy area (abdomen). This is called a retroperitoneal lymph node dissection. It is sometimes used for other types of cancer.

This operation can cause nerve damage, which may cause retrograde ejaculation. This is when semen goes into the bladder instead of coming out through the penis when you ejaculate. The semen then leaves your body harmlessly in your urine (pee).

Other operations can damage nerves and blood vessels to the penis. This may affect erections and ejaculation. These operations include surgery to the prostate, bladder, bowel, penis, spine.
Surgery to the pituitary gland

When surgeons remove a pituitary gland tumour, they try to leave some of the gland. This means it can continue releasing hormones. But this is not always possible.
Surgery to the womb or ovaries

For some cancers, surgery involves removing the womb (hysterectomy), the ovaries or both. Your healthcare team can explain the impacts of this operation, and give you support.
Surgery to the cervix
Surgery may be used to remove small cancers from the cervix. This may affect fertility or increase the risk of complications during pregnancy. But it depends on the type of operation you have.

Surgery to the cervix may include the following operations:

Large loop excision of the transformation zone (LLETZ) – a small area of cervix is removed using a thin, loop-shaped tool. LLETZ surgery can cause scarring. It may also narrow the cervix.

Cone biopsy – a cone-shaped section of cervix is removed. The area removed is larger than with LLETZ surgery.

Trachelectomy – the whole cervix is removed. Nearby areas may also be removed, such as the upper part of the vagina.

It is important to get information and support from your cancer doctor and specialist nurse about how surgery may affect your fertility. They can explain whether you are likely to need fertility treatments such as IUI or IVF. Some people will need a caesarean section to deliver their baby. Others may have a higher risk of miscarriage or early labour.

The Royal College of Obstetricians & Gynaecologists has more information about some operations and about pregnancy and birth.

After surgery

After surgery to the testicles

After surgery, you can have tests to check whether you are producing healthy sperm.

If you are producing sperm, you may be able to try to start a pregnancy by having vaginal sex or using fertility treatments such as IUI or IVF.

If you stored sperm before cancer treatment, you may decide to use it with fertility treatments such as IUI or IVF. Or you may decide to find out about using a sperm donor.
After prostate surgery

After prostate surgery, you can have tests to check whether you are producing healthy sperm. If you are producing sperm, you may be able to try for a pregnancy by having vaginal sex or with fertility treatments such as IUI or IVF. If you have erection or ejaculation problems, you may be able to have ICSI treatment.

If you stored sperm before cancer treatment, you may decide to use it with fertility treatments such as IUI or IVF. Or you may decide to find out about using a sperm donor.
Other surgery and erection or ejaculation problems

There are drugs that may help push semen out of the body when you ejaculate. Or it might be possible to collect sperm from your urine (pee) and use it with ICSI.

If you have erection problems, you may be able to have sperm collected by sperm extraction and use it with ICSI.

If you stored sperm before cancer treatment, you may decide to use it with fertility treatments such as IUI or IVF. Or you may decide to find out about using a sperm donor.
After pituitary gland surgery

After surgery, you can have tests to check how your fertility and hormone levels have been affected.

If your fertility is not affected, you may be able to try to start a pregnancy by having vaginal sex or using fertility treatments.

If your hormone levels are low, you may be able to have injections to stimulate the testicles to produce sperm, or the ovaries to release an egg. These are called gonadotrophin-replacement injections. You may be able to start a pregnancy by having vaginal sex or using fertility treatments.

If you stored sperm, eggs, embryos or ovarian tissue before cancer treatment, you may decide to use these with fertility treatments. Or you may decide to find out about using a sperm or egg donor.
After a hysterectomy

If the womb is removed, you will not be able to get pregnant and give birth. But if the ovaries have not been removed, you may still produce eggs. You may be able to start a pregnancy with a surrogate using your own eggs or donor eggs.
After surgery to remove the ovaries

Having 1 ovary removed is sometimes called fertility-sparing surgery. The remaining ovary continues to release eggs and hormones. Because you still have a womb, you may be able to get pregnant and give birth yourself.

If both ovaries are removed, you will have an early menopause and will not produce any more eggs. If you stored eggs, embryos or ovarian tissue before surgery, you may be able to use these with fertility treatments. Or you may decide to find out about using an egg donor.

Hormonal therapy and fertility

For some types of cancer, hormones encourage the cancer cells to grow. Your cancer doctor may treat you with a hormonal therapy drug. These reduce the levels of hormones in the body or block their effect on cancer cells.

Hormonal therapy for prostate cancer
Hormonal therapy drugs for prostate cancer reduce testosterone levels. This affects how your body produces sperm. Low testosterone also causes:

loss of sex drive

problems getting or keeping an erection.

After treatment ends, these changes may gradually improve. But this can depend on whether you have had other treatments, such as pelvic radiotherapy or surgery. You may need to continue taking hormonal therapy drugs to control cancer. Your cancer doctor can give you more information about this.
Hormonal therapy for breast cancer

Hormonal therapy drugs for breast cancer reduce oestrogen levels.

For women, trans men and other people assigned female at birth, these drugs can affect fertility. The effects are usually temporary, but you may need to take hormonal therapy drugs for a number of years. This means you may have less time to start a pregnancy after treatment. Or you may have a natural menopause before you finish treatment.

During treatment, monthly periods may change or stop. They usually start again after you have finished taking hormonal therapy drugs, but this can take a few months. It is still important to use contraception to prevent a pregnancy during hormonal therapy. This is because the drugs may harm a baby developing in the womb. Your cancer doctor or nurse can explain more about this.

If you have a natural menopause while taking treatment, you may not be aware of it. This is because the side effects of hormonal therapy drugs are similar to the symptoms of the menopause.

If you are taking hormonal therapy drugs to reduce your risk of breast cancer coming back, you may be able to stop treatment for a time to start a pregnancy. It is important to talk to your cancer doctor if you are thinking about stopping treatment. They can give you information and help you understand all the possible risks before you make a decision.

For men, trans women and other people assigned male at birth, there is not much information about how these drugs affect your fertility. Your cancer doctor can explain more about this and give you advice.

After hormonal therapy

After hormonal therapy treatment, you can have tests to help check how your fertility has been affected.

If your fertility recovers, you may be able to try to start a pregnancy by having vaginal sex or using fertility treatments.

If you stored sperm, eggs, embryos or ovarian tissue before cancer treatment, you may decide to use these with fertility treatments. Or you may decide to find out about using a sperm or egg donor.

Your healthcare team can support you and tell you more about your options.

Targeted therapy and immunotherapy

Targeted therapy drugs find and attack cancer cells. Immunotherapy drugs use the immune system to recognise and kill cancer cells. These treatments are used to treat many different cancers. Because they are newer types of treatment, doctors do not yet know exactly what effect they may have on fertility.

If you are treated with a targeted therapy or immunotherapy drug, your cancer doctor can talk to you about possible risks to your fertility and the options you may have.

After targeted therapy or immunotherapy

After treatment, you can have tests to help to check how your fertility has been affected. You may be able to try to start a pregnancy by having vaginal sex or using fertility treatments.

If you stored sperm, eggs, embryos or ovarian tissue before cancer treatment, you may decide to use these with fertility treatments. Or you may decide to find out about using a sperm or egg donor.

About our information

References

Below is a sample of the sources used in our fertility and cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Lambertini M, Peccatori FA, Demeestere I, et al. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines. Annals of Oncology, 2020; 31, 12, 1664-1678.

National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. [Internet]. 2017, Available from www.nice.org.uk/guidance/CG156 [accessed November 2022].

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.