Reproductive Questions for Cancer Survivors: Fertility, Pregnancy, and Sexual Relationships

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If I’m planning to receive chemotherapy or radiation therapy, is there anything that I can do to increase my chances of being able to get pregnant in the future?

Possibly. The goal of treatment is to cure your cancer and hope that at the same time  your ovaries can be protected  from the side effects of chemotherapy and/or radiation. Although there are limited scientific studies, a surgical procedure to move the ovaries out of the field of radiation or medicine that temporarily turns the ovaries off and keeps the eggs safe, may be helpful in increasing the chances of becoming pregnant later. Everybody is different and factors such as your age at treatment, kind of cancer you had, and the type of treatment you received, will determine what treatment option your gynecologist or reproductive endocrinologist recommends for you.

Freezing of ovarian tissue: Some fertility centers are able to freeze ovarian tissue. Talk to your doctor to see if this is a possible option for you.

Freezing eggs: This requires a procedure to remove eggs from your ovaries and then freeze them. The medical term for this is “oocyte” (egg) “cryopreservation” (freezing) of a human egg.

Oophoropexy: This is a surgical procedure that is done to move one or both of the ovaries away from where the radiation is pointed. A procedure called a laparoscopic oophoropexy is often recommended.

GnRH agonists: This is a man-made hormone and medical treatment that works by temporarily shutting off the ovaries which causes symptoms similar to menopause. This medicine is available in a nasal spray or injection. GnRH agonists work by lowering the estrogen level and stopping the eggs in the ovaries from being stimulated. Most women will not have periods while taking this therapy, however, some side effects of treatment may include irregular vaginal bleeding, depression, headaches and/or insomnia. Usually a woman will start to ovulate again and get her period about 6 weeks after stopping this medicine. A few studies have shown that women who receive GnRH agonists while on chemotherapy have a better chance of preserving their ovarian function, but others show no effect.

Oral Contraceptive Pills (OCPs): Most health care providers feel that OCPs may have a protective effect on fertility. This is based on a small research study that compared the amount of “follicles” or young “eggs” a woman has before and after chemotherapy. Early findings suggest those women, who were taking OCP’s during chemotherapy, had the same amount of follicles (young eggs) before and after treatment.

Before you plan to receive cancer treatment, talk with your doctors about which option (to preserve your fertility) is best for you.

If I had chemotherapy or radiation, will I be able to get pregnant?

If chemotherapy or radiation has not affected your ovaries or uterus, then you should be able to get pregnant. If chemotherapy or radiation has affected your uterus and ovaries then you will need to discuss options with a fertility specialist.

If you’re planning to become pregnant, like all women, you should start taking a daily multivitamin that contains at least 400 micrograms of folate.

Other Fertility Issues

If I get pregnant with my own eggs after cancer treatment, will my baby be normal?

Yes! Your chance of having a normal baby is the same as other women your age.

Should I expect any problems with my pregnancy or breast-feeding since I had cancer?

In most cases, women who become pregnant after cancer treatment are able to have normal and healthy pregnancies. In some studies, women who had high amounts of radiation to their pelvis had higher rates of miscarriages (the fetus died) or early births. Every woman’s pregnancy is different and should be followed closely by her doctors regardless of whether or not she has received cancer treatment.

Your ability to breast-feed your child after your pregnancy will not be affected unless you have received radiation treatment to your breast area or head during your cancer treatment. Although the breast that received radiation will most likely produce little or no milk, you will still be able to feed your baby with the other breast if it was not exposed to radiation.

Is there a chance that my children will get cancer too?

While some cancers run in families, most cases of cancer are caused by something random and do not increase the risk of cancer for other family members. Only 5-15% of all cancer cases are related to a gene that you inherited. Most cancer survivors have healthy children. If you have concerns, you should talk to your health care provider or a genetics counselor.

Who can I talk to about fertility issues?

The first person you should talk to about fertility issues is your gynecologist or a reproductive endocrinology specialist. He or she will be able to figure out if your cancer treatment had any effect on your ovaries and/or uterus. If needed, your gynecologist can refer you to a fertility specialist who can help you with your options.

What are the chances that my cancer treatment caused my infertility?

Infertility is a common problem that affects millions of couples in the world. It may be difficult for your doctor to tell whether your infertility is a result of your cancer treatment or a condition that existed before your cancer.

The chances that you are infertile because of cancer treatment depend on a few factors:

  • Your age at treatment: Girls who are treated in childhood usually have fewer reproductive problems than those who are treated in their teen or adult years. Also, older women are more likely to be infertile and have Premature Ovarian Insufficiency (POI). This is because girls are born with all the eggs that they will ever have. The older you are and the more menstrual cycles you’ve had, the fewer eggs you have left. Younger girls have a larger supply of eggs and may be able to finish cancer treatment with some eggs still remaining in their ovaries.
  • The kind of cancer you had: Some cancers need treatments that are more harmful to your reproductive organs than others. An example of this would be a cancer that requires either surgery on your pelvic organs or direct radiation to your pelvis.
  • The kind of treatment you received: Low amounts of radiation to areas of your body not near your reproductive organs are less likely to cause infertility. Some cancer treatments cause higher rates of infertility.

Sexual Relationships After Cancer

Will I be able to have a normal sex life?

Most likely the answer is yes. Having a sexual relationship often involves thinking a lot about your inner feelings, therefore, it can be very helpful to talk to your partner about how having cancer has impacted you emotionally. Treatment for cancer may have left you with scars from operations, loss of hair,  loss of body weight, loss of parts of your body (such as a breast, arm, or leg), or other physical changes. You may experience sadness about these changes and you may also have fears and anxieties about sharing your body with a partner. You may also be concerned about what your partner’s response might be. Talking with your partner and telling him or her about your fears may help you to better understand each other.

Is it normal for it to take a long time before feeling comfortable in a relationship?

Yes. Some cancer survivors worry about being “different”, in their social and sexual development because of the struggles they’ve been through. Because of this, you might have a hard time getting comfortable in your relationships, or you could find it difficult to discuss with your partner what you want in a relationship. It is important to remember that lots of girls/women who have not had cancer feel better moving at a slower pace for many different reasons. There is no reason to rush your relationship, and you should take as much time as you need to feel comfortable with your partner. There is nothing wrong with taking your time!

What physical problems might I have with intercourse?

Some cancer survivors may have sexual problems because of their cancer treatment. These include a lowered sexual response, pain, vaginal dryness, and less of an interest in sex. Surgery that has changed the size or shape of your vagina may cause difficulty with intercourse. In addition, if you have POI, you might have vaginal dryness and less of an interest in sex because of low hormone levels. Vaginal dryness can cause pain with intercourse, but vaginal lubricants such as K-Y Jelly™ or AstroGlide™ often help with this problem. If you take HRT (hormone replacement therapy) it is likely that most of these symptoms will go away.

Should I tell my partner about my cancer?

Sharing information about your cancer with a romantic partner is a very personal decision. It is a difficult one to make because it’s hard to know when the time is right to bring it up. Some girls worry that their partner will find them less attractive if they find out about their cancer or that the news will “scare them away.”

You should talk about your cancer when you feel ready and comfortable with sharing it. Your partner will not be able to tell from having intercourse with you that you have had cancer. However, if you have had surgery on your vagina you might have physical changes that your partner could have questions about, and you may want to prepare some answers.

In recent years there has been a great improvement in the survival rates for girls and women who have had cancer. Your quality of life after surviving cancer is extremely important. Be sure to take care of yourself! If you have any concerns, be sure to talk with your doctor(s) so that all of your questions are answered.