Cancer and fertility for young women This information is an extract from the booklet Fertility support for young people affected by cancer. You may find the full booklet helpful. We can send you a free copy see page 9. Contents What is fertility? Cancer treatment and fertility Your feelings Common questions about cancer and fertility Preserving fertility in young women What is fertility? In women, fertility means being able to get pregnant. The parts of your body that allow you to make babies are called your reproductive system. A woman has eggs stored in her ovaries. To make a baby, a man s sperm needs to fertilise a woman s egg. You are born with a large number of eggs that are stored in your ovaries. No more eggs are made after you are born. Fallopian tube Womb Cervical canal Vagina Ovary Womb Bladder Cervix Female reproductive system Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 1 of 9
Once a month, one of your ovaries releases an egg. This is called ovulation. It happens from the age you go through puberty to the age you have the menopause (see below). This process is controlled by chemicals in the body called hormones. The main female hormones are called oestrogen and progesterone. They are made in the ovaries. After being released from the ovary, the egg moves along the fallopian tube. This is where it can be fertilised by a sperm. If it is fertilised, it is called an embryo. The embryo will continue to move to the womb, where it can bury itself into the womb lining and grow into a baby. If the egg isn t fertilised, it will be released from the body 14 days later with some of the womb lining, as a period. Menopause As women get older, hormone levels in the body change. The ovaries stop releasing eggs each month and periods stop. This is known as the menopause and means you can t get pregnant anymore. Cancer treatment and fertility Starting treatment Your cancer doctor or specialist nurse will talk to you about your treatment options and their possible side effects. The main treatments are: chemotherapy radiotherapy surgery stem cell transplants hormonal therapy targeted therapy. After diagnosis, it can feel like everything happens very quickly. It will take some time for you to adjust to the changes in your life. Try to talk to your family and friends about what s happening to you and how you feel. Page 2 of 9 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
How treatment can affect fertility in women For women, cancer treatment may: damage the eggs or ovaries make periods irregular or stop for a while (known as temporary infertility) cause an early menopause and permanent infertility. Early menopause Some cancer treatments can affect the ovaries and cause an early menopause. This means that some women won t be able to have children using their own eggs. This is also known as premature ovarian failure or premature menopause. Some cancer treatments can cause a temporary menopause or menopausal symptoms, such as hot flushes or a lower sex drive. Other effects on fertility Stress When women go through stressful situations such as serious illness, it can affect their periods. Their periods may: become irregular stop altogether for a time and then restart stop and not restart (see Early menopause above). Sexual effects Any problems that stop you having sex may also stop you getting pregnant, even if you re still making healthy eggs. Long-term effects Some treatments can cause long-term damage to the heart or kidneys. If this happens to a woman, she may be advised not to get pregnant. If this applies to you, your doctor will give you more information. Our longer booklet Cancer treatment and fertility information for women contains more detailed information about how cancer treatments can affect fertility. We also have another booklet for young people called Sex and relationships that talks about how treatment can affect your sex life and what you can do. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 3 of 9
Contraception Throughout your treatment and for up to a year afterwards, you should use a barrier form of contraception (such as condoms or the cap). This is because some side effects of cancer treatment, such as sickness and diarrhoea, can make other contraceptives (like the pill) less effective. It s important that you don t become pregnant while you are having treatment. Cancer treatments may harm a developing baby. It can be confusing if you re being told to use contraception while your doctors are also talking about how treatment might affect your fertility. Even though your doctors will talk to you about your fertility and ways of preserving it (see page 8), sometimes this is just a precaution. The doctors can t know how the cancer or its treatment will affect your fertility. It is possible that you will remain fertile throughout treatment. Your feelings Cancer can have a huge effect on your emotions. You may experience a mixture of fear, anger, sadness, loneliness or depression. You may feel like this at diagnosis, during treatment, or when you re recovering and adjusting to life after treatment. It s important to talk to your cancer doctor or specialist nurse about fertility before treatment starts, if possible. There may be ways to preserve your fertility (see page 8). However, if you need treatment urgently, there may not be time to do this. People s reactions to the risk of infertility vary. You may come to terms with it quickly and feel that dealing with the cancer is more important. You may find that the impact doesn t hit you until treatment is over and you are sorting out your life again. You may not have given much thought to your fertility and whether or not you want a family in the future. Or you may have always known that you wanted to start a family. Page 4 of 9 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
It is something that worries me. I do think, if I am infertile, is that going to affect my chances of a relationship with somebody in the future? I don t know. It s something that I ll have to think about in the future, I think, and then I ll have tests done and that kind of stuff. Chandani They did explain that treatment could reduce fertility, but at the time I was 21. It was kind of the last thing on my mind. But it has been getting to me recently, as I ve been getting older and we ve had a couple of babies in the family. Siobhán Being asked to think about the future when you ve just been diagnosed with cancer can be very difficult. Talking to other young people in a similar position may help you feel less alone. Our online community is a good place to talk to others. Visit macmillan.org.uk/community Our cancer support specialists on freephone 0808 808 00 00 can also talk to you about your worries and give you details of other useful organisations. I thought losing my fertility would be something I d be absolutely devastated about. But when you re actually faced with cancer, it puts everything into a different perspective. Nicola The quote above is from a video on Macmillan s website, where Nicola talks about her experience of cervical cancer and the impact on her fertility. Visit macmillan.org.uk/ livingwithcervicalcancer to hear the rest of her story. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 5 of 9
Common questions about cancer and fertility Will my fertility be affected? Most teenagers and young adults who have cancer won t have long-term fertility problems. Usually, it s difficult to know until some time after the treatment whether any damage has been done, and whether this is temporary or permanent. For people who have temporary fertility problems, how quickly fertility comes back will vary from person to person. Your cancer specialist can talk to you about what to expect. If your fertility is permanently damaged, you won t be able to have children naturally. This can be very distressing. It may help to get some emotional support from an organisation such as the Infertility Network UK (visit infertilitynetworkuk.com or call 0800 008 7464). Can I stop the effect of treatment on my fertility? If you are having radiotherapy, it is sometimes possible to protect pelvic organs from its harmful effects. This depends on where the cancer is. Otherwise, unfortunately, there is nothing you can do to stop the treatments affecting your fertility. Your cancer specialist should talk to you about preserving your fertility before starting treatment (see page 8). Current studies are looking at using hormone therapy to protect fertility in women having chemotherapy. But we don t know how effective this is yet. If I have an early menopause, are there any treatments I can have? Most young women who have an early menopause from cancer treatment should be offered hormone replacement therapy (HRT). Taking replacement hormones has a protective effect on your body. It does this by keeping your hormone levels similar to what they d be if you hadn t had cancer treatment. HRT helps to reduce your risk of developing brittle bones (osteoporosis) and heart disease. Page 6 of 9 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
Occasionally, women are advised not to take HRT because of the type of cancer they have. Your cancer specialist will advise you about this. If I m infertile or have an early menopause, will my body age more quickly? No. Taking replacement hormones (see the previous question) will allow your body to age in the same way that it would have done otherwise. Can I have sex while having chemotherapy? Yes. But it is a good idea to use a barrier form of contraception throughout your treatment and for some time afterwards. This is because there s a small chance that drugs can be passed on to your partner through body fluids. Cancer treatment can also damage eggs, which could damage a baby that is conceived at this time. Do I need to use contraception if I might be infertile? It may be confusing if your doctor tells you to use contraception when they ve also told you that you may be infertile. The problem is that no one can know whether the treatment has definitely caused infertility. It s best to use contraception to avoid any chance of you becoming pregnant accidentally. What happens if the treatment has affected my fertility? If you find out that the cancer or its treatment has affected your fertility, you may start thinking about fertility testing and treatment. You may have to decide: whether to get your fertility checked whether to go for fertility treatment what sort of fertility treatments to have whether or not to stop fertility treatment. Talking to professionals who are trained to help you with these decisions could be useful. You can talk to staff at the hospital where you had your treatment, or they may refer you to another fertility specialist. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 7 of 9
Preserving fertility in young women If you are having periods, it may be possible to freeze and store embryos (fertilised eggs) before cancer treatment begins. This might be done even if the treatment is unlikely to affect your fertility. To store embryos, your eggs need to be fertilised with sperm from your partner. Before eggs are fertilised and stored, both of you must sign a consent form. Neither person can use the embryo to start a pregnancy without the other person s permission. If you split up in the future and one person withdraws their consent, the other person cannot use the embryos. If you don t have a partner, or you are concerned that you might split up with your partner in the future, you may be able to store frozen, unfertilised eggs. In the past, the chance of getting pregnant using stored, unfertilised eggs was very low. This is because the technology used to freeze the eggs wasn t very good. However, a newer technology called vitrification has improved this. Vitrification is now just as effective as using fresh eggs. Not all IVF units can do vitrification, so it s important to speak to an IVF specialist who can offer this. Our longer booklet Cancer treatment and fertility information for women talks more about fertility preservation. Page 8 of 9 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Fertility support for young people affected by cancer or any other cancer information, visit be.macmillan.org.uk or call 0808 808 00 00. We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support 2013. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN DECEMBER 2014 Planned review in 2017 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 9 of 9