After cancer treatment

You should avoid starting a pregnancy if you are having cancer treatment. Some treatments may damage sperm. This can affect a baby if a pregnancy starts during treatment. Cancer treatment can also harm the baby as it grows in the womb. It may cause problems during the pregnancy, or long‑term problems for the child later in life.

If you are thinking about starting a pregnancy, talk to your GP or cancer doctor first. This is important even if you finished treatment some time ago. They can give you information about any extra health checks you need.

For men

When you have finished cancer treatment, you may need to wait for your sperm to recover. It is hard to know how long this will take or if it will happen. Getting your semen tested is the only way to find out if your sperm has recovered. Your doctor or specialist nurse can tell you more about this and how long you should wait.

For women

When you have finished cancer treatment, your body may need time to recover. Doctors usually advise waiting at least a year before trying to get pregnant. But it can depend on the type of cancer and treatment you had.

For some women, cancer treatment may cause an early menopause. This may mean you have less time to get pregnant. If you want to try for a baby, your doctor may advise you to start
before your mid-30s.

Some people decide not to have children. This may be a clear choice they are happy with. Sometimes it is more complicated. You may feel cancer has taken the choice away from you.
This can be very upsetting. It may help to talk to someone about this. There is no right or wrong way to feel. Everyone is different. 

Your GP can give you support and may suggest a counsellor for you to talk to. Other organisations can also offer emotional support, such as the British Infertility Counselling Association and Fertility Network UK.

If you are single or in a same-sex relationship and want to have children, you can become a parent by:

• adoption or fostering
• co-parenting – an agreement to conceive and raise a child with someone who is not your partner
• surrogacy
• fertility treatments – women can use donor sperm.

NHS funding rules for fertility treatment apply and may be different in different areas. It is always best to talk to your GP for more information.

There are laws about becoming a legal parent in all these situations. If you are in a same-sex relationship, organisations such as Stonewall and Pink Parents can offer information and support. The Human Fertilisation and Embryology Authority (HFEA) has more information about fertility treatments.

It is natural to worry about cancer coming back. No one can tell you exactly what will happen in the future. But your cancer doctor may be able to give you information about what is likely to happen. For some people, the risk that cancer will come back gets less as time goes on. They may decide to wait for a few years before trying to start a pregnancy.

Can being pregnant make cancer come back?

Research suggests that for almost all types of cancer, pregnancy does not make cancer more likely to come back. If you have one of a rare group of tumours called gestational trophoblastic disease, your doctor will talk to you more about this.

No. Cancer cannot be passed from a parent to child. A small number of people have an inherited cancer gene that increases their risk of getting cancer. But this is rare and most cancers are not caused by inherited cancer genes. Talk to your doctor if you are worried about the risk of cancer running in your family. They can arrange for you to see a specialist if needed.

It is your decision whether to have fertility tests or not. Some people want to get as much information as possible about their fertility. Having the test results may help you understand your options and plan for the future. But everyone is different.
This section has some things to think about before you decide.

Do I want fertility tests?

Some people decide to have tests because they want to try to have a baby. But you do not have to be in a relationship or be ready to start a pregnancy to have fertility tests. You may just want to know more about your fertility.

Sometimes other people want you to have fertility tests. This might be a partner or close family. This may seem like a good reason, but it may mean you have tests when you are
not ready. Think about if you want to have the tests. If you do, decide when is a good time for you.

Am I ready for the results?

It is important to feel you can cope with the test results. If you are not sure you are ready to know, it may help to talk to your healthcare team first. They can answer any questions and explain the possible issues for your fertility. Think about who will support you when you get your test results.

If you have a partner, it may help to talk to them before having the test. Try to talk about your plans for the future, how the test results might affect these and how you would cope.

Your cancer doctor will talk to you about how long you should wait after you have finished cancer treatment before you have fertility tests. If you have tests too soon after cancer treatment, your body may still be recovering and you will not get an accurate test result.

Some people decide they do not want to have tests until they are:

• ready to cope with the results
• a certain age
• in a long-term relationship
• ready to have a child.

Some stages of life are busier or more stressful than others. You may be going through exams, leaving school or college, leaving home or starting a new job. If you are coping with a lot of changes, it may not be the best time to think about fertility testing.

Your cancer doctor can tell you how long you have to wait after cancer treatment before having your semen tested. When you are ready, you can talk to your cancer doctor or GP about fertility testing. You can have your semen tested to find out if you are producing healthy sperm. The semen sample will be analysed in a laboratory. If needed, you can redo the test to see if things
have changed. If you had sperm frozen before cancer treatment, you can also ask to have this tested. A fertility specialist will usually talk to you about the test results.

What does the test involve?

You give a sample of semen by masturbating (wanking) into a small container. You do this at the fertility clinic, in a private room close to the laboratory. This means the results are more
accurate as the sample can be checked quickly. 

You might be embarrassed about doing this. The staff at the clinic will be very understanding and will try to put you at ease.

Sometimes it may be possible to collect a sample at home and take it to the clinic. You need to keep the sample warm and take it to the fertility clinic soon after producing it. You can talk to your nurse or doctor about this.

If you cannot give samples by masturbating, it may be possible to collect sperm from the testicle.

Usually women can be referred to a fertility clinic after trying to get pregnant for 1 to 2 years. But after cancer treatment, your cancer doctor or GP can refer you sooner or before you start trying. If needed, you can have these tests done again to see if things have changed.

What do the tests involve?

Fertility tests can measure the number of eggs in your ovaries (your ovarian reserve) or how close you are to the menopause. 

Your doctor will ask you about your periods and take blood tests. There is a blood test you can have even if you are not having periods. You may also have an ultrasound scan of the ovaries
to look at the follicles that hold the eggs. The ultrasound probe is put inside the vagina. This scan is called an antral follicle count. 

Taking the contraceptive pill or hormone replacement therapy (HRT) can affect the results of some fertility tests. Let your doctor know if you are taking either of these.

If cancer treatment has made your periods stop, they may sometimes come back months or years after cancer treatment finishes. If your periods change, you can have these tests done again. Your doctor will talk to you about the options available to you.

You usually start by seeing your GP. They may arrange for you to have some fertility tests. If you want to have fertility treatment with a partner, they will need to have some tests too.

Your GP will then arrange for you to talk to a specialist doctor at a fertility clinic.

At the fertility clinic, the doctor will talk to you about your fertility and any treatments that may help. They will answer any questions you have and arrange any other tests you need. Your fertility doctor will also ask you questions about your lifestyle. This can help them see if there are changes you can make that might help improve your fertility.

Some people find it hard to make the decision to have fertility treatment. This can be because of moral, cultural or religious views. You may want to talk to a partner, family member or religious adviser. Or you may find it useful to talk to someone else, such as your GP, a counsellor or a social worker.

This depends on whether you have NHS treatment or private treatment.

Your GP can tell you which clinics offer NHS treatment in your area. If you have already had fertility preservation or fertility tests, you may be able to go back to the same clinic. If you have private treatment, you can choose your clinic. You can arrange this yourself, but it can be useful to have a referral letter from your GP.

You can get details of all the fertility clinics in the UK from the Human Fertilisation and Embryology Authority (HFEA). The HFEA also give advice on choosing a clinic.

The NHS may pay for some fertility treatments, but there are rules. These rules apply to the person you are having fertility treatment with as well as you. NHS rules and funding are different across the UK. Your fertility doctor can give you information about this.

Private fertility treatment

Some people choose to pay for some, or all, of their fertility treatment privately. You may be thinking about this if:

• you are not eligible for NHS treatment
• you are worried about NHS waiting times
• the NHS does not offer the treatment you want or need.

There are no standard charges for private treatment. You can contact clinics to find out what treatments they offer, how much they charge and their success rates.

IVF (in vitro fertilisation)

How does it work?
The specialist mixes collected eggs and sperm together in a dish. They do this in a laboratory.
Some eggs may be fertilised and grow into embryos.

What happens next?
If suitable embryos develop, the specialist puts one embryo or occasionally more into
the womb. They can store any other embryos for future use.

How do they do it?
The specialist puts a fine tube through the cervix and into the womb. They use the tube to put the embryo into the womb.

ICSI (intracytoplasmic sperm injection)

How does it work?
This is similar to IVF. But the specialist uses a fine needle to inject a single sperm into
an egg. They do this under a microscope. Some eggs may be fertilised with the injected sperm and grow into embryos.

What happens next?
If suitable embryos develop, the specialist puts one embryo or occasionally more into the womb. They can store any other embryos for future use.

How do they do it?
The specialist puts a fine tube through the cervix into the womb. They use the tube to put the embryo into the womb.

IUI (intrauterine insemination)

How does it work?
The specialist puts the collected sperm directly into the womb. They do this when an ovary is most likely to be releasing an egg.

What happens next?
If an egg is fertilised, a pregnancy may develop.

How do they do it?
The specialist puts a fine tube through the cervix into the womb. They use the tube to put the sperm into the womb.

Fertility treatment using a donor

Some people have these treatments using donor sperm, eggs or embryos. But this can be more complicated and it will not suit everyone. This might be because:

• it is not always funded by the NHS
• it can be hard to find a donor
• of moral, cultural or religious views.

Some people may find it hard to make the decision to use a donor. The fertility clinic will offer you and your partner (if you have one) counselling before you decide to use a donor. You may also want to talk to your family, friends or a religious adviser. You can also talk to a social worker.

If you decide to use your frozen sperm, it will be carefully thawed in a laboratory when it is needed. If you did not have sperm collected before cancer treatment, it may still be possible
to use your fresh sperm. Your fertility doctor can talk to you about your options.

If your sperm count is low

If you are producing sperm, but not very many, you may be able to start a pregnancy by having sex. But your chances of starting a pregnancy are likely to be higher using ICSI or IVF. You may
also decide to use sperm that you stored before cancer treatment.

If your hormone levels are low

To produce sperm, your body needs hormones from the pituitary gland and the testicles. Some cancer treatments can affect your hormone levels. You may be able to have injections that replace the missing hormones. This may help you start producing sperm again. These are called gonadotrophin replacement injections.

While you are having the injections, you may be able to start a pregnancy by having sex. Or you can collect sperm to use with IVF or ICSI. When you stop having the injections, your body will
stop making sperm again.

If your body does not produce sperm

If your body does not produce sperm, you cannot start a pregnancy by having sex. If you stored sperm before your cancer treatment, you can use this for IVF, ICSI or IUI. Or you may choose to use sperm from a donor.

If you cannot have sex

Rarely, cancer treatment causes changes that mean you might not be able to have sex. You may find it difficult to get or keep an erection. This is called erectile dysfunction. This can be
very difficult to cope with. If your body is still producing sperm, your doctor may be able to collect sperm for IVF or ICSI. If you stored sperm before your cancer treatment, you may be able to use this. Or you may decide to use sperm from a donor.

If you are releasing eggs

If your ovaries are releasing eggs, you may be able to get pregnant by having sex. But if tests show you are unlikely to get pregnant this way, fertility treatments such as IVF or ICSI might
increase your chances.

If you are not releasing eggs

If your ovaries have been removed or have stopped releasing eggs, you will not be able to get pregnant naturally. If you stored eggs, embryos or ovarian tissue before your cancer treatment, you may be able to use these. Sometimes people use eggs or embryos from a donor.

If you decide to use your frozen eggs or eggs from a donor, these are usually fertilised using ICSI. If suitable embryos develop, they may then be put in your womb. If you decide to use your frozen embryos or embryos from a donor, these are carefully thawed and put in your womb in the same way. If you froze ovarian tissue, this can be put back in your body using keyhole
(laparoscopic) surgery. If the tissue starts making eggs, you may be able to get pregnant naturally or with fertility treatments such as IVF or ICSI.

If it is hard to have sex

After cancer treatment, you may find it hard to have sex. There are treatments that can help, but it can depend on what is causing the problem. It is always best to ask someone from your
healthcare team for expert advice. If your fertility has come back, IUI may help you to get pregnant without having sex.

Unfortunately, there is always a risk that fertility treatment will not work. This can happen to anyone having fertility treatment, not just people affected by cancer.

Your chance of fertility treatment working may be affected by:

• the type of cancer treatment
• your fertility test results
• age (for women).

Your fertility doctor will explain this before you start treatment. But it is still upsetting if treatment does not work.

Some people decide to try again. But this can be a hard decision to make. Fertility treatment can be emotional and stressful. It can also be hard physically. And if you are paying for treatment, it can be expensive.

You may want to think about whether adoption, fostering or surrogacy are right for you.

Counsellors in fertility clinics can offer support and advice. There are also organisations that offer counselling, such as the British Infertility Counselling Association (BICA). Your healthcare team might also know about support groups in your area.