Fertility

Fertility can be a really difficult topic to think or talk about, regardless of how you feel about having children. Many young people have questions or concerns about their fertility after a cancer experience, sometimes not until months or years after treatment finishes.

This topic is about breaking down key information about fertility and cancer, acknowledging the range of experiences and emotions people may have, and providing the tools and support needed to explore your own fertility status if/when you choose to do so.

We recognise that some young people reading this may not identify with their sex assigned at birth, and that sex and gender are not binary concepts. The use of female and male in this topic refer to biological sex only.

WHAT IS FERTILITY?

Fertility refers to a person’s ability to have children. The ovaries in females and testes in males are reproductive organs that play a key part in this process.

IN FEMALES...

The ovaries (there are two) are where eggs mature and the hormones progesterone and oestrogen are made. Every female is born with a limited number of immature eggs that decreases as they get older.

Eggs develop in the follicles within each of the ovaries. About every 28 days, a mature egg is released. This is called ovulation. The egg travels into the fallopian tubes which transport the egg to the uterus. The trip down the fallopian tubes takes about 5 days and is where the egg can be fertilised.

An egg must be fertilised by a sperm to make a child. If the egg is not fertilised, you will have a period. If the egg is fertilised, it will attach to the wall of the uterus where it will continue to grow during pregnancy.

Problems with fertility

Fertility problems in females can happen for a number of reasons, such as issues with hormone production or messaging between the ovaries and brain, not having enough eggs, or damage to the reproductive organs. Some sexually transmitted infections (STIs) can also affect fertility.

IN MALES...

The testes (balls) make sperm and the hormone testosterone. Sperm mature as they leave the testes and move through the epididymis tube. This takes about 72 days, making the sperm ready to fertilise an egg.

Problems with fertility

Fertility problems in males can happen for a number of reasons, such as issues with hormone messaging or production, not having enough sperm (low sperm count), or problems relating to sperm shape, movement or transport. Some sexually transmitted infections (STIs) can also affect fertility.

HOW CANCER CAN AFFECT FERTILITY

Cancer and its treatment can impact fertility in a range of ways (e.g. by affecting certain hormones or damaging parts of the reproductive system). This can result in problems conceiving, fathering or carrying a baby. Sometimes this is temporary, sometimes it’s permanent. For females, it can also mean a narrower window of time in which you are able to have a baby.

It’s important to know that not all cancers and treatment affect fertility. Whether or not (and the degree to which) fertility is affected depends on a number of factors, including:

your age and whether or not you had gone through puberty at the time of treatment
the type of cancer involved
the area(s) treated (i.e. for surgery or radiotherapy)
the type, dose, and combination of drugs as well as the length of time they were given (i.e. for chemotherapy)
the dose and total number of treatments (i.e. for radiotherapy)

Having had treatment does not automatically mean your fertility has been affected, and working out the risk for those who may have been affected is not an exact science. Many people with many different risk profiles go on to have children naturally, or with a bit of help.

It’s also important to remember that problems with fertility are relatively common in the general population, regardless of whether or not people have had a cancer diagnosis.

Either way, finding out about any known or potential fertility problems can be helpful in working out your options and making the best decisions for you in health and life going forward.

FERTILITY PRESERVATION

Depending on your individual circumstances and the factors mentioned above, you may have had or been offered fertility preservation interventions prior to starting treatment (e.g. sperm, egg or tissue banking/freezing). There may still be ways to preserve your fertility now if needed as well.

Either way, talking to your treating team is the best place to start to find out about any known risks to your fertility and explore your options going forward.

YOUR FERTILITY STATUS

Whether or not you’re in a relationship or sure about your feelings on having children, understanding your fertility status can be helpful in making the best decisions for you both now and later.

Knowing your status helps you to understand your current health needs and plan for the future. If you are considering having a family at some stage, learning about your fertility status, options and any related financial costs can help you plan for when you’re ready, or deal with any potential limitations to your fertility (e.g. if your treatment has put you at risk of early menopause). It can also help reduce stress or worry about the uncertainty of not knowing.

Having said that, it’s important to acknowledge that finding out about your fertility is a personal decision. Some people want to know, while others don’t- there is no right or wrong choice to make or way to feel.

Keep in mind that while getting your period or being able to ejaculate semen can be signs that your body is returning to normal, they are not always signs of fertility. Be sure to practice safe sex either way to protect your sexual health and avoid unwanted pregnancy.

FIRST STEPS

If you do decide to find out about your fertility, the first step is talking to your treating team about whether or how your treatment may have had an impact (see below for more information on talking about fertility).

You can also ask your GP or treating team to refer you to a specialist fertility clinic (females) or andrology clinic (males) for testing. The clinic will contact you to discuss the results, your fertility status and options going forward.

For females, testing at a fertility clinic usually involves them taking a full medical history and history of your periods, along with some blood tests. You might also have a physical examination, which may include an internal ultrasound of your ovaries and x-rays of your fallopian tubes and
uterus.

For males, testing at an andrology clinic typically involves providing them with a sample of your semen by masturbating, in private, into a jar. There may also be other options for sample collection. Your sample is then analysed to determine sperm number and quality.

Fertility testing can be an emotional experience for many people. If you do decide to find out about your fertility, you may find it helpful to bring along your partner (if you have one) or a trusted friend/relative when you have the tests, and/or receive the results.

IF YOUR FERTILITY HAS BEEN AFFECTED

Hearing that your fertility has been impacted by cancer can be difficult news to take. However, it doesn’t always mean that you won’t be able to have children of your own.

Many people do go on to have children naturally, though in some cases it may take longer- or need to happen sooner- than expected. Others may need a bit of help (IVF is one example but there are other approaches as well). There are also options such as the use of donor sperm, eggs or embryos, surrogacy, fostering or adoption.

There are many ways to become a parent- with or without a partner, and with or without your own sperm, eggs or uterus.

Once you know your fertility status- and when you feel ready- talk to your doctor or fertility specialist about the options available to help support your fertility and to assist if/when you are ready to have children.

Everyone has the right to information and options about their fertility, regardless of individual circumstances, gender identity or sexuality. Finding the right support for you is important- see sections below for more info.

FEELINGS AND REACTIONS

Finding out that cancer and its treatment has impacted your fertility can be devastating, and often brings about a roller coaster of emotions that may include shock, anger, sadness, worry and grief. At times you might not know how you feel or why.

The feelings you may have in reaction to such news can be complex regardless of whether or not you want children. It can be deeply upsetting having choices you thought would be available to you taken away, or having to think about your fertility sooner than you wanted or thought you needed to. It can also affect how you feel about yourself, a partner and your body.

The way you think and feel about having children may also have been affected by your cancer experience. Some people are reluctant to start a family due to concerns about what may happen in future, or doubts about their ability to physically and emotionally raise children.

It’s okay to feel this way, or to not want children for any other reason. But if your feelings bother or upset you, find someone you can talk to about it.

However you are feeling about your fertility or having a family, know that it is normal and valid. Gender, sexuality, culture and family upbringing can all be influences as well. The important thing is to talk to people you trust about any concerns or worries you have. They can help you find solutions, make some sense of it all or just help ease the load.

You might also find the information and practical strategies in the ‘Emotional Health & Wellbeing’ topic useful in dealing with any difficult thoughts or feelings you are experiencing.

GETTING SUPPORT

Your GP, treating doctor or nurse are the best places to start if you want to understand any impacts your cancer experience may have had on your fertility, or to get a referral for fertility testing. They are also there to support you in dealing with any physical or emotional impacts you are experiencing as a result.

No matter what your situation is, finding ways to express how you are feeling is really important. Talking to someone you trust, be it a partner (if you have one), close friend or family member can help. Others find it easier to confide in someone outside their inner circle, such as:

a counsellor or psychologist (your GP or treating team can help link you in with someone). Fertility clinics also often have specialist counsellors available.
one of the experienced cancer nurses you can access via the Cancer Council Helpline (13 11 20 Australia-wide)
a CanTeen counsellor experienced with cancer issues for young people (by phone, email or online), or someone at Kids Helpline or Lifeline
others who have been through a similar experience (e.g. face-to-face or online support groups or forums)

Young people who identify as LGBTIQ+ may also find the information and supports in the youth cancer resource Being Ok... Being You helpful.

TIPS FOR TALKING ABOUT FERTILITY

Talking about fertility and the feelings it may bring up can be difficult or uncomfortable. Fertility can also be a socially or culturally taboo topic for some. Many people worry about how others will react, be it their health care team, family, or a current/future partner. Below are some strategies that may help.

Write it down. It can help to write down what you want to say or any questions you want to ask before having any discussions about fertility.
Be open and honest about your feelings. This can be hard at first but it often gets easier the more you do it, and is a really important part of helping you process/deal with your experience.
Let people know what you need. Whether it be information, a listening ear, or an acknowledgement of how important something is to you, communicating your needs to others can help them better understand and support you.
Dealing with difficult reactions. It can be hard for others to understand what you have been through or how you are feeling, and while most people will be sensitive and supportive, some may react to discussions about fertility with comments that can feel hurtful, dismissive or invalidating. As hard as it may be, being honest about your feelings and what your needs are is usually the best way to deal. Seek out additional or alternative support if you need to.

WITH HEALTH PROFESSIONALS

Don’t be afraid to ask questions. Knowledge is power, and being well-informed about your fertility and options can help you feel more in control and able to cope.
Take someone you trust to appointments with you if you feel comfortable doing so- it can be helpful having someone there as support or to write things down.
Having the right support is so important. Most healthcare professionals want to help and will be sensitive to your feelings and concerns about fertility, but if you don’t feel that you’re getting the information and support you need, don’t be afraid to seek out someone else.

If you are ready and able to have children naturally, be sure to talk to your doctor about your plans so they can help support your health and safety in the process.

WITH CURRENT/FUTURE PARTNERS

Talking to a partner about your ability to have children can be difficult and stressful, particularly if you don’t know your fertility status. In new relationships, many people worry about how the other person will react to any problems they may have with fertility, and when to bring the subject up.

There is no right or wrong time to talk about your fertility, but it is often best to do so if or when you feel a relationship is serious. If you don’t already know your fertility status, this may also be a good time to find out. Getting guidance from a fertility counsellor on how to approach these conversations can help a lot.
Be open and honest with each other about your feelings and needs. Being vulnerable with someone can be hard, but communication is key to working through any challenges and making decisions about what your future may hold.
Check out the topics on ‘Relationships’ and ‘Intimacy & Sex’ for more information on relationships with partners after treatment.

USEFUL LINKS AND RESOURCES

While this topic and the links below are a great place to start for general and youth-specific information about cancer and fertility, they are no replacement for a discussion with your GP or treating team.

The impacts cancer and its treatment can have on fertility are highly individualised, and everyone’s experience and needs are different. Talk to your health care team for information and advice that is specific to you and your circumstances.

Maybe Later Baby? A guide to relationships, sex and fertility for young people after cancer (CanTeen) – honest, clear information about fertility options after treatment and issues relating to sex and relationships.
FUTuRE Fertility – an oncofertility service with fact sheets for young people on various topics relating to fertility and sex, such as common questions about fertility after cancer and fertility-related psychological impacts
Fertility and cancer (Cancer Council) – answers many common questions about fertility before, during and after treatment
Fertility after cancer (Western and Central Melbourne Integrated Cancer Service) – videos and other resources for those born biologically male and those born biologically female to support and inform fertility-related discussions and decision-making
Being ok... being you (Victorian AYA Cancer Service) – a resource for young people with a cancer experience who identify as LGBTIQ+
Your local youth cancer service – each Australian state has a team of health care professionals specialising in the cancer treatment and care of young people aged 15-25 that you can contact for help and advice

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Advice From Clinicians

Podcast

ReGenerate · Fertility

Quotes

The impacts of cancer treatment on fertility (if any) are unique for everyone. Even if you don’t plan to have children, knowing your fertility status can be helpful when it comes to sexual health and other aspects of your wellbeing. If you have questions or concerns about your fertility, speak to your GP, a member of your treating team or another health professional you know and trust.

Below are some thoughts, experiences and advice other young people have shared with us about fertility after treatment for cancer.

How do you feel about your fertility?

“I will not know for 12 months post-treatment whether I am fertile or not… so I don’t see the need to worry or fret about it.”

“I don’t intend to have children, this has not changed, so it has not been a concern for me.”

“My chances of having children is quite low now, however before my experience I never saw myself having kids anyway. I was asked if I wanted to sperm bank; however, I was quite sick and didn’t really see the point. I guess my values don’t see myself having kids either so overall I wasn’t affected by that.”

“My debulking surgery including a full hysterectomy and oophorectomy, meaning I am unable to have children of my own. During my surgery there was someone ready to take any tissue from my ovaries to be used via surrogacy, but unfortunately this was not possible. I am only 25 and was talking about having a family with my long term partner in the next few years. I am still grieving this loss, and feel like I always will be, however we are looking at other options and are determined to still have a family in some form.”

“I’m indifferent to my fertility. I only have one ovary left and I was put into early menopause during treatment. I started chemo 3 weeks after I was diagnosed and had surgery, so I had no time to do an egg collection. I finished treatment six months ago but I still haven’t had my period. I’m not really worried about it though, and I am booked in to see my fertility specialist next month.”

“It’s not lost on me that I happened to be cast on the side of good fortune when time allowed me to freeze my eggs, but I don’t always think about it. I wasn’t concerned about what may happen in the future when the question of my fertility was on the frontline. I felt this strange over-confidence towards the whole process; that this was something I was doing for someday but today wasn’t the time to concern myself with it. Maybe the magnitude of having to grapple with such a decision hasn’t hit me, or maybe because I was moved from doctor to nurse to gynaecologist and psychologist within a manner of hours meant I was constantly feeding questions about how I felt rather than sitting with the feeling itself.

Whether I need them (the eggs) or not, whether they’ll work or stop, was and still is a pain I don’t choose to reckon with. Despite knowing I want to be a mother, time is outside of my control. Whether that comes naturally, from a test tube or by signing papers at a border, if I find myself on the side of good fortune again, I’ll dive in and if life pulls another punch and I am unable to have a child, like all pain and grief, I’ll learn to not survive it, but endure it.

I’m fully aware that the feelings scattered in-between these words aren’t as easily reassured by a poignant prose but maybe, hopefully, by reading them we can both acknowledge that some things are out of control, in fact, everything is and however long it takes to sit more lightly with this great big grey area sprung by cancer, let it be.”

What worries or concerns do you have?

“Whether the treatment has rendered me infertile AND if my ONE sample is enough to have children.”

“No real issues; if I do change my mind in the future on having kids there are so many options these days.”

“Part of my grief is feeling like things aren’t fair, why some people are able to have children and I can’t- this can easily turn into a negative spiral. I am processing my feelings and feel in control, but I am worried that one day I might spiral so far I won’t be able to pull myself out. It is a very dark place.”

What advice do you have for others?

“If you have time, educate yourself about the different forms of fertility preservation, whether that’s freezing eggs or some of your ovary, or being put into a temporary menopause. You may not even be thinking about having kids now, but it’s better to have some options, rather than none.”

“If you are wanting children it is pushing to store your sperm or eggs, if you have the strength and will for it. But that doesn’t mean the end of world if you can’t. There is always adoption, or having someone else help out. I know that it’s not the norm but either is going through cancer.”

“The earlier the conversations about fertility are happening the better. If your treatment has left you unable to have a family ‘traditionally,’ take the time to grieve but also remember that grief is not a linear timeline.”

“Get all the right advice before treatment [if you can]. Then don’t worry about what you can’t control.”

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