Chemotherapy, radiation, hormone therapy, and some surgeries can all lower fertility or cause infertility, but the risk depends on the specific treatment, the dose, and your age. Some fertility changes are temporary. Others are permanent. The best time to talk with your doctor about protecting your fertility is before cancer treatment begins.
Medical Disclaimer: This page is for general education only. It is not medical advice, diagnosis, or treatment, and reading it does not create a provider-patient relationship. Talk with a licensed healthcare provider about your specific situation. If you are having a medical emergency, call 911 or go to the nearest emergency room. See our full Medical Disclaimer.
Don’t Wait: Fertility Options Are Time-Sensitive
If having a biological child someday matters to you, raise it with your care team as early as possible — ideally before your first treatment. Ask for a referral to a fertility specialist, such as a reproductive endocrinologist, so you understand your options and timeline before decisions get made for you by the treatment schedule. If treatment needs to start right away, some preservation options can still be considered; ask your doctor whether any apply to your situation.
Which Cancer Treatments Can Affect Fertility
Fertility can be affected by the type of treatment, the dose, how long treatment lasts, your age at the time of treatment, and your fertility health before diagnosis. Here is a general look at how different treatments can play a role.
Chemotherapy
Chemotherapy can harm the ovarian follicles that contain egg cells, which can affect hormone levels and future fertility. Certain drug types, including alkylating agents, carry a higher risk. Receiving high doses or several chemotherapy drugs together can raise that risk further.
Radiation Therapy
Radiation to the pelvis, reproductive organs, or brain can affect fertility. Radiation near the uterus can affect blood flow or cause scarring. Radiation to the brain can affect the glands that signal the ovaries to release hormones needed for ovulation. Some newer radiation techniques may have less impact on fertility than standard radiation, so it’s worth asking which type is planned.
Hormone Therapy
Hormone therapy (also called endocrine therapy) blocks or changes hormone levels to slow certain cancers, and this can affect ovarian function. Some research has looked at whether pausing hormone therapy to try to conceive is an option for certain breast cancer patients without raising short-term recurrence risk — this is a question to bring directly to your oncologist, since it depends on your specific diagnosis.
Immunotherapy and Targeted Therapy
The effects of immunotherapy and targeted therapy on fertility are still being studied. If either is part of your treatment plan, ask your doctor what is currently known about that specific drug and fertility.
Stem Cell Transplant
A stem cell transplant (also called a bone marrow transplant) usually involves high doses of chemotherapy, radiation, or both beforehand, which can affect the ovaries.
Surgery
Surgery for gynecologic cancers may involve removing the uterus or ovaries, which can affect the ability to become pregnant or carry a pregnancy. Surgery for cancers in the abdomen or pelvis can sometimes cause scar tissue that affects the fallopian tubes or uterus.
Primary Ovarian Insufficiency: What It Is
Cancer treatment can cause the ovaries to stop working properly, a condition called primary ovarian insufficiency (POI). Some people with POI still ovulate occasionally and have irregular periods. For others, the damage is permanent and leads to early menopause. Symptoms can include irregular or missed periods, hot flashes and night sweats, vaginal dryness, sleep problems, mood changes, joint or muscle aches, and trouble concentrating. POI can also raise long-term risk for bone density loss and cardiovascular issues, so it’s worth discussing monitoring with your care team even after active treatment ends.
Fertility Preservation Options Before Treatment
These are the main approaches doctors and fertility specialists currently use. Not all options fit every situation — your age, diagnosis, treatment timeline, and personal preferences all factor into which ones apply to you.
- Embryo freezing: Eggs are collected after hormone stimulation, fertilized with sperm in a lab, and the resulting embryos are frozen for future use.
- Egg freezing: Mature eggs are collected and frozen without fertilization, to be thawed and fertilized later.
- Ovarian tissue freezing: Egg-containing ovarian tissue is surgically removed and frozen, then later thawed and placed back in the body. This option doesn’t require delaying treatment for hormone stimulation and can be used for girls who haven’t yet gone through puberty.
- Ovarian shielding: A protective shield is placed over the ovaries during radiation to reduce their radiation exposure.
- Ovarian transposition: A surgery that moves the ovaries away from the area that will receive radiation.
- GnRH agonists: Medications that temporarily shut down ovarian activity, sometimes used alongside chemotherapy for breast cancer.
- Radical trachelectomy: For some early-stage cervical cancers, this surgery removes the cervix while leaving the uterus, fallopian tubes, and ovaries in place.
The success rate, cost, and availability of these procedures vary, and not every hospital offers every option on-site. A fertility clinic referral can help you understand what’s realistic for your circumstances and timeline.
Comparing the Main Preservation Options
- Embryo freezing — Requires: hormone stimulation, egg retrieval, sperm for fertilization. Timing: needs some lead time before treatment starts, which your care team will help plan. Notes: most established method.
- Egg freezing — Requires: hormone stimulation, egg retrieval. No sperm needed at freezing. Notes: option when a sperm source isn’t available or desired yet.
- Ovarian tissue freezing — Requires: minor surgery to remove tissue. Notes: doesn’t require delaying treatment for hormone stimulation; only option for girls who haven’t reached puberty.
- Ovarian shielding / transposition — Requires: positioning or a surgical procedure done around the time of radiation planning. Notes: specific to radiation-based treatment.
Ask your fertility specialist which of these fit your treatment timeline, since some need more lead time than others.
Using Birth Control During Treatment
Even when treatment lowers fertility, pregnancy is sometimes still possible, and some cancer treatments can be harmful during pregnancy or increase miscarriage risk. Your doctor may recommend a specific method of birth control during treatment. Ask what’s advised for you and for how long, since this can extend past the end of active treatment.
Reproductive Follow-Up Care After Treatment
Recovery of fertility after treatment varies widely and isn’t guaranteed. Questions worth bringing to a follow-up visit include:
- Should I keep using birth control now that treatment has ended, and for how long?
- What are the chances my fertility could return, based on my specific treatment?
- If changes are temporary, roughly how long does recovery typically take for a treatment like mine?
- Should I be monitored for primary ovarian insufficiency or early menopause?
- If I want to try to conceive, is there anything about my treatment history my future obstetric care team should know?
Some people go on to conceive naturally after treatment; others need fertility treatment or rely on eggs, embryos, or tissue preserved earlier. A reproductive endocrinologist can help interpret where you stand based on your own hormone levels and cycle history, not a general timeline.
How to act on what you know about Reproductive Health After Cancer Treatment
- Ask your oncology team directly whether your specific treatment plan is likely to affect fertility.
- If having biological children matters to you, ask for a fertility specialist referral before treatment starts, even if it feels like an extra step during a stressful time.
- Discuss which preservation options fit your timeline, diagnosis, and personal preferences.
- Ask about the cost and whether your state requires insurance to cover any part of fertility preservation for cancer patients.
- After treatment, schedule a follow-up conversation specifically about reproductive health, not just cancer surveillance.
What remains uncertain about Reproductive Health After Cancer Treatment
Children, adolescents, and young adults with cancer face fertility-related decisions that differ from those of adults, and options like ovarian tissue freezing are specifically relevant for those who haven’t gone through puberty. People with hormone-sensitive cancers need treatment plans that account for both cancer safety and fertility goals together, which is a conversation for your oncologist and fertility specialist working jointly. This page does not cover every cancer type, every treatment combination, or personal cost and insurance situations, which vary by diagnosis, treatment, state, and provider. It’s a general educational overview, not a personalized fertility plan.
Common questions about Reproductive Health After Cancer Treatment
Does every cancer treatment affect fertility?
No. The effect depends on the treatment type, dose, duration, and your age, among other factors. Some people go through treatment with no lasting effect on fertility, while others experience temporary or permanent changes. Ask your care team about your specific treatment plan.
Can I still preserve fertility if treatment needs to start right away?
Sometimes. Some options, like ovarian tissue freezing, don’t require the same lead time as egg or embryo freezing. Ask your doctor and a fertility specialist whether any option still fits your timeline, even if treatment is urgent.
Will getting my period back after treatment mean my fertility is fully back to normal?
Not necessarily. Some people ovulate and have periods after treatment but still have reduced ovarian reserve or a higher chance of early menopause. A provider can check hormone levels and other markers to give you a clearer picture than menstrual cycles alone.
Is birth control necessary during treatment if my periods have stopped?
Missing periods doesn’t rule out the chance of pregnancy. Ask your oncology team whether birth control is recommended for you during and after treatment, since this depends on your specific situation.
Educational Disclaimer
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. It does not recommend any specific fertility preservation method for any individual and does not cover costs, insurance coverage, or success rates, which vary by provider, treatment, and location. Always consult a qualified health care provider and a fertility specialist about your specific diagnosis and treatment plan before making fertility-related decisions.