A diagnosis of cancer is always life-altering, no matter how old you are. But for young people, there’s often a particular concern: Will I still be able to have children someday?
An estimated 84,000 people between the ages of 15 and 39 found out they had cancer in 2024—that’s more than 4 percent of all cancer diagnoses. Being proactive about fertility preservation before cancer treatment can eliminate some of that uncertainty.
“Cancer doesn’t have to end those dreams of having a family,” says UNC Health fertility doctor Colleen Milroy, MD. “When you’re facing an overwhelming diagnosis, fertility preservation is something tangible you can do for yourself. We offer hope by increasing the odds that you can achieve your family-building goals after treatment.”
Dr. Milroy explains how cancer treatments affect fertility and the steps you can take for future family planning if you’re a young person diagnosed with cancer.
How Cancer Treatment Affects Fertility
Every situation is different, so speak to your doctor about how your specific diagnosis and treatment plan might affect your fertility, but broadly, the most common cancer treatments can affect both female and male fertility in a few ways.
“Chemotherapy can damage the ovaries and affect the number of eggs available for the reproductive lifespan,” Dr. Milroy says. “This can cause some women to enter a premature menopause state. It can also affect the signal pathways between the brain and the ovaries so that you don’t ovulate. That’s thought to be a protective function during treatment, but it can continue after treatment, making it harder to achieve pregnancy.”
Chemotherapy also can damage the cells that produce sperm, slowing or stopping sperm production. This change may be temporary or permanent.
It’s important to note that there are many different types of chemotherapy drugs, which is why you should consult with your oncologist and a fertility specialist once you know what kind you will receive.
“Based on studies of various chemo agents, we usually have an idea whether the risk to fertility will be high or low,” Dr. Milroy says. “We can do an individual risk assessment based on a patient’s treatment plan.”
With some chemotherapy regimens, you may have a greater likelihood of your fertility returning to normal levels on its own, while others have a high likelihood of causing infertility.
Radiation therapy delivered to the pelvic region can disrupt or damage both sperm production and egg quantity and quality. For women, it may also affect their ability to successfully carry a pregnancy to term.
Surgery is a common treatment for some of the most common cancers in people under 40, including testicular cancer, colorectal cancer, breast cancer and cervical cancer. Some of these surgeries involve the reproductive organs; women with certain types of hormonal breast cancer may elect to undergo removal of reproductive organs to reduce future cancer risk.
Lastly, hormone therapy is used in some treatment regimens, including breast cancer and prostate cancer. These hormones decrease the long-term risk of cancer returning, but they also can change the menstrual cycle and hormone levels in men.
Again, individual risk to fertility varies by patient, and Dr. Milroy says it’s possible for markers of potential fertility to return to normal after treatment. Your doctor can help you understand what to look for and what tests can help inform your decision making.
“Women have a marker of ovarian reserve called anti-mullerian hormone (AMH) that we can check before and after cancer treatment to see the impact on egg supply,” she says. “For the menstrual cycle, we can watch and wait to see if it comes back after treatment.”
Fertility Preservation Options
The most common ways to preserve fertility before cancer treatment are sperm banking, egg freezing and embryo freezing. If you start the conversation about fertility preservation when you receive your cancer diagnosis, you can often complete these processes before treatment begins, Dr. Milroy says.
“With egg freezing, you use injectable medications to grow eggs, have an egg retrieval procedure and then freeze those eggs until you’re ready to use them,” Dr. Milroy says. “It usually takes about two weeks, and you can start cancer treatment the next day.”
With embryo freezing, the process begins the same way—injectable medications and an egg retrieval—but then a partner or donor’s sperm is added in a lab to create embryos that can be frozen.
“In situations where a certain gene has led to cancer, patients have the option to test their embryos for that gene and decrease the chances that the child will have the same genetic concern,” Dr. Milroy says.
Men typically can bank sperm multiple times in the time before treatment begins. This sperm is then frozen for as long as needed.
When you’re cleared for pregnancy after treatment, your doctor can transfer an embryo to your uterus, or use the frozen egg or sperm in fertility treatments, namely intrauterine insemination (IUI) or in vitro fertilization (IVF).
Dr. Milroy says more options for fertility preservation are on the way in the coming years.
“There are a few experimental options that are coming to UNC Fertility in the near future,” she says. “One option is to surgically remove strips of an ovary and freeze ovarian tissue for transplant after treatment. We will also be able to freeze testicular tissue for prepubescent boys and men.”
These options are beneficial for very young patients who have not gone through puberty and may not be able to produce mature eggs or sperm for freezing. After transplanting the frozen tissue back into the patient, the hope is that the organs will be able to use that healthy tissue to begin operating normally again, producing eggs or sperm.
Dr. Milroy says another emerging treatment is to surgically move the ovaries away from the field of radiation in order to minimize the impact.
If you’re not able to freeze eggs, embryos or sperm before treatment, and your fertility is affected after treatment, there are still options available. You can use donor eggs, donor embryos or donor sperm if pregnancy is a goal, or consider a gestational carrier or adoption.
Pregnancy After Cancer
Your specific diagnosis will affect how soon after treatment you can pursue pregnancy.
“It’s a process of shared decision-making with the patient, the oncologist and a fertility doctor,” Dr. Milroy says. “There are different protocols for different cancers and treatments, so you may be asked to delay pregnancy. Research is ongoing about how to shorten that timespan so that pregnancy is safe for the woman and the baby.”
As an example, the hormone therapy typically used following breast cancer treatment to prevent cancer recurrence has historically led to recommendations to delay pregnancy for five years, but Dr. Milroy says that as researchers learn more, timelines are changing and could further evolve.
Before pregnancy, you may want to consult with an obstetrician who specializes in high-risk pregnancies to identify specific risks for your situation and to understand if your cancer history will require any changes to typical pregnancy care.
“Pelvic radiation usually leads to a higher risk pregnancy than chemotherapy, for example,” Dr. Milroy says.
Starting a Conversation About Future Fertility
While there are several options to preserve future fertility, you will have to make a decision about what you’ll do fairly quickly, which is difficult when you’re trying to process a diagnosis. Fortunately, it’s a conversation that your oncologist will typically start.
“As cancer has affected more young people, there’s been a huge change in oncology counseling, and it’s created a new window for us as fertility doctors to be involved in care before cancer treatment begins,” Dr. Milroy says. “Time is of the essence because of treatment, but we can complete fertility preservation quickly. You might receive a cancer diagnosis, talk to a fertility specialist within 48 to 72 hours, and a few weeks later, your eggs are frozen.”
One aspect of the decision-making about fertility preservation will be cost. Start by contacting your insurance company to review benefits. Your doctor or care coordinator can let you know if you’re eligible for any assistance or financing programs. For example, UNC Fertility partners with Livestrong to ensure a lower out-of-pocket cost for egg stimulation and all required medications.
These conversations are important to have before you begin treatment, even if you’re not sure whether you want children. Don’t hesitate to initiate the conversation with your oncology team or request a referral to a fertility center at the time of diagnosis.
“We want to give patients information so they can feel empowered about their decision-making,” Dr. Milroy says. “We want to reduce uncertainty and regret, and early discussion about these topics helps to facilitate that. These options can give you hope and a family, especially as the treatments continue to evolve.”
If you have questions about your fertility, talk to your doctor. If you need a doctor, find one near you.