In females, fertility refers to the ability to get and stay pregnant. Infertility means trying to get pregnant with a partner for at least 1 year without using birth control and not becoming pregnant.
Fertility problems can be side effects of certain chemotherapy medicines, radiation therapy, or surgery. This does not mean that everyone who has these treatments will have fertility problems. Fertility effects can depend on:
Type, dose, and combination of treatments
Age at the time of treatment
Duration of treatment
Health and other medical conditions
Each person’s risk is different. Many people who have treatment-related fertility problems are still able to have children later in life, either naturally or with medical help.
Fertility preservation is the process of taking steps to protect your fertility so that you may have a better chance of getting pregnant and having a baby in the future.
Before treatment starts, talk with your care team about possible effects on fertility and options to protect fertility.
Find more information about fertility preservation on Together Teens & 20s:
How the female reproductive system works
Infertility or fertility problems can happen when the reproductive system is damaged after chemotherapy, radiation, or other treatment.
Puberty
Puberty is the stage in life when a girl’s body goes through physical and hormonal changes that prepare her for adulthood. This usually happens between ages 8 and 14 in girls. During puberty, the brain signals the ovaries to make estrogen and progesterone. These hormones cause changes such as breast development, wider hips, and the start of menstrual periods.
Menstrual cycle and pregnancy
The ovaries store and release eggs. Each month, hormones tell the ovaries to prepare an egg. They also tell the uterus to thicken its lining. About once a month, one ovary releases an egg. This is called ovulation. The egg travels through a fallopian tube toward the uterus.
The egg can be fertilized by sperm after sex. The fertilized egg moves to the uterus and attaches to its lining, and pregnancy begins.
If the egg is not fertilized, the lining of the uterus sheds and leaves the body as a menstrual period. If you are pregnant, hormones pause the monthly menstrual cycle, so you don’t have periods.
Each month, the cycle starts again. The average menstrual cycle is about 28 days, but this can be different from person to person. Menstrual cycles can vary based on:
Normal variations in cycle length
Irregular periods at the beginning of puberty
Contraceptive use, such as oral birth control pills or intrauterine devices (IUDs)
Poor nutrition, heavy exercise, or stress levels
Medical conditions such as polycystic ovarian syndrome (PCOS), diabetes, or thyroid disorders
Risk factors for fertility problems in females
A healthy reproductive system is important for the ability to have children. A female is born with all of the eggs she will ever have. Fertility depends on many factors, including age, the number and quality of your eggs, how well your hormones work, and the health of your reproductive organs.
Risk factors for fertility problems include:
Medical conditions that affect the brain, pituitary gland, or reproductive organs
Surgery to the brain, pelvic area, or reproductive organs
Your health care provider can diagnose fertility problems after puberty and once menstrual periods have started. Fertility tests may include a physical exam, including a pelvic exam, imaging tests such as a pelvic ultrasound, and lab tests.
Your provider may also check hormones in your blood. These may include:
Follicle-stimulating hormone (FSH): FSH helps in egg production and regulating the menstrual cycle.
Estradiol (estrogen): Estradiol is a form of estrogen. Estrogen helps develop and maintain female sex characteristics.
Luteinizing hormone (LH): In women, LH causes the ovaries to release an egg during ovulation.
Progesterone: This hormone prepares the body for pregnancy.
Anti-Müllerian hormone (AMH): Levels of AMH can help determine the quantity and quality of a female’s remaining egg supply. AMH levels usually start to drop after puberty and throughout adulthood until a female reaches menopause. If AMH levels are low, fertility preservation may be more difficult.
In some cases, your provider may recommend further testing. These tests may include imaging tests to examine the fallopian tubes and uterus.
Choosing Female Fertility Preservation Before Starting Chemotherapy
Childhood cancer treatments may impact a patient's fertility. Read about Thanaydi Sandoval's decision to have fertility preservation before starting treatment.
Options for fertility preservation depend on many factors, including age, whether a female has gone through puberty, and past and future treatments. Not all options are safe and effective for all patients.
Some fertility preservation procedures may not be covered by health insurance. They may be an out-of-pocket expense. Ask your care team about financial assistance programs or grants for fertility preservation.
Talk to your care team to understand the options, costs, and risks.
Egg freezing (oocyte cryopreservation)
In this procedure, eggs are removed from the ovary and frozen for later use. When ready to build a family, the eggs can be thawed and fertilized with sperm in the lab to make embryos (in vitro fertilization or IVF). The fertilized egg (embryo) is put in the female’s uterus to begin the pregnancy.
Egg freezing is only an option for females who have started having periods and who have enough healthy eggs. It is not always possible because treatment must be delayed for a couple of weeks to collect the eggs. This option can also be a risk for patients with tumors that are sensitive to hormones or who have other medical problems.
Embryo freezing (embryo cryopreservation)
In embryo freezing, or cryopreservation, eggs are collected and fertilized with sperm in the lab (in vitro fertilization or IVF). The fertilized egg (embryo) is frozen and stored. When ready to build a family, the embryo can be placed in the female’s uterus to grow.
Embryo freezing is only an option for females who have started having periods and who have sperm from a partner or sperm donor. This option is not always possible because treatment must be delayed for a couple of weeks to collect the eggs. It can also be a risk for patients with tumors that are sensitive to hormones.
Ovarian tissue freezing usually involves removing 1 ovary. The ovary is frozen and stored. When ready to build a family, tissue from the ovary is put back in the female’s body. The goal is for the implanted ovary to release eggs or to allow egg retrieval. Often, patients will need to undergo in vitro fertilization (IVF).
Ovarian shielding
Shielding helps prevent radiation from damaging the ovaries. A protective shield is placed over the pelvic area during radiation therapy to reduce exposure. This may help to make healthy eggs in the future.
Ovarian transposition (oophoropexy)
During this procedure, the ovaries are moved away from the area that is getting radiation therapy. The goal is to reduce exposure to radiation to lessen damage to the ovaries.
Ovarian suppression therapy (gonadal suppression)
A female gets a medicine called a GnRH agonist (or gonadotropin-releasing hormone agonist) that stops the ovaries from working for a while. The medicine tells the pituitary gland to stop the release of reproductive hormones. This causes the ovaries to stop ovulation. The female will not have a menstrual cycle. This may help protect eggs from damage during treatment. After treatment, hormone therapy is stopped, and the ovaries may start to work again.
Surgery
Some patients may need surgery to treat problems in the reproductive organs that affect fertility. Surgery may help by opening blocked fallopian tubes, treating endometriosis, or removing growths such as cysts,polyps, fibroids, or scar tissue.
Other fertility treatments
Other ways to support fertility may include lifestyle changes that promote overall health, such as healthy eating, maintaining a healthy weight, and managing stress. It is also important to manage chronic medical conditions and treat hormone imbalances.
Fertility medicines: Medicines may be used to help the ovaries release eggs.
Intrauterine insemination (IUI): Healthy sperm are placed directly in the uterus around the time of ovulation. IUI may be done along with fertility medicines.
In vitro fertilization (IVF): Eggs are removed from the ovaries and fertilized with sperm in a lab. When they form an embryo, it is placed in the uterus.
Timed intercourse: Ovulation can be tracked using tests so that females know their most fertile window.
Donor options: Donor eggs, sperm, or embryos, or having another female carry the baby (surrogate) may be an option.
Continue to use birth control
Some people think they cannot have children and may skip birth control. But pregnancy can happen, even with irregular or missed periods. If you are sexually active and not planning a family, use birth control. Use condoms to help prevent sexually transmitted infections (STIs).
Questions to ask your care team
Talk to your care team about the risk of fertility problems before starting treatment, even if the care team does not bring it up. These questions can help you to plan ahead and find support:
How likely is it that chemotherapy, radiation, or illness will affect fertility in the short term or long term?
Are fertility changes likely to be temporary or permanent?
Are there other recommended treatments that will not cause fertility problems?
What fertility tests do I need?
What fertility preservation options are available?
Should I see a fertility specialist or reproductive health doctor?
Are there resources to help with emotional support or financial concerns related to fertility?
Key points about fertility problems in females
Infertility happens when the reproductive system is damaged or does not work properly.
Chemotherapy, radiation, surgery, and other treatments can sometimes affect fertility in females.
Not everyone who has these treatments will have fertility problems. Certain treatments carry a higher risk.
Fertility testing may include a pelvic exam, imaging tests, and blood tests to measure hormones.
Talk to your care team about fertility preservation options before starting treatment. Some preservation options must be done before treatment begins.
Fertility preservation options depend on age, puberty status, diagnosis, and timing of treatment.
A fertility specialist and social worker can help you understand options, risks, timing, and costs.
Fertility problems (infertility) can be a side effect of illness or treatments. Learn about male fertility preservation options and how to talk to your doctor.
Fertility problems (infertility) can be a side effect of illness or treatments. Learn about female fertility preservation options and how to talk to your doctor.
