If being diagnosed with cancer in your 20s or 30s isn't enough, you're often told you'll need to think about preserving your fertility too. Cancer and its treatments can impact your fertility - but how depends on loads of different factors. And the decisions you'll need to make often need to be made quickly before you start treatment. If you've got ovaries and a uterus, there's a couple of things you need to be aware of around how cancer and its treatments can impact your bits and bobs.

"I would have loved more advice on fertility and options surrounding that. I felt really rushed into making a fairly uneducated decision"

How can cancer treatment affect the ovaries and uterus? It can...

• Impact the production of certain hormones that are essential for the production and maturation of eggs in the ovaries

• Reduce the number of eggs stored in the ovaries (so you might go into menopause earlier than you would have done naturally)

• Stop ovaries from working (either temporarily or permanently)

• Damage the lining of the uterus

• Include surgery to remove the uterus

Check out our Trekstock Talk on how cancer treatment can affect the ovaries and uterus.

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Questions to ask your medical team

Your cancer doctor (oncologist) will be able to explain the risks to your fertility based on your individual treatment. Fertility preservation usually needs to happen quite quickly before treatment starts but you should feel comfortable with any decisions you're making. Talking to loved ones, people you trust and your medical team can help you make sure you're happy with your decision. You could ask your doctors:

• How will my fertility be affected?
• Is there time for me to store eggs, embryos or ovarian tissue?
• Are there any ways I can protect my fertility during treatment?
• What type of contraception should I use during treatment?

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COMMON WAYS TO PRESERVE FERTILITY IF YOU'VE GOT OVARIES OR A WOMB

The two main options are:

1. Embryo Freezing 

• This involves going through the process of IVF - so fertilising an egg with sperm and freezing the resultant embryo
• It is the most successful method of fertility preservation
• As mentioned above, there are a huge number of variables that affect the success; the OncoFertility Consortium in the USA does provide some more information on this here
• Once an embryo is frozen, it can be stored for up to 10 years

2. Egg Freezing 

• This involves the same process as above, without fertilisation of the eggs. You will still be treated with a fertility drug to stop your own cycle for 2 weeks, followed by a hormone to stimulate the production of lots of eggs. Theses eggs will be collected and stored
• Once frozen, these eggs can also be stored for up to 10 years
• Both of these techniques involve the use of hormone therapy which can increase oestrogen levels
• For those with hormone-sensitive cancers it is important to talk about the risks with your oncologist; you may be offered drugs called ‘aromatase inhibitors’ to keep the levels of oestrogen lower

The success rate for fertility preservation techniques is difficult to assess, but we do know that it is low. This is something that you should take into account before making a decision, particularly if it might result in a delay to your treatment.

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Fertility after cancer treatment

Immediately after treatment it can be difficult to know the impact on your fertility. There are four possible outcomes. You might have:

1. Normal Fertility

Many women who undergo cancer treatment have no change in their fertility and are able to have a baby naturally.

2. Fertility Followed by Early Menopause

Many cancer treatments damage some, but not all, of the eggs in your ovaries. This means that you may have a period of time when you are fertile after cancer treatments and then go into early menopause.

3. Compromised Fertility
This can happen from damage to the ovaries, hormone production or reproductive system. This damage can make natural conception hard, but pregnancy may be possible with help from a fertility doctor.

4. Immediate Menopause
This can happen if your eggs are damaged or destroyed by your cancer treatments and/or your reproductive organs are damaged or removed, or if you need to take medication to keep you in a medically induced menopause.

You can have tests after your treatment to find out what's what. Speak to your GP or cancer team to arrange this.

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What about if I've already had my cancer treatment, or it's already underway?

If your treatment is already over, or it's already happening, it's important to chat to your team about any questions or concerns you have around your fertility. And remember, there are some really great organisations out there supporting people dealing with fertility issues, like the Fertility Network. Don't feel like you have to go it alone.