How Chemotherapy Affects Fertility

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Chemotherapy can have the unintended side effect of harming a woman's ovaries, leading to a reduction or stopping of estrogen and progesterone production. The term for this is called chemo-induced ovarian failure, or CIOF. If hormone production is reduced or stopped, a woman may stop menstruating or she may have irregular periods. In addition, she may experience menopausal-like symptoms, like hot flashes or vaginal dryness and itching.

If a woman is not menstruating every month, she is not ovulating or releasing an egg every month. Therefore, she would not be able to get pregnant and is infertile at that time. 

Infertility Risk

Approximately two-thirds of women stop menstruating after starting chemotherapy for breast cancer, according to a study in Cancer Control.

Will Fertility Return?

In some women, their ovarian hormone production starts functioning again after chemotherapy. In other women, it does not and menopause begins at a younger age. Remember, just because you start having periods does not mean you are ovulating—you still may have difficulty or not be able to get pregnant. 

Whether or not a woman becomes fertile again depends on a lot of factors, according to the American Cancer Society. They include:

  • Type of chemotherapy used
  • Dosage of chemotherapy 
  • Age—women younger than 40 are at a lower risk of having chemo-induced ovarian failure than woman older than 40, according to a study in the Journal of the National Cancer Institute

    Infertility Causing Drugs

    The type of chemotherapy affects a woman's chance of developing infertility. For instance, cyclophosphamide (Cytoxan), cisplatin (Platinol), and doxorubicin (Adriamycin) are most likely to damage ovaries, according to the American Cancer Society. Methotrexate, 5-fluorouracil (5-FU), and vincristine have a low risk of damaging ovaries.

    What to Do

    Speak with your doctor about your personal risk of infertility before you undergo chemotherapy. Also, if you are considering pregnancy after chemotherapy, be sure to ask your doctor when this is possible. Usually, doctors recommend waiting six months after chemotherapy before attempting a pregnancy.

    This may be a difficult time for you—having breast cancer at the prime of reproduction or simply before you are ready to be menopausal. Be informed so you can prepare yourself properly. Stay strong and get the support you need. 

    Sources

    American Cancer Society. (2015). A Guide to Chemotherapy: Sex, fertility, and chemotherapy. Retrieved October 14th 2015. 

    American Cancer Society. (2013). Fertility and Women With Cancer: How cancer treatments can affect fertility in women. Retrieved October 14th 2015. 

    Minto SE & Munster PN. Chemotherapy-induced amenorrhea and fertility in women undergoing adjuvant treatment for breast cancer. Cancer Control. 2002;9:466-72.

    Shuster LT, Rhodes DJ, Gostout BS, Grossardt BR, & Rocca WA. Premature menopause or early menopause: long-term health consequences. Maturitas. 2010 Feb;65(2):161.

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