Frequently asked questions

Should I have children after I’ve had cancer?

After a cancer diagnosis, many people wonder if they should even think about having children. They may question whether a genetic factor might have caused them to get cancer and if they might pass this cancer gene to their children. But only about 5% to 10% of cancers have a strong link to a gene that is passed on from parent to child. (See “Do children of cancer survivors have higher risks of getting cancer?” below.)

Survivors also may worry that treatment with chemo or radiation could cause birth defects or other health problems for future children. Studies show that babies conceived after cancer treatment don’t have birth defects or health problems any more often than babies whose parent didn’t have cancer. But problems are more likely if a baby is conceived during (or too soon after) cancer treatment, so it’s important to know how long to wait before trying to have a baby.

People with cancer already have many worries from dealing with the disease and its treatment. Concerns about the cancer coming back, how long they can expect to live now that they’ve had cancer, and the costs of raising a child are other serious issues that people with cancer face when thinking about having children.

There are no simple answers to the question of whether to have children. Each person’s cancer situation is unique. It helps to get as much information as you can before you make a decision that will affect the rest of your life as much as this one will. You might want to discuss these concerns with a genetic counselor, geneticist, reproductive specialist, and/or a mental health professional.

Depression, anxiety, and stress may affect your ability to think as clearly as you would like about your reproductive choices. Talk about these issues and concerns with the people whose opinions you value and trust — your spouse or partner, health care team, family, close friends, clergy, etc. There are support groups as well as health professionals who deal with fertility issues for people with cancer. Ask your doctor to refer you to one of these specialists.

Is pregnancy safe after cancer?

Despite concerns that pregnancy could cause cancer to return, studies to date have not shown this to be true for any type of cancer. Breast cancer is the type most people worry about because of the hormone changes that happen during pregnancy. So far, studies suggest that survival rates in women who become pregnant after breast cancer are as good as women who do not. But this issue is still being studied. Every cancer is different, so it’s not possible to say that it’s safe for all cancer survivors to become pregnant.

Many women don’t know that pregnancy can be a problem if cancer treatment has damaged their heart or lungs. When organs have been damaged, the added physical stress of a pregnancy can lead to serious health problems for the mother and the growing fetus.

Radiation aimed near the uterus, especially if the woman had it done when she was a child, can limit the ability of the uterus to stretch as the fetus grows. This creates an increased risk of having a premature or low birth-weight baby, or even having a miscarriage.

If you are thinking about getting pregnant after your cancer treatment, it’s a good idea to first see a specialist in high-risk obstetrics to find out if you have any health risks because of your cancer treatment. Your cancer doctor (oncologist) can also talk with you about how your health, your cancer and cancer treatment, and your risk of cancer coming back might affect pregnancy and parenthood.

If I didn’t take action to preserve my fertility before cancer treatment, is it too late or do I still have options?

The answer to this question depends on your type of cancer and treatment. Start by discussing this question with your oncologist. You may need to be seen by a fertility specialist.

After cancer, how will I know if I need to see a fertility specialist?

It’s best to discuss fertility with your oncologist first, because everyone’s cancer diagnosis and treatment is different. But if you have had trouble conceiving for 6 to 12 months, despite having sex at the right times of the month, you may have a fertility problem.

After cancer treatment, how long should I wait to conceive?

Since each person’s situation is different, this is something to discuss with your doctor to find out what’s best for you.

How long can sperm, embryos, eggs, and tissues be frozen?

Indefinitely. Samples have been stored for decades without damage. Most of the risk occurs in the freezing and thawing processes, so once they are frozen they can be stored for many years.

Is it safe to ripen eggs for harvest – for embryo freezing and later IVF (in vitro fertilization) – before treatment for breast cancer?

Some oncologists are concerned because hormones given to ripen multiple eggs for harvesting raise estrogen levels far above normal. As discussed in “Embryo freezing,” adding letrozole or tamoxifen to the hormones may help block estrogen from being able to nourish breast cancer cells.

So far, studies do not show that pregnancy after breast cancer causes cancer recurrence. Also, IVF does not appear to cause breast cancer.

What role does age play in fertility after cancer for women and men?

For women, getting older is a factor in fertility whether or not you have cancer. The older you are, the harder it is to get pregnant. Cancer treatments that cause premature menopause affect a woman’s fertility.

Research suggests that the younger a woman is when she gets damaging cancer treatments, the less likely it is that she will become infertile. This may be because a younger woman has more eggs in reserve, so more eggs remain after treatment.

In general, a man’s fertility will begin to decline between ages 40 and 50. But cancer treatment can affect fertility in men of all ages, including boys who have not yet reached puberty.

Chemo may be more damaging to sperm production in men who are over 40.

Do fertility drugs cause cancer?

A few early studies suggested a link between fertility drugs and ovarian cancer, but more recent studies suggest there’s no direct link between them. If you are getting any of the drugs that stimulate eggs, talk with your doctor or nurse about their short- and long-term risks and side effects.

Are the rates of birth defects higher in children born to cancer survivors who have had treatments like chemo and/or radiation therapy than in the general public?

So far studies strongly suggest that children born to cancer survivors are no more likely than others in the general public to have birth defects.

Do children of cancer survivors have higher risks of getting cancer?

Research shows that no unusual cancer risk has been identified in the offspring of cancer survivors. The exception to this is in families who have true genetic cancer syndromes. If there’s a lot of cancer in your family, you might want to check with a genetic counselor to see if any of your potential children would have a higher than usual chance of having cancer.

If it looks like I am fertile after treatment, should I use the sperm, embryos, or eggs I froze before treatment?

This decision should be made with the help of a fertility specialist or a reproductive endocrinologist. Most fertility specialists would recommend that cancer survivors who recover fertility should try to conceive naturally with the sperm or eggs they are producing. There’s no proof of an increased risk of birth defects in children born after cancer treatment. Fresh is usually preferred over frozen, but there could be other factors that affect your individual situation.

Do cancer survivors have trouble adopting because of their medical history?

There’s no published research on this subject. Most adoption agencies say they do not rule out cancer survivors as parents. But they often require medical exams and a letter from an oncologist saying that the cancer survivor has a good prognosis (outlook for survival).

Some agencies or countries that offer international adoption may require that a cancer survivor be cancer free for 5 years before applying for adoption.