Fertility problems

Your hospital team can tell you if your treatment is likely to reduce your fertility, and if your fertility is likely to come back. If you’ve not started treatment yet, you might have options to preserve your fertility. But this isn’t always possible, as some people need to start blood cancer treatment very quickly.

If you’ve found out your treatment has affected your fertility, this can be very hard emotionally. It's OK to ask for support.

Before treatment:

• Will blood cancer treatment affect my fertility?
• Early menopause
• Contraception during treatment
• Preserving fertility before treatment
• Questions to ask about fertility
• When preserving fertility is not possible

After treatment:

• Fertility testing after treatment
• The emotional impact of infertility
• Coping with infertility
• Ways to have a family

Some – but not all – treatments for blood cancer can reduce fertility. It can be a side effect of treatment for leukaemia, lymphoma, myeloma and other types of blood cancer.

For some people the effect on fertility is temporary, and their fertility comes back after treatment. But sometimes reduced fertility caused by blood cancer treatment is permanent. Your hospital team can tell you if the treatment they recommend is likely to reduce your fertility, and if they expect this to be temporary or permanent.

The blood cancer treatments that are most likely to reduce fertility are:

• Some combinations of chemotherapy drugs.
• High-dose chemotherapy. This is often used before a stem cell or bone marrow transplant.
• Radiotherapy to your pelvic area. This can be used to treat lymphoma.
• Total body irradiation (TBI). This is sometimes used before a stem cell or bone marrow transplant, and usually causes permanent infertility.

Reduced fertility can happen because the treatment damages the parts of the body involved in making babies, including:

• ovaries – where eggs are stored
• testes (testicles) – where sperm is made
• the womb – where babies grow during pregnancy.

Some treatments can also affect levels of fertility hormones in your body.

Radiotherapy to the pelvic area and TBI can damage the womb. This can increase the risk of losing a baby during pregnancy (miscarriage).

It’s important to use contraception during treatment, even if you’ve been told the treatment will reduce your fertility. This is because:

• There’s still a chance you could get pregnant or get someone else pregnant while having treatment.
• Some blood cancer treatments could harm your baby if you got pregnant during treatment. They could also increase the risk of losing the pregnancy (miscarriage).
• Some drugs used in blood cancer treatment can pass into semen (the fluid that carries sperm). This could harm your baby if you got someone pregnant during treatment.
• You may be at high risk from infections during treatment. Using a barrier method like condoms will help protect you from sexually transmitted infections (STIs).
• If you’re having chemotherapy, a small amount of the drugs could be present in your body fluids. To protect your partner during sex, your hospital team might recommend using a barrier method until a few days after treatment.

Ask your hospital team or GP about the best type of contraception to use.

This section is about preserving fertility before you have treatment. If you’ve already started or finished treatment, you might want to skip this section and read our information about testing fertility, the emotional impact of infertility or ways to have a family instead.

If there's time and you feel well enough, you might be able to have treatment to preserve your fertility before starting blood cancer treatment. If you think you might want children in the future, speak to your hospital team as soon as possible after your diagnosis. They can refer you urgently to a fertility clinic to talk about your options.

Before having fertility preservation you’ll usually need to have a blood test to check for infections such as HIV and hepatitis. Having an infection should not stop you being able to have fertility preservation. But it’s important to check so the fertility clinic can store your samples safely.

Types of fertility preservation include:

• Your fertility clinic will ask for your consent to store your sperm, eggs, embryos or ovarian tissue. You’ll have several forms to fill in.
• If you freeze embryos with your partner’s sperm, you both need to give consent for storing them and how they can be used. It’s important to talk to your partner about what to do with the embryos if you split up or one of you dies.
• The fertility clinic should arrange for you – and your partner if you have one – to speak to a counsellor so you understand all the issues involved and can give informed consent.
• You can change or withdraw your consent at any time by contacting the fertility clinic.
• Sperm, eggs, embryos and ovarian tissue can legally be stored for up to 55 years in the UK. The fertility clinic will contact you every 10 years to renew your consent.
• It’s important to tell the fertility clinic if you move or change your contact details. If they can’t contact you to renew your consent, they might destroy the sperm, eggs, embryos or ovarian tissue.

Fertility preservation and storage is usually available free on the NHS for people having cancer treatment. But the rules on who the NHS will fund fertility preservation for, and how long it will pay for storage, vary in different parts of the country. Your hospital team or fertility clinic can let you know what the NHS funds in your area.

Even if the NHS funds your fertility preservation and storage, this does not always mean they will fund fertility treatment for you in the future. There are different rules in different parts of the country about who the NHS will fund fertility treatment for.

This means you might have to pay for private fertility treatment to use your frozen eggs, embryos, sperm or ovarian tissue to make a baby.

The Human Fertilisation and Embryology Authority has information about costs and funding of fertility treatment.

Often people with blood cancer need to start treatment very soon after they’ve been diagnosed. If you need to start treatment straight away, there might not be time to preserve your fertility first. It also might not be possible if you are feeling too ill to give a sample or go through fertility preservation treatment.

Some people are able to have fertility preservation later, in between rounds of treatment. But this isn’t an option for everyone.

It can be very upsetting to hear that your treatment might affect your ability to have children, but there’s no time to have fertility preservation. If you would like to talk about how you’re feeling, call our Support Service free on 0808 2080 888 or email [email protected].

Talk to your hospital team if you have any questions or worries about your fertility after treatment. They can arrange for you to have tests to check your fertility.

If you don’t see the hospital team anymore, speak to your GP. They can arrange for you to have fertility testing or refer you to a ‘late effects’ clinic. This is a clinic run by doctors and nurses specialising in the long-term effects of cancer and cancer treatment, including fertility.

Usually, doctors refer people for fertility testing after one to two years of trying to get pregnant. But you can be referred earlier than this if you’ve had cancer treatment.

There's no right or wrong way to feel if you’re told your treatment has affected your fertility. Some people feel completely devastated. For others it might feel less important.

These are some of the emotions people have described when affected by infertility:

• sadness, loss and grief – for many people, finding out they cannot have children in the way they expected is a very real loss. It’s natural to feel sadness at this loss and need to take time to grieve.
• changes to the way you feel about yourself – sometimes, our ability to have children can be an important part of our identity and the way we see ourselves.
• anger – you might feel angry that your plans for having a family have been taken away from you. If fertility wasn’t discussed with you before your treatment, you might feel angry that you weren’t given all the information.
• isolation – you might feel like people around you can’t understand what you’re going through. If you find it hard to be around friends or family who are pregnant or have children, you might distance yourself from them, at least for a while. This can make you feel very isolated.

The emotions around infertility can affect anyone, whether they already have children or not, and whether they are in a relationship or single.

Even if you weren’t sure if you wanted children in the future, you might feel as if this option has been taken away from you. This can be very hard.

Finding out you may be infertile can be life-changing, so it’s understandable if you feel like you’re struggling. But there are some things you can do to help you cope.

You don’t have to go through this alone. You might want to connect with other people going through the same thing on our online community forum. Your hospital team or fertility clinic may also be able to put you in touch with local support groups.

It can help to talk to a partner, close friend or family member about how you’re feeling. You could also contact our free Support Service. You don’t need to have any specific questions, you can just call us to talk about how you’re feeling.

If you have a partner, you might find it difficult to talk to them about infertility. They are likely to be going through their own emotions about it, but might not express them in the same way.

Some couples find it helpful to speak to a counsellor together. This can help you both explore your feelings about infertility together. We’ve included some ways to find a counsellor further down this page.

Dealing with infertility is really hard. It’s important to acknowledge this, and be kind to yourself.

We have tips on small things you can do to feel better in your daily life. You don’t need to do them all. Just trying one could help.

It’s okay to ask for help. Your hospital team can tell you about options for emotional support, including counselling. You could also ask your GP, or self-refer online on the NHS website in England or through Breathing Space in Scotland.

If you’ve been referred to a fertility clinic, ask if they can arrange for you to see a counsellor specialising in infertility.

If you want to have children, there are many options that may be able to help. The options that are right for you will depend on how your fertility is affected, your age, your wishes, values and beliefs.

There are a range of fertility treatments that may be able to help you have a baby. These may use either:

• your own eggs, embryos or sperm if you were able to store these
• donated eggs, sperm or embryos.

You can find out more about the different types of fertility treatment from the Human Fertilisation and Embryology Authority (HFEA) website. They also have information about fertility treatment for LGBT+ people.

Surrogacy is when a woman, called a surrogate, becomes pregnant and gives birth to a baby for you. This might be an option if you (or your partner if you have one) are unable to carry a pregnancy.

To find out more about surrogacy, you could contact a support organisation such as Surrogacy UK.

Adoption means you become the legal parent of a child. Fostering means you look after a child who can’t stay with their own family. This could be for a short or long time.

You can get details about adoption and fostering from your local social services department, or from an organisation like Adoption UK.