Learn my risk of fertility problems
How do I find out my risk of fertility problems?
Each person has a different risk of fertility problems after treatment for cancer or a blood disease. Your doctor or nurse can estimate your risk of fertility problems compared to the general public, and tell you which risk level you're in.
Doctors call this an “estimate” because they can’t tell you for sure what will happen with your fertility. But they can tell you what is most likely to happen.
Your doctor or nurse will consider things like:
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Your age and if you’ve gone through puberty when you start treatment for cancer or a blood disease
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What type of treatment you need, how much, and where you need the treatment in your body
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Your overall health and medical history
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Knowing your risk level can help your doctor or nurse recommend fertility preservation options to you. It can also help you and your family decide which choice is right for you: fertility preservation or to wait and see.
Why do I need to know my risk level?
What are the three levels of risk for fertility problems?
Your doctor or nurse may also say “high level of increased risk.”
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Your risk of fertility problems is higher than other people your age who have had treatment for cancer or a blood disease and people your age who haven’t.
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You’ll most likely have some damage to your fertility, but doctors may not know exactly how much.
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After your treatment, it may be difficult to have biological children. But some people with a higher risk level have had biological children.
If you have sex and don't want to have a baby now, you should use contraception (such as birth control pills and condoms) even if you are at a higher risk of fertility problems and think you can’t have a biological child.
Important note!
Your doctor or nurse may also say “significantly increased risk."
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Your risk is lower than some people who have had treatments for cancer or a blood disease. But your risk is higher than other people your age who have and haven’t had treatment for cancer or a blood disease.
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Some people may have problems with their fertility after treatment for cancer or a blood disease. But it's hard for doctors to know which people.
​Your doctor or nurse may also say “minimally increased risk.”
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Lower risk isn’t the same as no risk. Even at a lower risk level, your treatment for cancer or a blood disease may lower your fertility and lower your chances of having a biological child.
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People your age who haven’t had treatment for cancer of a blood disease can also have fertility problems. Doctors think your risk will be slightly higher compared to them.
1. Higher risk level
2. Medium risk level
3. Lower risk level
Can my risk level change?
Yes. Doctors can’t know for sure if you will need more treatment for cancer or a blood disease.
Your risk of fertility problems may go up if you need treatment for a longer time, at a higher amount, or with a stronger type than you first thought.
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If you’re interested in fertility preservation, try to do it before your treatment begins if you can.
After treatment
I have ovaries - how do I check my fertility?
Whether you choose fertility preservation or to wait and see, you will see your doctor or nurse for follow-up visits after you finish treatment for cancer or a blood disease.
They usually want to see you about one year after you finish treatment to monitor your health. They can also check your fertility.
You doctor or nurse will check if and how often you get your period. After you finish treatment, it can take a while for your period to return and be regular. Depending on the treatment you had, your period may not return or may not be regular.
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You doctor or nurse can also check to see how your ovaries are working:
What if my ovaries don't work well?
If your ovaries don’t work well (called primary ovarian insufficiency or POI), your doctor or nurse can give you medicine or other treatments to help replace your hormones.
These treatments can help you manage symptoms that feel like menopause in an older person, such as:
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Night sweats
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Hot flashes
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Mood swings
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Dryness in your vagina
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A higher chance of weak bones (osteoporosis)
Important note!
With POI, there is still a chance that you could get pregnant. So you should use contraception (such as birth control pills and condoms) if you are having sex and do not want to have a baby right now.
How will my doctor monitor my health and check my fertility?
You can check your hormones through a blood test (anti-mullerian hormone or AMH).
In some cases, you can have your ovaries checked through a small device in your vagina (a transvaginal ultrasound).
Some tests may require visiting a fertility specialist (a doctor or nurse who helps people have children). You may need a referral to see a fertility specialist, and some tests may cost extra.
If your ovaries are still working, egg freezing may be possible after treatment.
I have testicles - how do I check my fertility?
Whether you choose fertility preservation or to wait and see, you will see your doctor or nurse for follow-up visits after you finish treatment for cancer or a blood disease.
They usually want to see you about one year after you finish treatment to monitor your health. They can also check your fertility.
After you finish treatment, it can sometimes take more than a year to start producing sperm again. Depending on the treatment you had, your testicles may not produce many or any sperm again.
How can a doctor check my fertility after treatment?
To check your fertility, a doctor can test:
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How many sperm your testicles are producing (sperm count)
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How healthy the sperm are (semen analysis) – to see if they are strong enough to swim to fertilize an egg
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How much semen you can freeze (volume)
Testing your sperm is easy and doesn’t cost a lot. You would ejaculate semen into a cup for testing in a lab.
You may be able to test your sperm as soon as 6 months after your last treatment for cancer or a blood disease.
Fertility tests may require visiting a fertility specialist (a doctor or nurse who helps people have children). You may need a referral to see a fertility specialist.
Your doctor or nurse may recommend you try an assisted reproductive technology if you're ready to have a biological child.
One assisted reproductive technology is called in vitro fertilization (IVF). In IVF, eggs and sperm are combined in a lab before being put into the uterus (where a baby grows).
What if my sperm count is low?
Your doctor may check your hormone levels or perform other tests.
It may be possible to extract sperm from the testicles using a minor surgical procedure (such as testicular sperm aspiration or extraction) for use with an assisted reproductive technology like IVF.
What if there is no sperm?
What are other ways I can take care of my health?
If you are having sex or plan to have sex, use contraception if you don't want to have a baby now. Get tested for sexually transmitted infections (STIs).
Protect yourself against other cancer types by getting the vaccine for HPV (human papillomavirus). Go to the CDC's website to learn more about HPV vaccines.
You may need to get screened for cancer at a younger age. For example, getting a colonoscopy to check for colon cancer sooner than other people your age.
Talk to your doctor or nurse about managing effects from your treatment for cancer or a blood disease.