Building Your Family after Cancer Treatment: Information for Women

This information explains options that women have for building a family after cancer treatment is completed.

How Cancer Treatment May Affect Fertility

To understand how cancer treatment may affect fertility, it is helpful to review the basics of female reproduction. Several different structures work together to allow you to conceive and carry a child.

Girls are born with about 1 million eggs. After puberty, the pituitary gland in the brain makes hormones that stimulate eggs in the ovaries to mature. Each month, one mature egg is released into the fallopian tube. This is called ovulation. If the egg is fertilized by sperm, it may form an embryo. The embryo passes into your uterus, where it may implant, resulting in pregnancy.

As a woman ages, she loses eggs. With fewer eggs, it is harder to get pregnant. For most women in the United States, at age 51 there are so few eggs (less than 1,000) that monthly menstrual periods stop and menopause begins. Five to 10 years before menopause, women generally become infertile, losing the ability to conceive naturally.

Cancer treatment can affect fertility in several ways.

  • Certain chemotherapy medications and exposing the ovaries to radiation can destroy eggs. The number of eggs you lose depends on the type of treatment you had and your age when you received treatment. Older women have fewer eggs, so the loss of eggs is more likely to affect their fertility.
    • Some women continue to have monthly menstrual periods with no impact on their fertility.
    • Some women continue to have monthly menstrual periods and are fertile for a period of time. However, because of the loss of eggs, they will become infertile and start menopause at a younger age.
    • Some women stop menstruating permanently and become infertile during or right after treatment.
  • Exposing the uterus to radiation can cause tissue scarring. This can make it difficult to become pregnant or to carry a pregnancy to term. Women who get pregnant after exposure of the uterus to radiation are much more likely to have miscarriages or go into labor early.
  • Surgery in the pelvis may remove or damage reproductive structures, affecting a woman’s ability to become pregnant or carry a pregnancy.
  • Surgery or radiation therapy to the brain may affect the functioning of the pituitary gland. Without hormones from this gland, women may stop having monthly menstrual periods, or their eggs may not mature.

If your oncologist has not discussed these issues with you, ask him or her how your treatment may have affected your fertility

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How to Evaluate Your Fertility after Treatment

Specially trained gynecologists called reproductive endocrinologists can evaluate your fertility. We generally recommend that you wait at least 1 year after completing cancer treatment to give your body time to recover from the effects of treatment.

Your reproductive endocrinologist will do a number of tests to evaluate your ovarian reserve, a term that describes the number and quality of your eggs. The tests may include:

  • A transvaginal ultrasound, in which a thin probe is placed in your vagina. Sound waves from the probe bounce off the structures in your pelvis and make pictures of your ovaries and uterus. Within the ovaries are follicles, which are small sacs of fluid. Each follicle contains a single egg. Your doctor will count the number of large follicles that can be seen on the ultrasound. These hold maturing eggs.
  • Blood tests to measure the levels of hormones related to fertility, including follicle-stimulating hormone (FSH) and antimullerian hormone (AMH).
  • A semen analysis from your male partner, if you have one. This is a test to see if he has enough healthy sperm to fertilize your eggs.
  • Other tests may be recommended by your doctor as well.

Your reproductive endocrinologist will review the results of the evaluation with you and recommend the best options for building your family.

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Pregnancy after Cancer Treatment

Most women are advised not to get pregnant immediately after treatment. There are several reasons for this:

  • If you received chemotherapy or radiation to the pelvic area, some of your maturing eggs may have been damaged from treatment. It takes about 1 year to clear these from your ovaries.
  • Your body needs time to recover from treatment so it is able to handle pregnancy.
  • If you become pregnant during the time when you are most at risk for an early recurrence or relapse of your disease, your doctors may not be able to monitor you with certain tests or scans.

Most women are advised to wait at least 1 to 2 years after cancer treatment is over before trying to get pregnant. Some women will not need to wait that long, but others will need to wait longer.

Although many women will have no problems with pregnancy after cancer treatment, some women will be in a high-risk category because of possible late effects from treatment.

  • Some types of chemotherapy and radiation therapy can affect the function of your heart, lungs, kidneys, or liver. Pregnancy places extra demands on your body that could put your health at risk.
  • Some treatments can affect your body’s ability to make certain hormones. You may need to replace these hormones in order to get pregnant and carry a pregnancy.
  • If you had radiation therapy to your pelvis, you may have scarring in your uterus. Depending on how much radiation the uterus received, you may not be able to carry a pregnancy.

Talk to your oncologist before you try to get pregnant. Ask if the timing is right for you and if there are any medical reasons that would make it unsafe for you to become pregnant. Ask if you should see an obstetrician who specializes in high-risk pregnancies. These doctors are called maternal fetal medicine (MFM) specialists. If your oncologist recommends this, you should consult an MFM specialist before you try to get pregnant.

If you are not yet ready to start a family, but may want to have children in the future, ask your doctor or nurse if you are at risk for early menopause. If you are at risk, you may be interested in information about freezing eggs or embryos for future use. Ask your doctor or nurse for the resource Fertility Evaluation and Fertility Preservation: Options for Women Who Have Completed Cancer Treatment.

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Options for Building a Family

Your options for building a family may include:

  • Natural conception
  • Ovarian stimulation, with intrauterine insemination or in vitro fertilization
  • Using your own frozen eggs or embryos
  • Using donor eggs or embryos
  • Surrogacy with a gestational carrier
  • Adoption

Each of these options is described below. At the end of this resource, you will find a list of resources to learn more.

Natural conception

Some women will be able to get pregnant without medical help. If you try to get pregnant and are not successful after 3 to 6 months, make an appointment with a reproductive endocrinologist for an evaluation. Based on the results of your evaluation, your reproductive endocrinologist will tell you if you should continue trying to conceive naturally or if you should consider other options for having a child.

Ovarian stimulation

Your fertility evaluation may show that you have enough eggs to become pregnant but need medical help. If this is the case, your doctor may recommend stimulating your ovaries with hormones (ovarian stimulation).

On or around the second day of your period, you start giving yourself daily injections of hormones for about 10 days. This will stimulate a group of eggs in your ovaries to mature. During this time, your doctor will monitor you with frequent blood tests and ultrasounds. There are 2 ways to proceed once your eggs are mature.

  • Intrauterine insemination (IUI): Your doctor collects a sample of semen from your partner or a donor and places it in your uterus around the time you ovulate to increase the chance that your egg will become fertilized.
  • In vitro fertilization (IVF): Your eggs are removed and fertilized in a laboratory. There are several steps to this process:
    • Egg retrieval: While you are under anesthesia (medication to make you sleep), a very thin needle is passed through the wall of your vagina to remove the mature eggs. The procedure takes about 15 minutes and you will go home the same day.
    • Fertilization: Your eggs are fertilized with sperm from your partner or a donor. Not all eggs will fertilize, and not all fertilized eggs will develop into embryos. Therefore, the more eggs you have, the greater your chance of success.
    • Embryo transfer: One or more embryos are transferred into your uterus using a very thin catheter (flexible tube) that is passed through your vagina and cervix. This is usually done in an exam room while you are awake. You and your doctor will decide how many embryos to transfer. The remaining embryos can be frozen and stored for future use.

Using your own frozen eggs or embryos

If you are not able to become pregnant naturally or with ovarian stimulation, and you froze eggs or embryos before treatment, you may be able to use these to attempt pregnancy. There are several steps to this process:

  • You will take hormones for 2 to 3 weeks to get the lining of your uterus ready for your embryo to implant. This process is called priming.
  • You and your doctor will decide how many embryos to transfer and that number of embryos will be thawed. If you froze eggs, these will be thawed and fertilized with sperm from your partner or a donor to create embryos.
  • One or more embryos will be transferred to your uterus using a very thin catheter that will be passed through your vagina and cervix. This is usually done in an exam room while you are awake.
  • If an embryo has implanted, you will continue to take hormones for several months to support the pregnancy.

Using donor eggs

If you are not able to become pregnant naturally or with ovarian stimulation, and you did not freeze eggs or embryos before treatment, you may be able to use eggs from a donor. The child will not have your genes, but you would experience pregnancy and childbirth.

Eggs are usually donated by young women who want to help other women build their families. Donors should be carefully screened to ensure they are medically and emotionally healthy. Most donors are anonymous, but some may allow a child to contact them when they reach adulthood. Donors may be willing to have contact with you during the process.

Finding donor eggs

Your fertility center may have an egg donor program or can recommend an egg donor agency. Reproductive lawyers with experience in this area can also recommend egg donor agencies. The cost for obtaining donor eggs is generally about $35,000, including medical expenses and compensation of the donor.

Sometimes, 2 people share the eggs of a single donor to lower the costs. Some agencies now have frozen eggs available for donation.

You may have a relative or friend who is willing to donate eggs for you. This is a good option for some people; however, even with the best of intentions, there can be problems if expectations are not clearly defined. Even if you know your donor well, she should have psychological and medical screenings before donating. It is also important to talk with a lawyer and be sure you and the donor fully understand all that is involved.

What is involved

Once you choose a donor and she has been screened, you will need to finalize the financial and legal arrangements. Then, your reproductive endocrinologist will plan the timing of the egg collection. There are several steps to this process:

  • To prime the lining of your uterus for implantation of the embryo, you will begin to take hormones a few weeks before the process begins.
  • The donor will give herself daily hormone injections for about 10 days to stimulate a group of eggs in her ovaries to mature. During that time, she will be closely monitored by her doctor.
  • When the donor’s eggs are mature, they will be removed (this is called egg retrieval). This is done with anesthesia, so she will be asleep. The eggs will be collected using a very thin needle passed through her vagina. The procedure takes about 15 minutes and she will go home the same day.
  • The eggs will be fertilized with sperm from your partner or a donor. Some of these fertilized eggs will start to divide and form embryos.
  • After 3 to 5 days, 1 or more embryos will be transferred to your uterus using a very thin catheter passed through your vagina and cervix. This is usually done in an exam room while you are awake. You and your doctor will decide how many embryos to transfer. The remaining embryos can be frozen and stored for future use.
  • If an embryo has implanted, you will continue to take hormones for several months to support the pregnancy.

Using donor embryos

If you are not able to become pregnant naturally or with ovarian stimulation, and you did not freeze eggs or embryos before treatment, you may be able to use embryos from a donor. The child will not have genes from you or your partner, but you would experience pregnancy and childbirth.

Embryos are usually donated by couples who have gone through fertility treatment and have unused frozen embryos. The terms “embryo adoption” and “embryo donation” have both been used to describe this but they have different moral and legal implications. Reproductive specialists generally feel that “embryo donation” is the correct term.

Finding donor embryos

Your fertility center may have an embryo donor program or can recommend an embryo donation agency. Some agencies are nondenominational (not associated with any religion) and some are faith based. The cost of donor embryos is less than that of donor eggs.

What is involved

Once the financial and legal arrangements are complete, your reproductive endocrinologist will plan the timing of the embryo transfer. There are several steps to this process:

  • To prepare the lining of your uterus for implantation of the embryo, you will take hormones for about 3 weeks.
  • One or more embryos will be thawed and transferred to your uterus using a very thin catheter passed through your vagina and cervix. This is usually done in an exam room while you are awake. You and your doctor will decide how many embryos to transfer.
  • If an embryo has implanted, you will continue to take hormones for several months to support the pregnancy.

Surrogacy with a gestational carrier

Some women cannot carry a pregnancy after cancer treatment. This can happen if your uterus was removed, if you had high-dose radiation to your pelvis, or if other medical issues make it unsafe for you to be pregnant. If this is the case, you can have another woman carry a pregnancy for you. Embryos you froze before treatment, fresh embryos created with your own eggs or donated eggs, or donor embryos are transferred into the carrier’s uterus. She will have no genetic relationship to the child.

Laws related to surrogacy vary from state to state. Some states do not allow a woman to be paid to carry a pregnancy. Some states require that the intended parents adopt the child after birth. Because the laws on surrogacy are very complex, we recommend that you talk with a reproductive lawyer before starting this process.

Finding a gestational surrogate

In order to qualify as a surrogate, a woman usually needs to have had at least one full-term pregnancy with delivery of a healthy child. In addition, she will need to live in a state that allows a woman to be paid to carry a pregnancy for someone else. You can find a gestational surrogate through a surrogacy agency or through a reproductive lawyer who specializes in surrogacy.

What is involved

Once you have found a possible surrogate, she should be carefully screened to make sure that she is medically and emotionally healthy. Then you will need to finalize the financial and legal arrangements. The cost of surrogacy can be $80,000 to $120,000, including the agency and legal fees, medical expenses, and compensation for the carrier. In some cases, you may have a relative or friend who is willing to carry a pregnancy for you without being paid. This is a good option for some people and would be considerably less expensive. However, even with the best of intentions, there can be problems if expectations are not clearly defined. Even if you know the woman well, she should have psychological and medical screenings before becoming your surrogate. It is also important to talk with a lawyer to make sure that you and your surrogate understand all that is involved and have a legal agreement.

A reproductive endocrinologist will plan the timing of your embryo transfer to the surrogate. Throughout the pregnancy, you and your surrogate will communicate as you have both agreed. You may even be allowed to be present at the birth.

Adoption

Adoption is another way of building your family after cancer treatment. Having a history of cancer does not prevent you from being able to adopt. In fact, some states, including New York, do not allow agencies to discriminate against prospective parents based on a history of cancer. You will likely need a note from your doctor that includes your diagnosis and treatment, affirms that you are healthy or “stable” and that there is no medical reason you could not parent a child. In addition, they may require a statement to the effect that your doctor expects you to be alive through a child’s majority (age 16).

Adoptions can be domestic (the child is born in the US) or international (the child is born and lives outside of the US). International adoptions are currently very restrictive; policies vary by country and often change. Some countries do not allow people who have been treated for cancer to adopt. 

There are several things to consider when pursuing adoption. Do you want to adopt a newborn baby, or are you comfortable adopting an older child? Do you want to adopt a child of the same race and ethnicity as you, or are you comfortable adopting outside your race? Would you consider adopting a child who has special health needs? It’s important to know what you are comfortable with before proceeding with adoption. The cost of adopting a new born child in the US is generally around $40,000 and can take as long as 2 years.

What is involved

Adoptions are arranged through an agency or with the help of an adoption lawyer.

  • Adoption agencies may be public or private. An agency caseworker is often involved in matching birth parents with the adoptive parents. The match is based on what the birth parents are looking for in adoptive parents and in the characteristics of a child the adoptive parents are hoping to adopt.
    • Public agencies are part of the state Department of Social Services. They usually work with children who have been taken away from their birth parents due to alleged abuse or neglect.
    • Private agencies may handle domestic adoptions, international adoptions, or both. Each agency has its own standards about who they will accept as adoptive parents. Children adopted through private agencies are usually younger than children adopted through public agencies. A private domestic adoption may the best option if you want to adopt a newborn child.
  • Lawyers can also arrange private adoptions. Adoption laws vary by state, so it is important to work with a lawyer who specializes in adoption and is licensed in the state in which you want to adopt.

There are several ways to find an adoption agency or lawyer.

The amount of information shared between birth parents and adoptive parents can vary. In the past, closed adoptions were common. Birth parents and adoptive parents did not know each other’s identity and had no direct contact after the adoption. Now, open or semi-open adoptions are more common. These allow some contact between the birth parents, the adoptive parents, and the child after the adoption. Everyone involved agrees on the type and amount of contact.

Before you can adopt, a social worker will do a home study to assess your ability to care for a child. The social worker will ask you things that may seem very personal. This is to make sure you understand what is involved and are ready to proceed with adoption. The social worker will also do a medical assessment and tell you exactly what you need from your doctor. Your agency or lawyer will tell you the best time to schedule the home study. Once the child is placed in your care, the social worker will stay in contact to help with any issues that may arise.

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Other Issues to Consider When Exploring Options for Building a Family

Financial issues

The cost of each of these options varies based on:

  • Your health insurance coverage for fertility treatment.
  • The family building option you choose. Using donor eggs or gestational surrogacy is expensive because you will have other additional costs, such as:
    • Psychological and medical screening of the donor or surrogate
    • Medical costs not covered by their health insurance
    • Travel expenses
    • Compensation
  • Agency fees
  • Legal fees

Listed below are a number of programs that provide financial help or grants to help people build a family.

  • Bonei Olam: www.boneiolam.org (for Orthodox Jewish couples)
  • InterNational Council on Infertility Information Dissemination (INCIID): www.inciid.org – select “IVF Scholarships”
  • The SAMFund: www.thesamfund.org –  select “Grants” under “Get Help”

You can also explore the following options:

  • The New York State Infertility Demonstration Project provides grants to help with medical costs based on income. Ask your fertility center if they participate in this and if you are eligible.
  • Some pharmaceutical companies provide fertility medications for a reduced fee or for free. Ask your fertility center if you are eligible and to help you apply.
  • Some banks and financing companies loan money for family building.
  • Some fertility centers, agencies, or lawyers will be willing to work out a payment plan for you. Some offer a sliding scale based on your income.
  • Some people have asked family or friends to organize fund-raising efforts in their community, house of worship, or workplace. Learn about crowdfunding here:

If you are considering adoption:

  • Ask your accountant if you are eligible for the Federal Adoption Expense Tax Credit. Based on your income, this may give you a tax credit on your federal income taxes for eligible adoption expenses.
  • Some employers provide adoption benefits to help with costs.
  • Help Us Adopt provides financial grants to help with adoption costs. For more information, go to: www.helpusadopt.org
  • National Adoption Foundation provides grants, loans, and information about other financial resources for adoption. For more information, go to: fundyouradoption.org

Legal issues

Laws on third-party reproduction (donor eggs, donor embryos, and gestational surrogates) and adoption vary by state. Legal issues with gestational surrogacy are particularly complicated. Ask the staff at your fertility center or agency how they address these legal issues and if they can recommend a lawyer. If not, you may want to speak with a reproductive or adoption lawyer on your own. Things to consider when selecting a lawyer include:

  • Experience in the family building option(s) in which you are interested.
  • The state in which he or she is licensed. Reproductive and adoption law varies by state. Make sure your lawyer is licensed in and knowledgeable about the states where you and your donor, surrogate, or birth parents live.
  • Other services provided. For example, if your lawyer can help you find an agency, donor, surrogate, or birth parents, or review legal documents and assist with adoption if needed.
  • How the lawyer charges for his or her services. Lawyers can charge a flat fee or charge by the hour.

You can find lawyers who specialize in reproductive law through the following organizations:

  • American Academy of Assisted Reproductive Technology Attorneys: www.aaarta.org
  • Path2Parenthood: www.path2parenthood.org – select “Find a Professional”
  • RESOLVE: The National Infertility Association: www.resolve.org – under “Resources” select “Professional Services Directory”

Emotional issues

If you are not able to get pregnant naturally, the process of building your family can be complicated, time-consuming, and expensive. It is common to experience feelings of anger, loss, or grief. If you find that these emotions become overwhelming, last for weeks, or discourage you from taking the next steps, consider talking with a counselor.

Your fertility center or agency may recommend a mental health counselor for you. You can also find counselors who specialize in dealing with infertility through the following organizations:

  • Path2Parenthood: www.path2parenthood.org– select “Find a Professional”
  • American Society of Reproductive Medicine, Reproductive Facts: www.reproductivefacts.org – under “Resources,” select “Find a Healthcare Professional”
  • RESOLVE: The National Infertility Association: www.resolve.org – under “Resources” select “Professional Services Directory”
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How to Get Started

This resource provides just a brief overview of the options for building your family after cancer treatment. Below are steps to help you further explore your options.

  1. Learn more. The next section lists resources for additional information.
  2. Speak with your oncologist when you are ready to build your family. Explain what you are considering, and ask if he or she has any concerns based on your personal medical situation.
  3. Make initial appointments with specialists.
    • If you are considering becoming pregnant, and your doctor recommends you work with a MFM specialist, schedule a consultation before you try to become pregnant
    • If you are considering assisted reproductive technology (including ovarian stimulation, IVF, or using donor eggs, donor embryos, or gestational surrogates), schedule an appointment with a reproductive endocrinologist. He or she will perform a fertility evaluation that will help clarify which options may be best for you. Your reproductive endocrinologist may also help you select donors, surrogates, agencies, lawyers, and mental health specialists.
    • If you are considering adoption, schedule a consultation with an adoption agency or lawyer.
  4. Plan for the financial costs. Ask your fertility center, agency, or lawyer for a detailed list of all of the expenses involved.
  5. Depending on which option you choose to build your family, you may need to meet with a mental health professional at some point. He or she will make sure that you understand what is involved and that you are ready to go through this process. Mental health professionals can also provide support as you make decisions about the options presented to you.
  6. Talk with family and friends about what you are considering. Ask for their support.

This process can be complicated, and it takes persistence and endurance. However, many people have gone through this before you and have been successful in building families after cancer treatment.

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Resources for You to Learn More about Your Options

A number of professional organizations provide information and support on all options for building a family. Search within each of their websites for specific topics.

You may also find this publication to be helpful: Having Children after Cancer, Gina M Shaw, Celestial Arts, Berkley, 2011

A number of organizations provide information and support on specific options for building a family.

Donor egg

Gestational surrogate

Adoption

This is a selected list of resources.

MSK makes no warranties or representations as to the accuracy or completeness, timeliness, or usefulness of any opinion expressed in this booklet. The information and opinions contained herein are not intended as a substitute for medical professional help or advice and are to be used only as an aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition. MSK does not warrant, endorse, guarantee, or assume responsibility for any opinions, information, products, or services offered by any third party referenced within this booklet.

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