Can cancer treatment affect fertility? What to ask before treatment starts

For many young adults, a cancer diagnosis can feel like the end of the future they imagined.

Suddenly, conversations revolve around chemotherapy, surgery, radiation, and survival. Dreams of marriage, children, and building a family often take a back seat.

But oncologists at Loma Linda University Cancer Center say one conversation shouldn't wait: how cancer treatment could affect fertility and what patients can do to preserve their options before treatment begins.

"Fertility is not a side issue for many patients," says John Shin, MD, medical oncologist at Loma Linda University Cancer Center. "It's deeply tied to their identity, future family plans, relationships, and a sense of hope."

While not every cancer treatment affects fertility, certain chemotherapy drugs, radiation involving reproductive organs, and some cancer-related surgeries can make it more difficult to have children. Since many fertility preservation options are most effective before treatment starts, early conversations are critical.

Understanding the risks

The impact on fertility depends on the type of cancer, treatment plan, dosage, and each patient's individual circumstances.

For men, sperm banking remains the most established fertility preservation option and can often be completed quickly. Women may consider egg freezing, embryo freezing, or ovarian tissue preservation, which typically requires additional planning before treatment begins.

Many patients worry that pursuing fertility preservation will delay cancer treatment. "For most cancers, fertility preservation can be arranged without compromising cancer care," Shin says.

Although some aggressive cancers require immediate treatment, many patients can safely incorporate fertility preservation into their treatment plan.

Separating fact from fiction

One of the biggest misconceptions, Shin says, is that cancer treatment automatically causes permanent infertility.

While some patients experience lasting fertility challenges, many maintain or regain fertility after treatment.

"Patients shouldn't automatically assume that because they received cancer treatment, they will never be able to have children," Shin says.

Another misconception is that fertility preservation is only important for people who are married or actively planning a family.

"You're making decisions for your future self," Shin says. "Even if someone is single today, they may one day wish they had explored their options."

He also encourages survivors not to assume they cannot become pregnant after treatment. Fertility can recover unexpectedly, making ongoing conversations about family planning and contraception just as important after treatment as they are before it.

Planning for life after cancer

Family planning doesn't end when cancer treatment is done.

Survivors may benefit from fertility testing, reproductive counseling, and consultations with specialists to better understand their options and determine when it is safe to pursue pregnancy.

At Loma Linda University Health, oncologists work alongside reproductive specialists, surgeons, radiation oncologists, nurses, social workers, and chaplains to help patients navigate these time-sensitive decisions.

"Fertility decisions are time-sensitive, and having all of these specialists working together allows us to move quickly and support patients through the process," Shin says.

The collaborative approach reflects Loma Linda University Health's commitment to whole-person care.

"We believe fertility isn't just a medical issue," Shin says. "It affects emotional health, relational health, and spiritual health as well."

Hope beyond a diagnosis

For many patients, discussing fertility isn't just about preserving the possibility of having children. It's about preserving hope.

"When we talk about fertility preservation, we're planning for a patient's life after cancer," Shin says. "We're saying that we believe there is a future worth preparing for."

Shin has celebrated with former patients who later shared they were expecting children after completing treatment. These are moments that serve as powerful reminders that cancer does not have to define a person's future.

For patients facing a new diagnosis, his advice is simple: ask questions early, understand your options, and don't be afraid to discuss your hopes for life after cancer.

"The last thing you want is to look back and realize you didn't know your choices," Shin says. "There is hope, and there are reasons to look toward the future."

Patients diagnosed with cancer who have questions about fertility preservation should talk with their oncology team as early as possible, ideally before treatment begins. Learn more about cancer care and treatment options at Loma Linda University Cancer Center at lluh.org/cancer-center.