As a person assigned female at birth, you likely have a lot of questions about how treatment and side effects may affect your ability to have children (your fertility).

If you think you might want the option of having a child at some point after cancer treatment, you might be able to take steps to protect your reproductive health. But it's important to talk with your doctor about this before starting treatment. And you may have to bring it up if your doctor doesn't. Talk about what's important to you. Share your fears or concerns. Your doctor can talk with you about your choices. They can also refer you to a reproductive specialist.

Not all cancer treatments may affect your ability to have children. It depends on many things, such as:

• Your age.
• The type of cancer you have.
• The kind of treatment you'll have.
• The length and dose of that treatment.

Here are a few ways in which common cancer treatments might affect your fertility:

• Surgery. Certain organs or parts of them may need to be taken out to treat the cancer. This may mean reproductive organs, such as your ovaries or uterus. In this case, you won't be able to get pregnant after treatment. Sometimes, other surgeries done in your pelvic area may harm your reproductive organs. This could also lead to fertility problems.
• Radiation therapy. High doses of radiation can kill cancer cells. This type of treatment can also affect nearby healthy cells. Radiation therapy to your pelvis may cause changes in your uterus or your ovaries. These changes may make it harder for you to get pregnant. Or you may not be able to carry a baby full term. If you need radiation therapy to your brain, it might damage your pituitary gland. Then it may not make the hormones needed to start ovulation and your monthly periods.
• Chemotherapy. Some of these medicines can damage your ovaries and eggs, especially when high doses are used. This damage may last for a short time. Or it can be lifelong (permanent) damage that leads to menopause.
• Other treatments. You may need other treatments that may affect your reproductive system. These include hormone therapy, targeted therapy, immunotherapy, and stem cell transplant. Your doctor can tell you more about the risks linked to the treatments you get.

If you think you may want to have children after your cancer care, talk with your doctor right away. It's best to talk about your concerns before you start treatment. This is when you tend to have more choices for preserving your fertility. Your doctor may also have you talk with a reproductive specialist.

These questions can help you start the conversation:

• What's the chance that my treatment could affect my fertility?
• Will these changes be short-term or permanent?
• Are there other treatment choices that would cause fewer fertility problems?
• What are my choices for protecting my ability to have children?
• Do I have time to look into and possibly have my fertility preserved?
• How long after treatment should I have to wait to try to have a child?
• How much do fertility preservation methods cost? Does insurance cover it?
• Do you recommend that I see a fertility specialist?

Your doctor can help you choose the best way to protect your fertility. Ask about any risks. These are the methods most often used:

• Cryopreservation. This method removes eggs from your ovaries and then freezes them. Another option is to have the eggs fertilized with sperm before they are frozen. This is called embryo cryopreservation. When you are ready to have a child, an egg or an embryo can then be thawed for use.
• Ovarian shielding. This is done to help protect your ovaries while you're getting radiation. During treatment, a lead shield is put on the outside of your body over your ovaries. There's still a risk of radiation exposure. But shielding can help lower it.
• Ovarian transposition (oophoropexy). This option may be used if you need radiation to your abdomen or pelvis. Surgery is done to move your ovaries and sometimes your fallopian tubes away from the place that will get radiation. This can be done as an outpatient surgery. Sometimes it's done at the same time as another, larger surgery.

Researchers are studying new ways to protect the fertility of people who need cancer treatment. One of these may be an option for you as part of a clinical trial. Talk with your doctor or a reproductive specialist to learn more.