Reduced fertility

This information is about ways to protect your ability to have a baby naturally (fertility) before starting lymphoma treatment. It also outlines ways of helping you to start a pregnancy (conceive) if you have difficulties after treatment.

Throughout this information, we use the words ‘male’ and ‘female’. Sometimes, we use ‘men’, ‘boys’, ‘women’ and ‘girls’. However, we recognise that not everyone identifies with these terms. Talk to your medical team so that they can use words that most suit you.

On this page

Which lymphoma treatments can affect fertility?

Chemotherapy and fertility

Chemotherapy and male fertility

Chemotherapy and female fertility

Radiotherapy and fertility

Radiotherapy and male fertility

Radiotherapy and female fertility

How can I preserve my fertility?

Fertility preservation for people who are trans, non-binary and gender diverse

Preserving male fertility

Preserving female fertility

If you have difficulties starting a pregnancy after treatment

Your emotional wellbeing

Frequently asked questions about lymphoma treatment and fertility

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Which lymphoma treatments can affect fertility?

Fertility is more likely to be affected by some lymphoma treatment than others. This applies to:

• certain combinations of chemotherapy drugs (regimens)
• high-dose chemotherapy used before a stem cell transplant
• radiotherapy to the area below your belly button (pelvic area).

Some targeted treatments, including antibody therapies might also affect your fertility. As these treatments are newer, scientists are still finding out about their effects on fertility.

Your doctors should talk to you about whether your lymphoma treatment is likely to affect your fertility. It’s a good idea to have a conversation with them about your fertility before you begin treatment. If you are a parent of a child with lymphoma, speak to your child’s medical team before his or her treatment begins.

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Chemotherapy and fertility

Some chemotherapy drugs can affect fertility, but not all.

The likelihood of this happening depends on factors that include:

• the type of chemotherapy drugs you have
• the total dosage of chemotherapy you have
• whether you are male or female
• your age, if you are female.

Type of chemotherapy drugs 

Your medical team should discuss with you whether there is a risk that your chemotherapy drugs could affect your fertility.  

Different chemotherapy drugs can have different effects on your fertility. This depends on how much damage they do to your ovaries or testes. 

You can find out more in our Frequently Asked Questions section.

Total dosage of chemotherapy drugs

The total dosage means how much of a chemotherapy drug you have. 

In general:

• The total dosage is higher with a higher number (cycles) of treatment.  
• The higher the total dosage of chemotherapy drugs you have, the more likely it is that your fertility will be affected.

Having a stem cell transplant usually involves high doses of chemotherapy, which increases the risk of having fertility difficulties.

Should I use contraception during chemotherapy?

Doctors usually recommend using a reliable method of contraception during treatment and for a while afterwards. You can read more about this in our Frequently Asked Questions section.

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Chemotherapy and male fertility

Chemotherapy often affects a male’s fertility, at least temporarily. Cells that divide quickly are sensitive to the effects of chemotherapy. This includes cells that make sperm.

As a side effect of chemotherapy treatment, males might experience:

• low sperm count (oligospermia)
• no sperm (azoospermia).

In some cases, however, a sperm count might be higher after treatment than before it. This is because the lymphoma itself and your general health can have an impact on the number and quality of sperm.

For those who have not yet started puberty, the testes (testicles) contain germ cells. These later develop into sperm. Chemotherapy can damage germ cells. This is why having treatment before puberty can affect a male’s later fertility.

Read more about chemotherapy and male fertility in our Frequently Asked Questions section, as well as about contraception during and after chemotherapy.

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Chemotherapy and female fertility

Most females who have lymphoma treatment can have children naturally afterwards. 

However, in both adult females and those who have not yet started puberty, chemotherapy can:

• damage eggs in the ovaries
• lower the number of eggs in the ovaries. 

Chemotherapy does not affect the ability of the uterus (womb) to carry a pregnancy.

It is very common for your periods to stop during chemotherapy. In younger females, they usually come back. However, it can take many months for ovulation (egg release) to begin after treatment. 

If chemotherapy lowers the number of eggs in your ovaries to a very low number, you might have an early menopause (premature ovarian insufficiency, or POI, where you no longer have menstrual periods). This is because females are born with their eggs already made in their ovaries. The number of eggs gradually lowers over time. Your last menstrual period (menopause) happens when there are not enough eggs left to keep regular menstrual cycles going. The average age of menopause in the UK is 51 years old. You can read more about how age affects fertility and about menopause on the NHS website.

Read more about chemotherapy and female fertility in our Frequently Asked Questions section.

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Radiotherapy and fertility

Radiotherapy uses radiation (high-energy X-rays) to destroy cancer cells. 

If radiotherapy is given to the pelvic area (just below your belly button), there is a possibility of temporary or permanent infertility in males and females. Talk to your medical team about this before you begin treatment. 

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Radiotherapy and male fertility

Radiotherapy to the testicles (tests) or surrounding areas, can cause temporary or permanent infertility. It can do this by:

• lowering sperm counts and testosterone levels
• damaging sperm cells and germ cells (that develop into sperm).

Reduced fertility can also be a late effect of radiotherapy to the testes or surrounding areas. A late effect is a health problem that can happen months or years after treatment. 

To minimise the risks, it is sometimes possible to shield the testicles during radiotherapy. 

In general, the effects on fertility depend on the dose of the radiation – the higher the dose, the more of an effect.

It also depends on where the radiation goes to:

• Radiotherapy given directly to your testes can cause permanent infertility.
• Radiation that goes to areas surrounding the testes can cause temporary or permanent infertility. This might include radiation to the tummy (abdomen), pelvis and spine.
• Total body irradiation (TBI), sometimes used before a stem cell transplant, usually causes permanent infertility.

Talk to your medical team about ways to help preserve your fertility options before you begin lymphoma treatment.

Should I use contraception during radiotherapy?

Doctors usually recommend using a reliable method of contraception during treatment with radiotherapy and for at least 3 months afterwards. 

Read more about radiotherapy and contraception in our Frequently Asked Questions section.

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Radiotherapy and female fertility

Depending on where it goes to, radiotherapy can affect the uterus (womb) as well as the ovaries. 

Females who have radiotherapy to the pelvic area (just below your belly button) are likely to have fewer eggs afterwards. This is because the eggs are very sensitive to radiotherapy.

If you do not have enough eggs to keep your menstrual cycle (periods) going, you will have ‘premature ovarian insufficiency’ (POI), also called an early menopause.

Pelvic radiotherapy can make the uterus  less able to carry a pregnancy. This can lead to miscarriage or the baby being born early (premature delivery). However, there is no known increased risk of problems in children born from women who have received radiotherapy.

Total body irradiation (TBI) also affects fertility because the pelvic area receives radiation during the process. This affects both the ovaries and the uterus. Females who have had TBI are often unable to carry a pregnancy.

If you are of reproductive age or younger, talk to your medical team about preserving your fertility before you begin lymphoma treatment.

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How can I preserve my fertility?

Fertility preservation efforts for males and females are generally more effective if you begin them before lymphoma treatment. If your child has lymphoma, talk to your child’s medical team before their treatment begins.

The National Institute of Health and Care Excellence (NICE) states that:

• There should be no lower age limit set on who should be offered fertility preservation before treatment.
• If you experience fertility difficulties, you should be offered support and the opportunity to have counselling – this is because of the emotional impact that fertility investigations and treatment can have.

Fertility preservation options might be available up until age 40. However, this varies across the NHS.

At diagnosis, the impact of the cancer and its treatment on future fertility should be discussed between the person diagnosed with cancer and their cancer team.

The National Institute of Health and Care Excellence

You can read more on the National Institute of Health Excellence (NICE) website.

Some of the techniques for preserving fertility have been used for many years. Others are newer and are still thought of as experimental. 

Fertility treatments are not always available on the NHS for people with cancer, and not all techniques are suitable for everyone. A member of your medical team or fertility specialist should explain any fertility preservation options to you. You should also be offered the opportunity to ask questions and to talk to a specialist fertility counsellor.

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Fertility preservation for people who are trans, non-binary and gender diverse

Fertility can be affected by gender affirming medical treatments, which aim to help people live in their preferred gender identity, or as non-binary. This includes hormone therapies and surgery.

Speak to your medical team for advice specific to your individual situation about options to help preserve your fertility. For example, they might advise that you stop taking hormone treatments for a while. In some cases, gender affirming surgery or taking hormone therapy for long enough could cause permanent sterility. 

The Human Fertilisation and Embryology Authority has information for trans and non-binary people seeking fertility treatment. The NHS website also has information about becoming a parent if you are LGBT+.

You can also find information and resources on the OUTpatients website, a UK cancer charity for LGBTIQ+.
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Preserving male fertility

Ways of preserving fertility in men include sperm banking and testicular tissue freezing. 

If you are interested in these, the Human Fertilisation and Embryology Authority has guidance on choosing a clinic, as well as an online database to search for fertility treatments, both NHS and private, across the UK.

I had sperm frozen and was told it would be kept for 10 years. My son’s mother and I had split up before all this, but it felt like the right thing to do.

Mark, diagnosed with Hodgkin lymphoma

Sperm banking (sperm freezing)

The National Institute of Health and Care Excellence (NICE) recommends all men whose cancer treatment could affect their fertility are offered sperm banking. Sperm banking is also an option for teenage males who have gone through puberty. 

Sperm banking involves collecting and storing the fluid that contains sperm (semen). The semen is preserved by freezing it at around -170°C. It is stored for you to use when you would like to have a baby. 

There are no known risks to using frozen sperm. However, cancer treatment can affect the number and quality of your sperm. You must therefore bank your sperm before you start lymphoma treatment. 

Don’t be embarrassed to ask about sperm banking. Your medical team can arrange for you to go to your local fertility clinic to discuss what’s involved and make this happen for you.

Richard Anderson, Professor of Clinical Reproductive Science

The Human Fertilisation and Embryology Authority website has more information about sperm banking (freezing).

Testicular tissue freezing (testicular cryopreservation)

With testicular tissue freezing, some of the tissue from your testicles (organs that produce sperm) is frozen and preserved. You can then use it when you want to have a baby. 

After lymphoma treatment, the testicular tissue (or cells from it) can be put back (transplanted) into the donor. This might restore fertility by starting up sperm production again.

This technique is quite new and experimental. No babies have been born through this procedure yet. As more boys who have frozen testicular tissue become old enough to use it, scientists will learn more. 

Testicular tissue freezing might be an option for:

• males who don’t produce any living (viable) sperm
• males who have not yet reached puberty – because the cells that will develop into sperm (germ cells) are already in the testicles.

Testicular freezing is offered only for research purposes in a very small number of centres at the moment. Your medical team can advise you on facilities available in your area.

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Preserving female fertility

The most common techniques for preserving fertility in women are egg freezing and embryo storage. Ovarian tissue freezing and ovarian transposition are more experimental techniques.

Not all techniques are suitable in all cases, and some are not available on the NHS. The Human Fertilisation and Embryology Authority has guidance on choosing a clinic, as well as an online database to search for fertility treatments, both NHS and private, across the UK.

You might be interested in the Cancer, fertility and me website, which aims to help women affected by cancer make decisions about preserving their fertility.

You can also listen to a podcast in which Lauren shares her experience of being diagnosed with lymphoma at age 24, which included freezing her eggs to help preserve her fertility, at the time frame 13:20.

Egg freezing

The most common option for women is to freeze eggs. You must do this before your treatment starts, as the treatment can affect your eggs. 

With egg freezing, you have injections to the tummy each day for about 2 weeks. This is to stimulate the ovaries. You can usually do this yourself. Under the guidance of an internal ultrasound scan, the eggs are then taken out and frozen.

Due to loss of fertility being a potential side effect of treatment, I was referred to a fertility clinic where I talked through my options and then began to prepare for egg freezing. This involved injecting myself twice a day for two weeks. I was very grateful for the community district nurses who helped me with this.

Mila, treated for Hodgkin lymphoma

You can read Mila’s story on our website.

The Human Fertilisation and Embryo Authority has information about egg freezing, including about how the process works, its success rates and risks.

Embryo storage

An embryo develops from a fertilised egg. The first part of the process of embryo storing is the same as for egg freezing. After this, the eggs are mixed with sperm, usually from your partner. Occasionally, sperm from a donor is used. 

The eggs develop into embryos, which are then frozen until you would like to have a baby.

Embryo storage might be an option if you have a long-term partner. However, it is important to know that if your partner (or the donor) withdraws his consent to use the embryos later on, they must be destroyed.

Ovarian tissue freezing  

Ovarian tissue contains eggs. Freezing ovarian tissue is a way of storing immature eggs. The tissue is taken out of your body by keyhole surgery. It can later be thawed and transferred back into your body when you want to have a baby. If the tissue starts to work and you start to ovulate again, it might be possible to conceive naturally, or by in-vitro fertilisation (IVF).

Ovarian tissue freezing is possible for females who have not yet reached puberty. 

As it is quite a new technique, only a small number of babies have been born using ovarian tissue freezing. However, it is becoming more widely seen an effective way of preserving female fertility.

Ovarian transposition

If you are having pelvic radiotherapy, ovarian transposition might be an option. This means temporarily moving the ovaries higher up into the tummy (abdominal) area, out of the way of radiation. 

There are varied success rates with ovarian transposition. If it doesn’t work, you might be offered a later procedure. This is to move your ovaries back to help you get pregnant naturally, or by using IVF. Talk to your medical team if you would like to find out more about ovarian transposition.

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If you have difficulties starting a pregnancy after treatment

There are ways to help both males and females have a baby if they have problems after lymphoma treatment. These are known as assistive reproductive techniques (ARTs). 

You can also read about ways to become a parent if you are LGBT+ on the NHS website.

The general recommendation is to try to conceive a child naturally at first, unless you already know that you have a fertility problem. You’ll give yourself the best chance of pregnancy if you have sex every 2 or 3 days. If you or your partner does not get pregnant within a year of trying naturally, you might like to seek advice. Sometimes, the difficulty is nothing to do with your lymphoma treatment, so it’s important to get it looked into properly with tests for both you and your partner.

Assisted reproductive techniques (ARTs)

Assisted reproductive techniques (ARTs) use both eggs and sperm. Scientists and doctors consider them to be safe for both the parent and the baby. 

There are different options of ARTs available for males and females. 

Success rates for these techniques vary significantly depending on the age of the woman. However, the general trend is that success rates have improved a lot over the years. There has also been significant reduction in multiple births that can happen with ARTs. 

Ways to help males father a child

After lymphoma treatment, it is possible to have tests to check if you are making sperm normally or not. Your medical team can offer advice if you would like to do this.

• If you are making sperm, fertility treatments using your sperm might be suitable for you.
• If tests show that there is a problem with your sperm production, you might be advised to use sperm that you stored before you had lymphoma treatment. If you didn’t store any, you might consider artificial insemination by donor (AID).

The following techniques might be available to you if you have difficulties conceiving naturally. There are lots of factors to consider. Availability and success rates also differ. It is therefore important to speak to a fertility specialist about what is the right treatment for you and to ask any questions you might have.

• In-vitro fertilisation (IVF): your thawed sperm is combined with your partner’s eggs in a laboratory. If fertilisation is successful, one of the embryos that develop from them are put into your partner’s womb (uterus) to begin a pregnancy.
• Intracytoplasmic sperm injection (ICSI): a single thawed sperm is injected into a single mature egg in the laboratory. An embryo is inserted into the uterus as in IVF (so you may hear this called ICSI-IVF). This technique can be useful when there are fewer sperm available than normal.
• Intrauterine insemination (IUI): your thawed sperm are directly inserted into your partner’s uterus.
• Artificial insemination by donor (AID): sperm from a donor is put directly into your partner’s uterus. If you do not have any sperm after your lymphoma treatment and you did not bank sperm, AID could be an option for you. Donor sperm can also be used in IVF, which might be a good option if artificial insemination does not work.

The NHS has more information about IVF and NHS-funded availability. 

Ways to help females have a baby

After lymphoma treatment, some females have tests to check their ovaries. This can help to find out if eggs are being released regularly. You might also have tests to look at the number of eggs left in your ovaries. 

• If you have enough eggs, you could have fertility treatment using the eggs in your ovaries.
• If you have a low number of eggs, you can use eggs or embryos that you stored before you had lymphoma treatment.
• If your egg number is very low and you did not store any eggs or embryos before your lymphoma treatment, you might consider fertility treatment using donated eggs. These eggs can be fertilised with your partner’s sperm or sperm from a donor.  

If your uterus is damaged after pelvic radiotherapy, you can discuss your options with a fertility specialist. You might consider surrogacy (where another woman carries and gives birth to a baby). Surrogacy might not be funded by the NHS and can be costly. It also comes with emotional and legal considerations, so you will need to take specialist legal advice.

If you stored ovarian tissue before treatment, using this might be an option to start a pregnancy. 

Other options for males and females

Ways of helping you to be able to have a baby naturally can be very effective. However, there are other options you might consider, such as adoption. 

You could also find out about fostering on the GOV.UK website. The information depends on whether you live in England, Scotland, Wales and Northern Ireland.

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Your emotional wellbeing

Thinking about and having fertility treatment can be emotionally challenging. There is support available. Speak to your medical team for advice – your clinical nurse specialist (CNS) is likely to be a good person to speak to. 

People who are having problems conceiving are offered counselling before, during and after investigation and treatment for their fertility problems.

National Institute of Health and Care Excellence (NICE)

We are also here to support you. Through our Buddy Service, we might also be able to put you in contact with someone who can relate to your experience. 

You can also find more organisations and resources in the fertility and pregnancy section of our useful organisations listing.  

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Frequently asked questions about lymphoma treatment and fertility

Below are some questions people often ask about lymphoma treatment and fertility. Speak to your medical team for advice specific to your situation.

What should I do if I’m worried that lymphoma treatment could affect my fertility?

Talk to your medical team if you’re worried that lymphoma treatment might affect your fertility. There are techniques available to help preserve your fertility. There are also ways of helping you to start a pregnancy if you have difficulty after treatment. These are known as Assisted Reproductive Techniques (ARTs).

The National Institute of Health and Care Excellence website has a list of suggested questions to ask about fertility problems: assessment and treatment.

Should I use contraception during lymphoma treatment?

Doctors usually recommend using a condom during treatment and for a while afterwards. 

One of the main reasons is that it is advisable to wait for a while after finishing lymphoma treatment before trying to conceive as well as for the reasons outlined below.

If you have chemotherapy:

• for males, chemotherapy drugs can pass onto your partner through your semen for around a week after treatment.
• for females, chemotherapy drugs can pass onto your partner through your vaginal fluids for around a week after treatment.

It is advisable to take such precautions during vaginal, anal and oral sex.

If you have radiotherapy:

You should use a reliable method of contraception during, and for at least 3 months after radiotherapy – your medical team can advise you further. 

For males, sperm might be damaged in the short-term after radiotherapy. Starting a pregnancy during, or soon after radiotherapy could cause abnormalities in the child. 

Which chemotherapy drugs affect fertility?

Different drugs can have different effects on your fertility. This depends on the damage they do to your ovaries or testes.

As a rough guide:

• There is a low risk of long-term damage with some regimens, such as ABVD – doxorubicin (Adriamycin®), bleomycin, vinblastine and dacarbazin.
• There is a high risk with some regimens, such as BEACOPP – bleomycin, etoposide, doxorubicin (Adriamycin®), cyclophosphamide, vincristine (Oncovin®), procarbazine and prednisolone.
• There is also high risk with the chemotherapy drugs busulfan, carmustine, melphalan and R-CHOP.

Less is known about the effects on fertility of some newer types of targeted treatments.

How soon after chemotherapy can a man have a baby?

It often takes a year or more after finishing treatment for your sperm count to recover. 

After a standard-dose chemotherapy regimen, your sperm count usually recovers and your fertility returns to the level it was at before lymphoma treatment.  

If you have had more intense treatment, you can discuss with your doctors whether a referral to a fertility clinic would be helpful.

As a general guide:

• Doctors usually recommend waiting a while after completing chemotherapy before conceiving a baby. This is because the drugs can pass onto your partner through your semen for around a week after treatment.
• It is not recommended to start a pregnancy within 3 months of finishing chemotherapy. This is to help give your body time to recover from treatment. It also helps to avoid starting a pregnancy using sperm that were being made while you were having chemotherapy.

Some people wait for around 2 years afterwards, when the risk of lymphoma coming back (relapsing) is usually lower. Seek advice from your doctor about your individual circumstances. 

How soon after chemotherapy can a woman have a baby?

Doctors advise against starting a pregnancy too soon after finishing chemotherapy. This is to give your body time to recover from treatment.

As a general guide, it is not recommended to conceive within 3 months of completing chemotherapy.

Some people wait for around 2 years after finishing lymphoma treatment, when the risk of lymphoma coming back (relapse) is usually lower. You can ask your doctor for advice about your individual circumstances. 

What does it mean if a technique is thought of as experimental?

This means that we don’t yet know how effective it is, and whether there might be any risks to you or to a child born from these techniques. In time, doctors and scientists will learn more.

Where can I find out more about the techniques described in this information?

The Human Fertilisation and Embryology Authority has more information about fertility preservation and assisted conception techniques. They also publish some key facts and statistics about these treatments, risks and success rates.