Fertility, Pregnancy and Contraception — on Bevacizumab

The FDA and EMA both specify that effective contraception must continue for at least six months after your last bevacizumab infusion before you attempt to conceive. This is the period the drug takes to clear to a level no longer considered a risk to a developing pregnancy. Your oncologist may recommend a longer interval depending on your individual situation, particularly if you are having other treatments alongside bevacizumab. Do not assume that finishing treatment means you can try to conceive immediately.

The prescribing guidance requires effective contraception but does not mandate a single method. What is appropriate for you depends on your full medical picture, which is why this should be discussed with your oncologist or gynaecologist rather than decided independently. Combined hormonal contraceptives can increase the risk of blood clots, and bevacizumab already carries an elevated clotting risk — making some methods less suitable. Tell your treating team all the medications you are currently taking so they can advise on the safest choice for your situation.

There is no clear evidence that bevacizumab alone causes permanent fertility damage in people, but the data are limited. The primary concern is the treatment period and the washout window that follows. It is also important to ask separately about each other treatment in your plan — chemotherapy, for example, can affect fertility in ways that are distinct from bevacizumab and sometimes more significant. A fertility specialist, consulted before treatment starts, can give you a clearer picture of what the full treatment plan means for your individual situation.

Tell your oncologist immediately. A cancer diagnosis during pregnancy is a complex situation that requires both an oncologist and a specialist maternal-fetal medicine team working together. Bevacizumab is contraindicated in pregnancy, and your team will consider whether treatment can be safely delayed, whether a different approach is possible, or what the risks of proceeding look like in your specific situation. This is not a decision to be made without specialist obstetric input alongside your oncology team.

This question does not yet have a definitive evidence-based answer, and it is best discussed directly with a fertility specialist who has access to your full treatment history. The practical questions are whether the six-month washout period has passed, what your ovarian reserve looks like, and whether other treatments — particularly chemotherapy — have affected your fertility independently of bevacizumab. Egg or embryo banking before treatment begins is the most reliable way to preserve options, because it avoids this uncertainty altogether.

Yes, if you are male. The FDA and EMA advise that men use effective contraception during bevacizumab treatment and for six months after the last dose. This reflects both the animal data on possible effects on male fertility and the fact that the risk to a partner's pregnancy through semen exposure is not yet fully characterised. If you are a woman on bevacizumab, your partner does not need contraception on that basis — but your own contraception must be reliable and must continue for the full six months after your last infusion.