Medical Oncologist
Drug guide · Rituximab
Fertility, Pregnancy and Contraception — on Rituximab
Rituximab and pregnancy do not mix safely. The drug crosses the placenta and can affect the immune system of a developing baby. Before your first infusion, you need a contraception plan — and if pregnancy is part of your future, your oncologist needs to know now.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
- Contraception is required — Effective contraception must be in place during treatment and for 12 months after your last dose.
- Rituximab crosses the placenta — It reaches the developing baby and can deplete the baby's immune cells — which is why the restriction exists.
- Fertility is not directly blocked — Current evidence does not show rituximab damages egg reserve or sperm production, but the evidence is still developing.
- Planning ahead keeps options open — Telling your oncologist about your family plans before treatment starts — not after — is the decision that matters most.
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Rituximab should not be used in pregnancy. It crosses the placenta and can deplete the developing baby's immune cells. The EMA product information requires effective contraception during treatment and for 12 months after your last dose. If you want to become pregnant, tell your oncologist before starting treatment.
What happens if rituximab reaches a developing baby?
Rituximab crosses the placenta, particularly from the second trimester onwards. When it reaches the baby, it depletes their B-cells — the immune cells responsible for making antibodies — just as it does in your own body.
A baby born after rituximab exposure in the womb may have very low or absent B-cell counts for months after birth. This means their ability to respond to infections and vaccines is reduced during that period.
Live vaccines — including BCG, which is routinely given at birth in India — must be deferred in these infants until B-cell counts have recovered. The delivery team needs to know about the rituximab exposure before the baby arrives.
Before you start rituximab: decisions to make now
- Tell your oncologist if there is any chance you are pregnant — a test before the first dose is standard.
- Say clearly if you want to have children in the future. This changes the conversation about timing and preservation.
- Ask about fertility preservation — egg or embryo freezing for women, sperm banking for men — before your first infusion.
- Confirm your contraception plan before treatment starts and keep it in place for 12 months after your last dose.
- Ask which contraceptive methods are suitable alongside your specific cancer treatment.
- If you are currently breastfeeding, tell your team before any dose is given.
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When can you try for a pregnancy after rituximab?
The EMA prescribing information for rituximab (MabThera) requires effective contraception to continue for 12 months after your last dose. Rituximab has a long half-life and can remain in your circulation for several months after treatment ends — the 12-month period allows for full clearance.
After 12 months, the decision to try for a pregnancy depends on more than the washout period alone. Your oncologist will also assess whether your underlying condition is stable and whether your immune function has recovered sufficiently.
An unplanned pregnancy during or immediately after treatment carries risks that are avoidable with planning. Tell your oncologist when you intend to start trying — in advance, not after.
How the requirements differ for women and men
| Women of childbearing potential | Men whose partners may become pregnant | |
|---|---|---|
| Contraception required | During treatment and for 12 months after the last dose | During treatment and for 12 months after the last dose |
| Effect on fertility | No direct effect on egg reserve reported; evidence still developing | No direct effect on sperm production reported; evidence still developing |
| Fertility preservation | Discuss egg or embryo freezing before your first infusion | Discuss sperm banking before your first infusion |
| If pregnancy occurs during treatment | Tell your oncology team immediately — do not wait for your next appointment | Tell your oncology team immediately — do not wait for your next appointment |
| Breastfeeding | Not recommended during treatment; ask your team when it is safe to resume | Not applicable |
Did you know?
Infants born to mothers who received rituximab during pregnancy may have depleted B-cells at birth, even when the baby appears entirely healthy.
These infants should not receive live vaccines — including BCG, routinely given at birth in India — until B-cell counts are confirmed to have recovered. The delivery team must be told about the exposure before birth.
Source: EMA Summary of Product Characteristics, MabThera (rituximab)
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Common questions
Frequently asked questions
Can I get pregnant after rituximab?
Yes, pregnancy after rituximab is possible. The EMA prescribing information requires effective contraception for 12 months after your last dose. After that period, whether it is safe to try depends on the stability of your underlying condition and your immune recovery — which your oncologist will assess. Tell your oncologist well in advance of when you want to start trying, so the timing can be planned around your follow-up schedule.
Does rituximab permanently affect my fertility?
Current evidence does not show that rituximab directly damages egg reserve in women or sperm production in men. However, the evidence base is still developing, and the condition being treated can also affect fertility in some cases. If having children matters to you, discuss fertility preservation before your first dose — egg or embryo freezing for women, sperm banking for men. This keeps the option available regardless of what emerges from the evidence later.
What contraception should I use while on rituximab?
Rituximab guidelines require effective contraception but do not specify a single method. Which method suits you depends on your cancer diagnosis, your other medications, and personal factors — some hormonal methods interact with certain cancer types. Ask your oncologist or a gynaecologist to help you choose. Whatever method you use must remain in place during treatment and for the full 12 months after your last dose.
What if I become pregnant while on rituximab?
Tell your oncology team immediately — do not wait for your next scheduled appointment. The team will assess the situation, which may include pausing treatment and arranging specialist obstetric review. Outcomes depend on how early in the pregnancy the exposure occurred and how much of the pregnancy is ahead. Acting quickly gives you and your team the best information to make decisions together.
Can I breastfeed while on rituximab?
Breastfeeding is not recommended during rituximab treatment. Rituximab is an IgG antibody, and IgG antibodies do pass into breast milk; whether this reaches an infant in amounts that matter clinically is not fully established, so the precaution is to avoid it during treatment. Ask your oncologist when it may be safe to resume after your treatment course ends, since the answer depends on your specific schedule.
Do men need to use contraception on rituximab?
Yes. The EMA prescribing information for rituximab applies to men as well as women. Men are advised to use effective contraception during treatment and for 12 months after the last dose. If fathering a child after treatment is important to you, discuss sperm banking before your first infusion — it is a straightforward step that keeps the option open regardless of how the treatment goes.