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Fertility and Cancer

If you have ever heard the words, “You have cancer”, your first thought probably wasn’t about your fertility. However, a man’s fertility – the ability to get a woman pregnant - can be affected by cancer, sometimes even before treatment begins. Here we will discuss the topics most relevant to patients who have been diagnosed with cancer, or have already undergone cancer treatment, who also want to father children.

Following are some frequently asked questions about fertility and cancer.  

How does cancer affect a man’s fertility?

Some cancers can damage a man’s fertility, even before treatment begins. For example, testicular cancer and Hodgkin’s lymphoma can lower sperm counts. Many men facing cancer want to have   children in the future. Some men may not know they have options to protect their fertility. The best time to address your fertility is before cancer treatment.

Ask your doctor about your   fertility-saving options   as soon as possible after your cancer diagnosis. It is important to bank sperm (freezing sperm through cryopreservation) prior to treatment, because this is the easiest and most effective way of preserving your fertility. Sometimes your doctors can choose a treatment plan that may do less harm to your fertility, but it is very difficult to guarantee that the treatment will not harm your fertility since each person’s body responds differently to treatment.

How does cancer treatment affect fertility?

Chemotherapy, radiation therapy, and some surgeries can cause fertility problems. Infertility may occur right away or in a few months. It can last for months or years, or be permanent. Cancer and its treatments can affect everyone differently.

Chemotherapy can reduce or stop sperm production, which affects your ability to father a child. Also, hormone therapy for prostate cancer often harms sperm production.

Radiation therapy can lower sperm production when treatment is to your whole body, testicles, or certain other areas. These sites include your pelvis (near the testicles), pituitary gland (a small hormone-producing gland at the base of the brain), and brain. The brain works with the pituitary gland to signal the testicles to make sperm and testosterone, the main   male sex hormone, so radiation to the brain may cause fertility problems if the pituitary gland is affected . Even when the testicles are protected from radiation using lead covering (also called gonadal shielding); some radiation may still reach them and cause damage to your sperm.

Surgery that removes both testicles stops sperm production forever. Removal of just one testicle to treat testicular cancer can lower the amount of sperm the body makes. Despite this, men with testicular cancer may still be able to father a child, unless the remaining testicle does not produce sperm or is affected by further treatments like chemotherapy or radiation.

Surgery of the prostate, bladder, large intestine, spine, or rectum may damage nerves and make a man unable to ejaculate semen (the fluid carrying sperm) from the penis. Sometimes this type of operation makes the semen go backward into the bladder. Called retrograde ejaculation, this problem means little or no semen (the fluid that carried sperm) exits the penis.

What is the chance of infertility after cancer treatment?

Not all men become infertile after cancer treatment. The impact that cancer treatment may have on fertility depends on many factors. These include:

  • Type and dose (amount) of chemotherapy
  • Dose and location of radiation therapy
  • Site of surgery
  • Your age (risk of infertility rises with age)
  • Your fertility status before treatment
  • Your body’s response to cancer treatment

Some cancer drugs are more likely to cause infertility than others. If you plan to have chemotherapy,  talk to your cancer doctor  (oncologist) about drugs that may be less likely to damage your fertility.

What are the options for fertility preservation?

Ideally, your doctor will refer you to a physician who specializes in treating male fertility problems. This may be a urologist or endocrinologist.

Male fertility-saving treatments for cancer patients include:

  • Sperm Banking: Freezing (cryopreservation) of sperm is the most successful way for men to preserve fertility before cancer treatment. The most common way to collect the semen sample is through masturbation. Men who cannot ejaculate may have vibrational or electrical stimulation to help them do so. The sperm stay frozen, or “banked,” until you need them. Freezing—even for many years—does not typically damage sperm. Cryopreserved sperm have been used over 20 years later to successfully help couples have children.
  • Testicular Sperm Extraction: Even if a man’s semen has no sperm, he may still have sperm production in the testicles. In testicular sperm extraction, a surgeon removes small pieces of testicular tissue (biopsy) while the patient is sedated or under local or general anesthesia. If the tissue contains sperm, the sperm are either frozen or used to fertilize a female partner’s eggs. This technique may be an option before or after cancer treatment.
  • Shielding of Testicles During Radiation Therapy:  It is sometimes possible to shield the testicles to protect them from radiation during treatment. However, even with shielding, it may be difficult to protect the testicles from all radiation, due to scattering of radiation from other parts of the body.

What are the success rates and costs of fertility preservation?

Many men who had cancer treatment go on to have children. Fertility success rates vary by treatment, the body’s response to treatment, the type of cancer, and the extent of the cancer at the time of diagnosis. The chance of pregnancy with banked sperm improves with higher numbers and quality of sperm at the time of banking, which is best performed prior to starting treatment. Advanced   fertility treatments such as intracytoplasmic sperm injection (ICSI)   may allow pregnancy even with just one sperm.

Fertility preservation can be expensive. Besides procedure costs, there may be a yearly or monthly fee for storing frozen sperm. Insurance companies might not cover the cost of certain fertility treatments. Financial help is available from some organizations (see the Resources section below).

How long should you wait after cancer treatment before trying to have a baby?

If you had chemotherapy or radiation, your doctor may suggest you wait 1 to 2 years or more after you stop treatment before you try to   start a family . It can often take this long for healthy sperm production to start up again. Until then, it is generally recommended to use a condom or other form of birth control, even if you think you are infertile in order to reduce the risk of starting a pregnancy with damaged sperm.

What are the effects of cancer treatment on male hormones?

Cancer treatment can lower or stop testosterone production. Lower-than-normal  testosterone   is called hypogonadism, or androgen deficiency. Removal of the testicles, radiation, or chemotherapy can cause low testosterone. So can androgen deprivation therapy (hormone therapy) for prostate cancer.

Some symptoms of low testosterone are:

  • Reduced sex drive
  • Poor erections
  • Low sperm count
  • Low energy
  • Tender, enlarged breasts
  • Hot flashes

What are the long-term health effects of low testosterone?

Over time, low testosterone may cause other health problems. They include:

  • Loss of muscle mass (size) and strength
  • Osteoporosis—thinning of bones, making them more likely to break
  • Mood changes and depression
  • Increased body fat
  • The “Metabolic Syndrome”, which can include cardiovascular disease and diabetes

What are the options to treat symptoms of low testosterone?

Testosterone replacement therapy can improve   sexual desire   and erections as well as mood, energy, bone density, and muscle size. Men should not take testosterone if they have prostate cancer or breast cancer. Also, do not use this treatment if you and your partner are trying to get pregnant because it reduces sperm production.

Another type of hormone therapy is human chorionic gonadotropin (hCG). This fertility treatment is an option for men who want to father a child but have low sperm counts and testosterone due to a problem with the pituitary gland or brain. This problem can occur with radiation therapy or a pituitary or brain tumor. If the pituitary gland has not been damaged, another medication that can stimulate the body to produce more testosterone and maintain sperm production is clomiphene citrate. Both hCG and clomiphene require careful monitoring and should be used only under experienced medical supervision.

Sometimes low testosterone is not due to a production problem, but can occur if too much testosterone is converted to estrogen (estradiol). This situation may occur if men are overweight or if there is an overproduction of the enzyme that converts testosterone to estrogen (aromatase). Treatment for this not to produce more testosterone, but rather to slow down the conversion of testosterone to estrogen with weight reduction strategies, medications called aromatase inhibitors, or both.

For men who cannot take testosterone, other treatments are available for depression and osteoporosis.  Your doctor can help you find a treatment that’s right for you.

What are the options if you are infertile?

When fertility does not return after cancer treatment, there are other ways to build a family. These include getting sperm from a donor and adoption. Some adoption agencies may have restrictions on adoption by cancer survivors, but others do not.

It is common to feel anger or a sense of loss about not being able to have a child. You may find it helpful to talk to a counselor or join an infertility support group (see Resources below).

What should you do with this information?

Your doctor may not bring up the topic of fertility preservation or low testosterone. You should raise the issue if you have concerns. Here are some questions to ask your doctor:

  • How quickly do I need to start cancer treatment?
  • Will my cancer or its treatment affect my future fertility?
  • What can I do now if I want to have children in the future?
  • Do any of these treatment options make my cancer treatment less effective or raise the chance of a recurrence?
  • May I still bank sperm even if I already started cancer treatment?
  • Will my cancer treatment cause low testosterone? If so, what can I do about it?

Cancer and Fertility Resources

For further information about cancer and fertility, please visit the below resources committed to cancer and fertility support and education.