Life After Cancer: Changes in a Man’s Fertility
Cancer can affect a man’s ability to have children (fertility). A man is considered infertile if he is unable to get a partner pregnant after a year of unprotected sex.
You are considered infertile if one or more of these happen:
Your testicles don’t make sperm
Sperm cannot get out of your body because the passage for sperm is damaged or blocked
The sperm are damaged
Doctors are still learning how cancer treatments affect fertility. Infertility after cancer treatment may be short term or permanent. Medicines, surgery, radiation, and other treatments can cause problems. Fertility problems also depend on:
The type of cancer and where it was in your body
How long treatment lasted
Your age when you had treatment
How long it has been since treatment ended
Your overall health
Talking with your healthcare team before treatment
Your healthcare team can tell you about how treatments may change your ability to get a partner pregnant. Talk about this before you start treatment.
You may choose to have sperm frozen and stored for future use. This is called sperm banking. Or you may choose a type of treatment that may help protect your fertility. Talk with your team about your options. The American Society for Reproductive Medicine has more information on sperm banking.
Fertility after chemotherapy
Chemotherapy (chemo) can damage sperm. It can also stop the body from making new sperm. After treatment, your testicles may not make sperm for a year or more, or may never make sperm again. During and for some time after treatment the sperm may be damaged. The effects depend on the medicines you get, the dose, and how long you were treated. Talk with your healthcare team about the medicines you took, and the risks of each on your fertility.
Fertility after targeted or immune (biologic) therapy
Researchers are still learning how these types of medicines affect a man’s fertility. They don’t work the same as chemo. Ask your healthcare team what effects your medicines may have on your fertility.
Fertility after radiation therapy
Radiation to the belly (abdomen) or testicles can harm sperm. High doses of radiation can also damage the cells that make sperm. Radiation implants (brachytherapy) are less likely to harm fertility. External beam radiation to the groin or pelvis has a much higher risk of long-term infertility. Radiation to the pituitary gland can also cause the testicles stop making sperm. Your healthcare team can tell you about the effects you may have from your radiation treatment.
Fertility after surgery
Surgery can change your fertility. If you’ve had both testicles removed (orchiectomy), this means you no longer make sperm. If one testicle is left and it works normally, it may still make sperm. Surgery to remove the prostate gland or seminal vesicles means that a man will no longer make semen. Semen is needed to carry sperm outside the body. Surgery may also damage nerves or blood vessels and cause problems with getting or keeping an erection. This is called erectile dysfunction (ED). In some cases, the tube that carries semen out of the body may be cut and prevent ejaculation. Sometimes surgery causes the semen to go into the bladder (retrograde ejaculation) instead of out the penis. Your healthcare team can tell you what to expect after surgery.
Working with your healthcare team after treatment
After treatment, your healthcare team can help you manage any effects on your fertility. If you plan to get your partner pregnant after your cancer treatment is done, talk with your team first. Ask how long you should wait after treatment. Some kinds of treatment used may change the genetic material in sperm and raise the risk for birth defects. You may need to wait at least a year or more. They can give you information to help you make decisions, help you find a specialist, and let you know when it’s OK to start trying for a pregnancy with your partner. They may also be able to help direct you to adoption or surrogate resources.
Ask your healthcare team:
How does my type of treatment affect fertility in men?
When is it safe to start trying to get my partner pregnant?
Do I need to see a fertility specialist? Can you refer me to one?
Working with a fertility specialist
A fertility doctor can help in various ways. If your fertility has changed because of cancer treatment, a fertility doctor can help you use sperm you froze before cancer treatment, or sperm from a donor. In some cases, sperm may retrieved after treatment through other methods. Sperm may be collected from urine. Or surgery may be done to take sperm directly out of a testicle. He or she will help you understand your options and what may work best for you.
It’s important to know that working with a fertility specialist may not be covered by health insurance. Fertility treatments can cost thousands of dollars, and in many cases more than one treatment is needed. Talk with the fertility specialist and your insurance company to learn what your out-of-pocket costs will be.
Fertility changes can be very stressful and upsetting. You and your partner may want to talk with a counselor. Ask your healthcare team for referral to counseling. They can also help you find a nearby support group or other resources.
March 21, 2017
Overview of infertility and pregnancy outcome in cancer survivors. UpToDate.
Cunningham, Louise, RN,Stump-Sutliff, Kim, RN, MSN, AOCNS