If you’re a man having treatment for cancer, there’s a possibility that your fertility will be affected. Here we explain which treatments can affect fertility and about protecting fertility before you start treatment.
Your feelings about your fertility
Finding out that treatment will affect your fertility can be as devastating as the cancer diagnosis for some men. It’s a huge thing to take in when you’re already trying to deal with your feelings about having cancer. Obviously how you feel will be different if you’ve already got children. But even if you have, you may have wanted to have a bigger family. Even if you weren’t intending to have more kids, knowing that you can’t may be hard to accept and can change how you feel about your body.
If having a baby in the future is important to you, do tell your cancer specialist how you feel. They will do everything they can to try and choose treatment that won’t affect your ability to have children.
A lot of people feel they need counselling to help them sort through their feelings about fertility. Only you will know when the right time for this is. You may want to speak to someone as soon as you find out. Or you may feel you need to focus on your treatment for now. Depending on the treatment you’re having, you may not know for a while whether your fertility has been affected or not.
Which cancer treatments affect fertility in men?
Any treatment that affects your testicles can cause infertility. Some treatments for pelvic cancers can affect ejaculation and also cause infertility. That means:
- Surgery to remove both testicles or surgery for pelvic cancers
- Radiotherapy to your pelvis (lower abdomen), which includes or is near to your testicles
- Hormone therapies
- Some chemotherapy drugs
- Possibly some targeted therapy drugs (also called biological therapies)
If you have testicular cancer, you will have the affected testicle removed. It’s rare to have cancer in both testicles. So as long as your remaining testicle is producing sperm, you won’t be infertile. Sometimes, the remaining testicle doesn’t work so well, so your doctor may suggest sperm banking before your surgery. (There’s more about sperm banking below)
Surgery for other pelvic cancers can sometimes affect fertility. Removing both testicles to cut off testosterone production is a treatment for prostate cancer. This will result in infertility but it isn’t used much now. Other surgery for prostate or bladder cancer can damage the nerves controlling erections. If you have your prostate removed, you will still be able to have an orgasm, but sperm will go backwards into the bladder (retrograde ejaculation) so you will be infertile.
Sometimes surgery to remove lymph nodes from your abdomen can cause damage to nerves that control ejaculation. Your surgeon will try to avoid these nerves as much as possible.
Any radiotherapy to your lower abdomen (tummy) can affect your testicles. For one type of testicular cancer, you may have radiotherapy to the groin, which can mean your remaining testicle won’t be able to produce sperm. With other types of cancer, if at all possible, your radiotherapist will arrange for testicular shielding. This means covering your testicles with a lead shield during your treatment. This reduces the radiation dose and may mean your testicles can still produce sperm. The radiation can damage developing sperm though, so you shouldn’t get your partner pregnant until your doctor tells you it’s safe to do so.
Total body irradiation is a type of treatment used to treat blood cancers - leukaemias, lymphoma and myeloma. After this treatment, you will be infertile. You have a high dose of radiation and usually high dose chemo as well. This will permanently damage the cells in your testicles that make sperm. You can’t have testicular shielding because there is a risk that leukaemia or lymphoma cells may be in your testicles.
This type of treatment won’t make you permanently infertile. But hormone therapy for prostate cancer can make it difficult for you to get an erection and may also lower your sex drive. The treatment can also affect sperm production while you are taking it, lowering your sperm count. All these problems usually go away when treatment is stopped.
Most people think of chemo when they think of cancer treatment making you infertile. But in fact, not all chemo drugs will do this. Your specialist will try to use chemo drugs that are less likely to cause infertility if you’re young and would like to have children in the future.
Unfortunately they can’t always tell how treatment will affect you. Even chemo drugs that are less likely to affect fertility can do. It also depends on the amount of treatment you have, your age when you’re treated and on other types of treatment you might have along with your chemo. During your treatment, you may have a lower sperm count or stop producing sperm altogether. After treatment has finished, sperm production may come back although this can sometimes take years.
While you’re having treatment, you should use a condom when you have sex. We know that some chemo drugs can come through in semen. So to protect your partner it’s best to use a barrier form of contraception.
Targeted and biological therapies
Many of these treatments haven’t been around for long enough for doctors to know how they will affect your fertility. We also don’t generally know how these drugs would affect a developing baby. So it isn’t a good idea to father a child while you’re on treatment. Some targeted treatments are known to cause serious birth defects. If you’re having treatment with drugs called thalidomide or lenalidomide, your doctor will ask that you and your partner both use contraception, just to be safe.
Combinations of treatment
Having more than one type of treatment means that there is a greater chance that your fertility will be affected. Most men are able to father a child after testicular cancer but the rates vary depending on the type of treatment they’ve had. Men who’ve had both chemo and radiotherapy have the lowest success rate, but still more than two out of three who tried successfully had a baby.
Are there any ways of keeping your fertility if you need cancer treatment?
It is generally less problematic for men to keep their fertility after cancer treatment than it is for women. There are a few options. Using frozen sperm will mean that you and your partner will need to have fertility treatment.
You will need to ask your doctor before you start your cancer treatment if you would like to bank some sperm. Sperm banking is an option for all men and boys past puberty to have sperm frozen and stored for use in the future. You’ll need to have blood tests for HIV and Hepatitis, as this is standard procedure for anyone banking sperm.
You produce a sperm sample through masturbating and this is frozen and stored in multiple ‘straws’. Each straw can be thawed individually so you don’t have to use all your sperm in one go. If possible, the clinic will ask you to produce two or three samples over a few days. But if you only have time to give one before your cancer treatment, that may be enough. It’s best not to have sex or masturbate for a few days before giving a sample. That way you’ll have more sperm in the sample. Most men find all this a bit embarrassing. You will of course have a private room at the clinic to provide your sample. If you can get the sample to the clinic in less than 45 minutes, you may be able to produce it at home and then take it straight there (keeping it warm on the way).
You can store sperm for 10 years or more, sometimes up to 55 years. You must keep in touch with the clinic so that they know you still want your sperm kept. The NHS provides sperm storage for men with cancer, so you shouldn’t have to pay. If you go to a private clinic, there will be an annual storage fee.
When you want to have a baby, some of your sperm can be thawed and either used to directly inseminate your partner, through IVF (test tube baby treatment) or in a fertility treatment called ICSI (see below). There’s no difference in success rates in IVF between fresh and frozen sperm.
If you can’t produce a sample for any reason, it might be possible for a doctor to electronically stimulate your pelvic nerves that control ejaculation. This won’t help if you have retrograde ejaculation but they may be able to collect sperm from your urine in that case (see below).
Surgical sperm recovery
If you can’t ejaculate to provide a sperm sample, you may be able to have sperm collected directly from your testicle. This means having a minor operation. While you are under anaesthetic, the surgeon will put a very thin needle into your testicle and remove some fluid or tissue. Sperm can be extracted from that and then frozen, as in sperm banking.
Getting sperm from your urine
If you have had surgery that means your sperm go back into your bladder when you ejaculate, it may be possible to collect sperm from your urine. You have a drink that affects your urine and makes it less toxic to sperm. You then have a pee, masturbate and then pee again. Sperm is then collected from this second urine sample and stored.
Your specialist may suggest a fertility treatment called ICSI if
- You weren’t able to bank sperm before you started treatment AND
- Your sperm quality has been affected by your treatment OR
- You banked sperm before treatment but it’s poor quality because of other reasons.
ICSI means that individual sperm are selected from your sample and injected directly into your partner’s egg before this is implanted during IVF. This can be done with sperm that has just been collected or with thawed sperm from a sample that has been banked.
This is more likely to be successful than simply mixing the egg with the sperm sample, which is how regular IVF is done.
If you don’t have any sperm frozen and then become infertile because of your treatment, there is the possibility of using donor sperm to get your partner pregnant. It’s best to do this through a fertility clinic. You’ll have the reassurance of knowing that the donor sperm will have been tested for infection and the donor’s medical and family history checked for inherited diseases that they could pass on. You can still use someone you know if you prefer. The clinic can give them all the tests and checks.
Testicular tissue freezing
As with ovarian tissue, researchers have been looking into the possibility of removing testicular tissue, freezing it and then putting it back later. The idea is that you can then produce sperm and father a child in the regular way. At the moment, this is still experimental though.
It’s likely to be most useful for young boys who haven’t started producing sperm yet. It is worth asking your cancer specialist whether it could be an option if you’re a parent of a boy diagnosed with cancer that could affect his future fertility.