Male fertility following cancer treatment

The diagnosis of cancer and the treatment that follows can be extremely stressful. Treatment options can include surgery, chemotherapy, radiation therapy and hormonal manipulation.

Many types of cancer treatment can affect male fertility either temporarily or permanently. Before your recommended treatment plan begins, it is important to talk with your doctor and other members of your health care team about how your fertility may be affected, as well as your options for preserving it.

How cancer treatments affect fertility

The endocrine glands and endocrine-related organs – such as the testes, thyroid and adrenal gland – release hormones that stimulate puberty and control fertility. Fertility problems occur when cancer, or cancer treatments, damage one of these glands or organs, or alter the part of the brain that controls the endocrine system.

The biggest concern for men is usually whether their treatment plan can damage sperm, affect their ability to make new sperm, or reduce or stop the production of semen (fluid in which sperm travels during sex). These changes increase the chances of infertility.

Cancer treatments that have known or potential fertility-related side effects include:

Chemotherapy: Drugs linked to fertility issues include alkylating agents, such as cyclophosphamide, chlorambucil, busulfan, procarbazine, carmustine, and melphalan (Alkeran), as well as cisplatin.

Radiation therapy: Radiation treatment may kill sperm cells and the stem cells that produce sperm. This includes whole-body radiation that is used during a bone marrow or stem cell transplantation, as well as radiation directed at the abdomen, pelvis, lower spine, on or near the testicles and the pituitary gland in the brain.

Surgery: Removal of the prostate, bladder, one or both testicles, or the pelvic lymph nodes may decrease fertility or cause infertility – depending on the procedure.

Fertility effects

For some men, cancer treatment leads to permanent infertility. In others, treatment may stop or slow sperm production for years before it returns. In general, men who receive higher doses of radiation therapy or chemotherapy need to wait longer for sperm production to begin again and have a higher likelihood of being permanently infertile.

Other factors, such as existing fertility issues or age, also affect fertility. Younger boys who receive treatment for cancer before undergoing puberty typically may not have as much sperm damage, while men over age 40 are less likely to regain fertility. Stronger cancer treatments, such as preconditioning chemotherapy for bone marrow/stem cell transplants may still cause permanent future infertility in children, though.

Many doctors recommend that men who had chemotherapy or radiation treatment wait at least two years after treatment before conceiving a child with their partner because their sperm may be genetically damaged and need time to repair.

It is important to note that although cancer treatments may make it less likely, a pregnancy can still occur.

Talk with your doctor about an appropriate time frame for you.

Fertility-preserving options

Most fertility-preserving procedures need to be performed before cancer treatment begins. Age, physical and sexual maturation and relationship status affect your options. Your regular doctor, or a doctor who specialises in fertility issues can help you explore those options, which may include:

Protecting the testes from radiation therapy: It is possible to shield the testes from radiation and prevent sperm damage if the cancer is located in another part of the pelvis.

Sperm banking: This procedure involves freezing and storing semen for in vitro fertilisation (IVF) procedures – a process that involves collecting a woman’s eggs and fertilising them with the stored sperm outside her body, for the purpose of later transferring the embryo back into her body for it to develop. It is an option for most men who experienced puberty. Even if few sperm are preserved, it is still possible to attempt pregnancy through a procedure called intracytoplasmic sperm injection (ICSI). During ICSI, a sperm is injected directly into an egg obtained during IVF procedures.

Testicular sperm extraction and epididymal sperm aspiration: For men who do not have mature sperm in their semen, this procedure involves removing a small amount of tissue from the testicle. This tissue is examined under the microscope for mature sperm, which can be frozen or used immediately for IVF.

Testicular-tissue freezing: This investigational option for boys who have not experienced puberty involves removing, freezing, and storing testicular tissue, which contains stem cells that may eventually become sperm, before treatment begins. Researchers are studying how to thaw the tissue and surgically put it back into the body to restore sperm-producing capabilities.

Not all of these options are appropriate for everyone. Some fertility-preserving procedures can be costly and stressful during an already stressful time and their effectiveness varies. Concerns about future fertility and making decisions about fertility preservation are stressful for many people. Talk with your doctor about referrals for counseling or other types of support to help you cope with these challenges.