Patient education: Preserving fertility after cancer treatment in men (The Basics)

What is fertility? — For men, "fertility" means the ability to get a partner pregnant. "Preserving fertility after cancer treatment" involves doing things before or during cancer treatment to raise the chances of being able to get a partner pregnant later.

Which cancer treatments can cause fertility problems? — Cancer treatments that can cause fertility problems include:

●Chemotherapy – Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing.

●Radiation therapy – Radiation involves getting high doses of X-rays.

●Surgery – If both of your testicles are removed, you will no longer make sperm (figure 1). This means that you will not be able to get a partner pregnant. (If only 1 testicle is removed, you might still be able to get someone pregnant.) Also, surgery near the testicles and penis sometimes damages nearby nerves. Nerve damage can make it hard to ejaculate. If ejaculation doesn't happen, sperm can't exit the penis. But in some cases, doctors can remove sperm directly from the testicles to help a couple get pregnant.

Both chemotherapy and radiation can damage the testicles. As a result, the testicles make no sperm, too little sperm, or unhealthy sperm. This is a problem because you need to have a normal number of healthy sperm to get a partner pregnant.

Not everyone who gets chemotherapy or radiation will have fertility problems. With chemotherapy, it depends on the medicine and the dose. With radiation, it depends on the dose and part of the body treated.

What should I do if I want to have children someday? — You should let your doctor know before you start your cancer treatment. In some cases, treatment that has a lower chance of affecting future fertility might be available.

Are there other ways to preserve fertility? — Yes. The main things that can be done to help men preserve their fertility are:

●Sperm banking – This involves collecting and freezing your sperm before you start cancer treatment. To collect your sperm, you will need to ejaculate. If you can't ejaculate, or if there is no sperm in your semen, your doctor can do a procedure to remove sperm from your testicle. After the sperm is collected, it is frozen and stored until needed.

Sperm banking is not a guarantee that you will be able to get a partner pregnant. But it is the most important thing that you can do to preserve your fertility. If you are interested in sperm banking, tell your doctor.

●Shielding your testicles during radiation treatment – This involves wearing a special shield on the outside of your body during radiation treatment. The shield covers and protects your testicles, so they aren't damaged by the radiation.

What if I still can't get my partner pregnant? — If you still have problems with fertility after cancer treatment, you have other options. Some people choose to try to have a baby using "donor" sperm from a sperm bank. In addition, adoption might be an option.

Couples can have a tough time making these decisions. You might find it helpful to talk to a counselor or go to a support group for people who are experiencing the same issues.

More on this topic

Patient education: Testicular cancer (The Basics)
Patient education: Radiation therapy (The Basics)
Patient education: Male infertility (The Basics)

Patient education: Testicular cancer (Beyond the Basics)