Questions to ask your health care team:
- Will my cancer treatments affect my fertility?
- Are there alternative ways to treat my cancer without compromising my fertility?
- What are my fertility preservation options?
- How much time do I have to preserve my fertility before I need to start my cancer treatments?
- How will I know if I am fertile after treatment? Are there tests that I can take?
- If I do not preserve my fertility, what are my parenthood options after treatment?
- How long should I wait after treatment before trying to have a family?
- What are the risks to my children based on my cancer and the treatment I receive?
- Can you refer me to a fertility clinic or reproductive specialist?
Male infertility is an inability to produce healthy sperm or to ejaculate sperm. Although sperm production usually recovers after cancer treatment, you should discuss the risks of infertility with your health care provider before cancer treatment begins. There are many ways men can preserve their fertility, which are explained further in our "Fertility Preservation Options for Men" article.
The risk of infertility from cancer treatments depends on many things including:
|Chemotherapy||Type, duration and dose|
|Radiation||Location and dose|
|Surgery||Location and scope of surgery|
|Other||Age, pre-treatment fertility status and cancer type|
The possibility of infertility can affect you emotionally, leaving you sad or upset. However, it's important to get help with fertility preservation as soon as possible. Your health care team can refer you to a licensed counselor who can help you through the emotional experience. You may also want to contact LIVESTRONG Cancer Navigation Services to get one-on-one emotional support, connections to support groups and connections to other survivors who have had a similar diagnosis.
Cancers that Could Cause Male Infertility
Some types of cancer temporarily lower a man’s fertility. Infertility is most likely to happen before cancer treatment and just after treatment is finished. An initial analysis may show infertility, but the results could change over the next month or even years.
For those who will recover sperm production, semen analysis will usually improve within one–three years after finishing cancer treatment. However, some men improve many years later. Men should use effective means of birth control even if there is possibility of infertility.
Fertility may be poor during the two years before testicular cancer is discovered. Although only one–three percent of men with testicular cancer get cancer in both testicles, the cancer-free testicle may not function normally. On the other hand, men treated for testicular cancer often end up with improved semen quality within several years.
Newly-diagnosed Hodgkin disease, lymphoma or leukemia
Recent surgery, fever or physical stress experienced by survivors may affect the quality of semen.
Treatments that Could Cause Male Infertility
Both cancer and cancer treatments can damage fertility. Here are some common treatments and their possible effects on fertility.
Radiation therapy can slow down or stop sperm cell production if the testicle is in or near the target area for the radiation. A shield can help protect the testicles, but radiation can “scatter” within the body, so it's difficult to shield the testicles completely. Total body irradiation used before some bone marrow transplants often causes permanent infertility. If the testicles get a mild dose of radiation, a man’s fertility may decrease but could recover over the next one–four years. If the radiation dose to the testicles is high, sperm production may be permanently damaged. Radiation damage to the part of the brain that controls hormone production can sometimes interfere with the hormone messages that control sperm production in the testicles.
The alkylating chemotherapy group does the most damage to fertility. It can cause germ cell loss or destruction and impact testosterone levels, which are crucial to male fertility.
Surgery to treat prostate or bladder cancer removes the prostate and seminal vesicles. These glands make the liquid part of a man's semen. They also cut the pathway for sperm cells to be included in the semen. Men with testicular cancer or colon cancer sometimes have surgery that can cause ejaculatory dysfunction.
Testing for Fertility
A man’s fertility status both before and after treatment can affect his ability to have children after cancer. A semen analysis is a simple way to test fertility. A sample is collected very soon after ejaculation and examined under a microscope. The analysis usually includes at least three scores that define semen quality:
- The sperm count is the number of sperm present. A normal count is at least 20 million sperm per milliliter of semen.
- The motility is the percentage of sperm that are actively swimming around. At least 50 percent of the sperm should be motile.
- The morphology is the shape of the sperm. It is considered normal if at least 30 percent of the sperm have an ideal shape. Some labs use a different (Kruger) scoring system which is stricter—only 14 percent of sperm cells need to have an ideal shape with this system.
Anserini, P., S. Chiodi, S. Spinelli, et al. “Gonadal Function Post Transplantation: Semen Analysis following Allogeneic Bone Marrow Transplantation. Additional Data for Evidence-Based Counseling.” Bone Marrow Transplantation 30 (2002): 447-51.
Bahadur G, Ozturk O, Muneer A, Wafa R, Ashraf A, Jaman N, Patel S, Oyede AW, Ralph DJ. Semen quality before and after gonadotoxic treatment. Human Reproduction 20 (2005):774-81.
Chan PT, Palermo GD, Veeck LL, Rosenwaks Z, Schlegel PN. Testicular sperm extraction combined with intracytoplasmic sperm injection in the treatment of men with persistent azoospermia postchemotherapy. Cancer92 (2001): 1632-7.
Eskenazi, B., A.J. Wyrobek, E. Sloter, et al. “The Association of Age and Semen Quality in Healthy Men.” Human Reproduction 18 (2003): 447-54.
Frias, S., P. Van Hummelen, Marvin L. Meistrich, et al. “NOVP Chemotherapy for Hodgkin's Disease Transiently Induces Sperm Aneuploidies associated with the Major Clinical Aneuploidy Syndromes Involving Chromosomes X, Y, 18, and 21.” Cancer Research 63 (2003): 44-51.
Golombok, Susan, F. MacCallum, E. Goodman, M. Rutter. “Families with Children Conceived by Donor Insemination: A Follow-Up at Age Twelve.” Child Development 73 (2002): 952-68.
Hjelmstedt, A., L. Andersson, A. Skoog-Svangerg, et al. “Gender Differences in Psychological Reactions to Infertility among Couples Seeking IVF- and ICSI-Treatment.” Acta Obstetrica Gynecologica Scandinavica 78 (1999): 42-8.
Kiserud CE, Schover LR, Dahl AA, Fosså A, Bjøro T, Loge JH, Holte H, Yuan Y, Fosså SD. Do male lymphoma survivors have impaired sexual function? Journal of Clinical Oncology 27 (2009): 6019-26.
Pasch, Lauri A., Christine Dunkel-Schetter, Andrew Christensen. “Differences between Husbands' and Wives' Approach to Infertility Affect Marital Communication and Adjustment.” Fertility and Sterility 77 (2002): 1241-7.
McIntosh, G. C., A. F. Olshan, P. A. Baird, et al. “Paternal Age and the Risk of Birth Defects in Offspring.”Epidemiology 6 (1995): 282-8.
Schover, Leslie. Overcoming Male Infertility: Understanding Its Causes and Treatments. New York: John Wiley & Sons, 2000.Shaw, Gina. Having Children After Cancer: How to Make Informed Choices Before and After Treatment and Build the Family of Your Dreams. Berkeley, CA: Celestial Arts, 2011.
Yogev L, Kleiman SE, Shabtai E, Botchan A, Paz G, Hauser R, Lehavi O, Yavetz H, Gamzu R. Long-term cryostorage of sperm in a human sperm bank does not damage progressive motility concentration. Human Reproduction 25 2010): 1097-103.
Wyns C, Curaba M, Vanabelle B, Van Langendonckt A, Donnez J. Options for fertility preservation in prepubertal boys. Human Reproduction Update 16 (2010): 312-28.