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1. How can chemotherapy, radiation and surgery pose a risk to fertility?
Cancer treatments like chemotherapy are designed to kill rapidly dividing cells throughout the body while leaving other cells intact. Cancer cells divide rapidly, but so do sperm cells in men. Thus, infertility is a potential side effect of cancer treatment, as damage to the testicles can occur. Individual factors like patient age, drug type, drug combinations and total drug dose affect the chance of becoming permanently infertile. Generally, younger men have a better chance of regaining fertility.
Radiation therapy also kills rapidly dividing cells, but only in or around its target area. If the radiation field includes the brain, it may affect fertility by damaging areas that control hormone production. Radiation therapy aimed close to, or at, the pelvic areas of the body can also cause infertility by directly damaging the testicles. In some cases, a shield can be used to protect the reproductive system. The location of the radiation field and the total dose will affect each individual somewhat differently.
Surgery to remove part or all of the reproductive system can cause infertility. When undergoing surgery it is important to understand which organs will be removed and their effect on fertility. It may be helpful to ask your treatment team to show you diagrams of your operation and to explain what to expect in terms of future fertility.
2. How many sperm samples should I bank?
There is no definite answer to this question. Generally, the more you bank the better, but after two or three specimens the additional benefit becomes marginal. Consider how many children you would like to have in the future as well as the quality of your sperm at the time you bank. Most sperm banks can run a semen analysis to give you a better idea of the viability of your sperm to help you make the decision of whether or not to bank additional specimen.
3. Should I still bank if my sperm count is low?
Generally, the more sperm you have and the better the quality of the sperm, the higher your chances are of achieving pregnancy. But, even if your sperm count is very low or of very poor quality, it is possible to bank it and successfully achieve pregnancy later. As a result of new reproductive technologies, a single sperm may be enough to achieve pregnancy. A specific technique called intracytoplasmic sperm injection (ICSI) allows for placement of individual sperm directly into a woman’s egg to create an embryo.
4. What is intracytoplasmic sperm injection (ICSI)?
ICSI is a procedure in which a single sperm is injected into a woman’s egg to create an embryo. Prior to the invention of ICSI, many sperm would be placed in a petri dish with one egg. One of the many sperm would penetrate the egg, fertilize it and create an embryo, which is the basic process of conception that occurs naturally inside a woman’s body. However, if the sperm quality was poor or there were not enough sperm, a fertilized embryo could not always be achieved through this method. With ICSI, the embryologist can choose the best sperm (usually the best shaped and fastest moving) and inject it directly into the egg with a needle. The result is a higher pregnancy rate. ICSI has revolutionized reproductive medicine and helped thousands of people who would otherwise be unable to achieve pregnancy.
5. Is it safe to bank sperm if I have already started cancer treatments?
This is not an easy decision, and you should talk with your health care team before banking sperm during any cancer treatment. Research shows that sperm cells and the stem cells that create sperm can be genetically damaged from cancer treatments like chemotherapy and radiation. DNA integrity may be compromised even after a single treatment. As a result, it is strongly recommended that you bank your sperm prior to starting chemotherapy and radiation. For men whose treatment regimen has consisted of surgery, there is no evidence to suggest that anesthesia has an effect on fertility, so you may safely bank sperm after surgery.
6. How long can sperm be frozen?
Sperm can be frozen indefinitely. Damage to the sperm occurs during the freezing and/or thawing processes, not while it is frozen. As long as sperm is successfully frozen, and it is kept in proper conditions, it can survive for many, many years. In 2004 a baby was born using sperm that had been frozen for 28 years.
7. Is sperm banking by a mail-in kit as effective as banking on-site at a sperm bank?
Sperm banks that have mail-in kits cannot guarantee the quality of the specimen. Factors that are out of the sperm bank’s control include quality of the sample and events that may happen during transit. Due to these factors, banking at a clinic might produce a higher-quality specimen than banking by mail. However, using a mail-in kit is a convenient and effective alternative to visiting a clinic. In addition, the kit allows for you to collect your specimen in a place where you feel comfortable. This method is also helpful if it is difficult for you to leave your house or the hospital.
8. Can anyone else use my sperm?
The sperm bank will release the sperm only to another sperm bank, physician or any other party with your authorization. No one else can authorize the release of the sperm. An advanced medical directive, or other legal paperwork, can be useful to ensure that the sperm cannot be used without your consent or to give someone else the legal right to use your sperm. It is important to carefully read all the documents presented to you at the sperm bank.
9. If I didn't preserve my fertility before my cancer treatments is it too late to conceive, or do I have options?
The ability to conceive after treatment depends on your cancer type and treatment regimen. You should consult with you health care team regarding your individual circumstances. Some men are able to achieve pregnancy naturally after treatment, but it is important to talk with a doctor about your own fertility status. You can also reference our Family-Building Options Tool and the Parenthood Options for Men article.
10. After cancer, how do I know if I am fertile?
The answer to this question is best discussed with your oncologist and may require consultation with a fertility specialist or urologist. If you have been attempting to achieve pregnancy for six to 12 months or longer without success, you may be experiencing infertility. Depending on your individual situation, including cancer type and treatment history, simple tests (such as a blood test to measure pituitary gonadotropins) may give you valuable information about your fertility status.
A simple way of measuring fertility after cancer treatment is to have a semen analysis. This procedure will provide data on how much sperm you are producing and the quality of your sperm. Men who undergo chemotherapy or radiation therapy may want to wait one to three years to see how much their fertility will recover. If you continue to produce sufficient numbers of sperm that have good motility (swimming power), you may be able to conceive naturally. Men who produce low sperm counts and/or have low motility may need to use Assistive Reproductive Technology (ART) to conceive. If you no longer produce any sperm, testicular sperm extraction, donor sperm and adoption may be options for parenthood.
11. After cancer, how long should I wait to try to conceive?
Most patients are told to wait two years. This number stems from a few different factors. First, most cancer reoccurrence occurs within two years after completion of treatment. Second, sperm exposed to chemotherapy and/or radiation may suffer genetic damage. For sperm, much of this damage is believed to repair itself within two years. It is important to consult with your medical team to determine your individual circumstances.
12. Do cancer survivors have trouble adopting?
There is no published research on this subject. Anecdotally, most adoption agencies state that they do not rule out cancer survivors as parents. However, adoption agencies often require medical examinations and/or a complete medical history. Most ask for a letter from an oncologist saying that the survivor has a good prognosis. Some also require that a cancer survivor achieve his five-year cancer-free anniversary before becoming eligible.
Some countries that participate in international adoption do not work with cancer survivors, or require a certain number of cancer-free years. Adoption methods vary greatly from public to private and domestic to international. It is important to research and understand the health restrictions of the agencies you choose to work with. You may want to visit our Fertility Resource Guide for a list of agencies.
13. Does age play a role in fertility after cancer?
In men, evidence suggests that fertility diminishes to some extent after age 40. Cancer treatments can affect fertility in men of all ages, including boys who have not yet reached puberty. Chemotherapy may be more damaging to sperm production in men older than the age 40.
14. Do other diseases or treatments lead to infertility?
Yes, hundreds of other diseases and treatments can lead to infertility. For example lupus, multiple sclerosis and rheumatoid arthritis patients may undergo chemotherapy and therefore be at risk for infertility or reduced fertility. Even common diseases like diabetes and health issues such as obesity or smoking can contribute to infertility. It is important to ask your medical team about the effects of any diseases or treatments that may negatively impact your reproductive system.
15. My insurance company does not cover my treatments. Are there ways to petition?
There are many insurance policies that fully or partially cover infertility treatments; you should call your insurance company to find out about your coverage. However, it is less likely that your insurance will cover fertility preservation as part of this coverage due to requirements associated with the diagnosis of infertility. A cancer patient generally will not meet that definition, since the patient is not infertile at the time of diagnosis. As a result, even if cancer patients have insurance with fertility coverage, they may be denied benefits because they do not meet the definition of "infertile." Some patients with existing fertility coverage have successfully petitioned for coverage on the following grounds:
- Infertility is a side effect of a necessary medical treatment. Coverage for the testing, prevention and treatment of all other side effects for this treatment are covered. Fertility treatments should be treated equally in this scenario.
- Fertility treatments are covered by the plan, but only at the point that the patient is diagnosed with infertility. As a cancer patient, one has the unfortunate foresight to know they will be infertile and therefore the coverage should start prior to the diagnosis.
Here is an example of a drafted petition letter.
More and more legislators and insurance providers are considering this coverage. For more information about insurance laws in your state, please see the American Society for Reproductive Medicine’s website. And for more information insurance coverage read the Fertility and Insurance article.
16. Are birth defect rates in children born to cancer survivors who underwent chemotherapy and/or radiation higher than the rates of birth defects in children whose parents have had no such treatment?
Rates of birth defects in the general population are two to three percent. Studies to date strongly suggest that children born to cancer survivors are no more likely than the general population to have birth defects. A few types of cancer (perhaps five to ten percent of all cancers) involve a mutated gene that can be passed from parent to child. If you have a strong family history of cancer you may want to consult a geneticist or genetic counselor to see if your children would have higher lifetime cancer risks than usual. Preimplantation genetic diagnosis (PGD) is a technique used by these professionals to understand the genetic health of an embryo.
17. What is preimplantation genetic diagnosis (PGD)?
Preimplantation genetic diagnosis (PGD) is a technique used during in-vitro fertilization (IVF) to test embryos for genetic disorders. PGD makes it possible for individuals with serious inheritable disorders to decrease the risk of having a child who is affected by the disorder. For example, it is now possible to use this technique to help decrease the risk of passing on a cancer-predisposing gene to your offspring.
18. Do chemotherapy and/or radiation cause genetic damage to sperm cells? If so, how long does it take to heal?
Sperm may suffer genetic damage, but research shows that the sperm cell supply appears to repair within two years.
19. Do children born to cancer survivors have higher risks of getting cancer themselves?
Research suggests that no unusual cancer risk has been identified in the offspring of cancer survivors except in families identified with true genetic cancer syndromes, for example, inherited retinoblastoma.
20. My child is prepubescent. Are options available to preserve his fertility?
For prepubescent boys, testicular tissue can be frozen. This procedure is still experimental and limited data on success rates exists, especially for children. Currently testicular tissue freezing is the only option available for prepubescent boys undergoing chemotherapy. For prepubescent boys undergoing radiation to the reproductive area, gonadal shielding is another option that could preserve fertility.
21. If I froze sperm prior to treatment, but am still producing sperm after treatment, should I use the frozen sperm or try to conceive naturally?
This decision should be made with the help of your health care team. Most infertility specialists would recommend that cancer survivors who recover fertility should try to conceive naturally with the sperm they are producing, if the time after treatment (generally, two years is recommended) and quality of sperm are sufficient. There is currently no proof of an increased risk of birth defects in children born after cancer treatment. While conceiving naturally is generally preferred over using frozen sperm, there are other factors to consider for each individual’s situation.
22. What strategies can help me cope with the emotional aspects of infertility in addition to cancer?
Many cancer patients feel like cancer-related infertility is a double blow. Feelings of anger, denial, depression, resentment, blame, and lack of control are common and understandable. You may experience a wide array of emotions as you deal with fertility issues during your cancer journey. You may find it helpful to talk to trusted members of your support system or to a professional counselor or social worker to help you process these feelings. LIVESTRONG offers cancer support services, which include both fertility preservation services and emotional support. Learn more about our cancer navigation services.