It is generally recommended that you wait six months-two years after you finish your cancer treatments before having your fertility tested, when sperm production has returned to normal. You should always check with your health care team for advice on your particular situation.
Don’t assume fertility or infertility—there are survivors who thought they were infertile and accidentally got their partner pregnant. If your partner is not pregnant after six months–one year of trying, you may want to see a reproductive endocrinologist and explore other ways to achieve parenthood.
When considering parenthood after cancer you may also be asking yourself: Will my children get cancer? Just because you had cancer does not mean your child will get cancer as well. Unless your cancer is genetically linked, your child’s risk of developing cancer is the same as that of the general public (two–three percent). Only a small percent of cancers are known to be hereditary. You may want to meet with a genetic counselor to better understand your risk factors.
Using Banked or Donated Sperm
If you banked sperm prior to your cancer treatments, it can be used to try to achieve pregnancy. If you did not bank sperm, using donor sperm is another way for infertile men to become a parent after cancer. On average, using banked or donated sperm costs $300–$750 per vial (in addition to costs for IUI or IVF).
Major sperm banks in the United States collect sperm from young men who go through a detailed screening of their physical health, educational and emotional history, family health history and even some genetic testing. Couples can choose a donor who matches their physical traits, educational record or talents. Couples can choose a donor who will remain anonymous or who is willing to have contact with a child later in life.
You can use banked or donor sperm to try to achieve pregnancy in the following ways:
Intrauterine Insemination (IUI)
IUI is a short procedure (usually five–10 minutes) in which a health care provider injects sperm into a woman’s cervix or uterus close to the time of ovulation (when an egg is released). Sometimes this is done when she ovulates naturally without the use of any fertility medications. However, the pregnancy rate of IUI can be significantly improved if the woman takes fertility medications to help mature her eggs. Sperm will be put directly into the woman’s uterus through her cervix using a catheter. Sperm can be fresh or previously frozen if you froze sperm prior to treatment.
On average, IUI costs $300 to $750 per cycle. Monitoring and medications can be an additional $2,500–$5,000. Success rates (meaning live babies born from the procedure) can range anywhere from 10–40 percent per IUI cycle, increasing to 50–70 percent after six IUI cycles. As with all reproductive techniques, the success rates vary greatly based on the woman’s age and fertility status, quality of the sperm and the experience of your reproductive center.
Many couples choose this as the first step in treatment because it is less invasive and less expensive than other treatment options.
In Vitro Fertilization (IVF)
IVF is an assisted reproductive technique in which a woman’s eggs are removed from the ovary and fertilized with sperm in the lab to create embryos.
In order for your female partner’s eggs to be retrieved, they have to be matured using injectable hormones. This process requires your female partner to use daily, self-administered injections of hormones for approximately 10–12 days, during which time she has regular blood tests and vaginal ultrasounds to monitor her progress. This process causes her ovaries to mature more eggs than they would in a natural menstrual cycle. For example, during a normal menstrual cycle one or two eggs mature whereas with ovarian stimulation as many as 10, 20 or 30 eggs could mature.
The eggs are retrieved through a 10–20 minute surgical procedure under general anesthesia. It is done vaginally by needle aspiration, so there are no scars. Once the eggs are collected, they can be fertilized in one of two ways. First, the sperm and eggs can be mixed together allowing the sperm to find and penetrate the eggs on their own. Second, through Intracytoplasmic Sperm Injection (ICSI), one sperm (usually the highest quality sperm as seen through a microscope) can be injected with a needle into the egg.
The resulting embryos usually grow and develop in the lab for three–five days. They then can be frozen for future use or used immediately to try to achieve pregnancy. If used immediately, a select number of embryos (usually one–three) will be implanted into your partner’s uterus during an outpatient procedure that takes less than an hour. The remaining embryos can be frozen for future use.
The success rates per frozen embryo transfer is 30–40 percent in the U.S. and varies by maternal age and reproductive center. Thousands of babies are born each year using this assisted reproductive technique.
On average, IVF costs $12,400 per cycle, not including medications which can range from $2,500–$5,000 or storage that can cost up to $400 a year.
Choosing the Right Assisted Reproductive Option for You
A number of factors may go into your decision-making process including cost, your partner's fertility status and the quantity and quality of banked sperm. Here are rough guidelines for how much sperm is needed for each option:
|IUI||Five million motile sperm per cycle|
|IVF||50,000–100,000 per egg per cycle|
|IVF with ICSI||One sperm per egg per cycle|
It is important you discuss these options and your partner's fertility status with your reproductive endocrinologist when you return to use the sperm to try to achieve pregnancy. Your health care team can give you the information you need to select the best method for you.
Using assisted reproductive technologies such as IVF or IUI may not be consistent with some men’s religious beliefs and practices. If you are concerned about this, please contact a trusted leader in your place of worship to discuss these beliefs.
Testicular Sperm Extraction
Testicular sperm extraction (TESE) is possible for males who do not have mature sperm present in their semen after cancer treatments. This means that if you did not bank your sperm prior to starting cancer treatments and currently have no sperm in your ejaculate, there may still be sperm in your testicular tissue that can be used with IVF to try to achieve pregnancy.
TESE is an outpatient surgical procedure available for males after puberty. Testicular tissue is obtained, usually by open biopsy, and then examined for sperm cells. If sperm cells are found, they are removed and used immediately or frozen for future use with IVF and ICSI.
Success rates vary depending on the exact technique of the biopsy used, but range from 30–70 percent. Studies have shown the presence of live sperm in 37 percent of men who had no sperm in their ejaculate after cancer treatment.
The average cost of testicular sperm extraction is $6,000–$16,000. Some insurance companies pay for the procedure if it is performed in conjunction with other treatments. There is such a wide range in cost because many factors are involved: hospital fees, anesthesia, staff time and equipment. If TESE is done at the same time as IVF to achieve pregnancy, there are additional costs.
Adoption is a viable option that can be considered by anyone seeking parenthood.
Adoption can be domestic, international, open or closed. Open adoption refers to a process in which the birthmother is known to you and you to her. The possibility for contact before and after the birth is possible. Closed adoptions are private in that you and the birthmother will have limited information about one another and no information about one another’s identities. You also may consider foster care with the possibility of adoption.
Regardless of which route you take, every state has laws that regulate adoption. In most cases, state-certified social workers will assist you in the process. Adoption agencies may be private nonprofit organizations, such as Jewish Family and Children’s Services or Catholic Charities. They may be local or state government bodies such as county child welfare service agencies. There are also for-profit organizations and lawyers that specialize in coordinating domestic and/or international adoptions.
Most adoption agencies report that they do not rule out cancer survivors as potential parents, especially with documentation from a doctor stating that lifespan and quality of life are expected to be good. However, some agencies do require a certain amount of time to pass before allowing a survivor to be eligible (e.g., five years). The adoption process takes time (six months–two or three years) and costs vary greatly, from $0–$40,000.