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Read BlogSome men are not able to have children due to the effects of cancer treatment. By identifying your risk for infertility, you can take steps before treatment to preserve your fertility. For men who have completed treatment, see “Family Building Options” below. There are options for survivors who experience infertility as a result of cancer or treatment. Contact Livestrong Navigation Services to learn more about how we can help you explore fertility preservation options.
Male infertility is an inability to produce healthy sperm or to ejaculate sperm. Although sperm production usually recovers after cancer treatment, but discuss the risks of infertility with your healthcare provider before cancer treatment begins. Sperm can be preserved and frozen for future use. However, if you have already started treatment, chemotherapy or radiation can cause genetic damage to sperm cells. Set up an appointment with a member of your health care team to discuss concerns or questions you may have. Ask for a referral to a fertility clinic or specialist.
Learning about infertility can cause stress. You may worry about the impact on your relationship or feel a loss of self-esteem. Talk with your health care provider if you think that the topic of infertility may be having an impact on your emotional well-being and consider whether a support group or some counseling could be helpful.
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 to 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.
Testicular cancer: Fertility may be poor during the two years before testicular cancer is discovered. Although only one to 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's disease, lymphoma or leukemia: Recent surgery, fever or physical stress experienced by survivors may affect the quality of semen.
Cancer treatment, not cancer itself, is often what damages fertility. Here are some common treatments and their possible effects on fertility.
A man is at higher risk for infertility if he gets two or more alkylating chemotherapy drugs, has higher doses of chemotherapy (for example before a stem cell or bone marrow transplant), or has a combination of chemotherapy and pelvic or whole body radiation. High doses of chemotherapy can damage sperm cell production and the testicles’ ability to make testosterone. This hormone is crucial in a man’s fertility.
A semen analysis tests a man's 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:
How it works: Before beginning chemotherapy or radiation, a man produces a semen sample at a medical laboratory or sperm bank or from home. Masturbation is the preferred method, since even using a condom during intercourse could leave the semen contaminated with bacteria. Samples produced at home need to be kept at body temperature and delivered to the lab within an hour. Some sperm banks provide kits a man can use at home, mixing a preserving chemical with his semen and using overnight mail to the lab. A semen analysis is done. As long as the sample contains some live sperm cells, it can be frozen and stored for future use in infertility treatment. Once frozen, samples can be kept for at least 20 to 30 years (possibly longer) without further damage.
How it works: If a boy is too young to produce sperm cells but will have a high risk of infertility after his cancer treatment, an experimental option is to put him under anesthesia for an outpatient surgery, remove several areas of tissue from his testicles, and freeze that tissue for future use. Once he is an adult and free of cancer, if he is indeed infertile he could use the tissue in one of several ways. None of these methods has yet produced the birth of a live baby, however. The tissue pieces could be thawed and put back into his testicle in the hopes that they would begin to produce sperm. This is a delicate process that would only work if his hormones were normal and his testicles were at a good temperature with a good supply of blood circulation.
When less than two million sperm cells are available for infertility treatment, the usual choice is to use them in In Vitro Fertilization with Intracytoplasmic Sperm Injection (IVF-ICSI).
How it works: The woman who will carry the child must undergo hormone shots for several weeks to stimulate her ovaries to ripen more than one or two eggs. The woman's eggs are harvested or collected through a minor outpatient surgery. The harvested eggs are cleaned in the laboratory and stored in individual dishes to be ready for fertilization. The embryologist uses a special microscope to choose a healthy-looking sperm and injects it into an egg. If all goes well, several embryos can be created. Usually just one or two embryos are placed into the uterus of the female partner in the hopes that they will implant and start a pregnancy.
This option is for men with semen quality that is closer to normal.
How it works: A man's semen sample is purified and concentrated to contain as many active sperm as possible. In a health care provider's office, the sample is put in a thin catheter (tube) and slipped directly through the woman's cervix into her uterus to give the sperm a head start on fertilizing the egg. The procedure is done at a woman’s midcycle, her fertile time of month. Sometimes the woman is given extra hormones to ripen more than one egg, but not in the high doses used in IVF. This is called superovulation. If an ultrasound shows that too many eggs are ripening, the insemination should either be canceled or the woman should have her eggs gathered and used for IVF instead. Otherwise there is a high risk of a multiple pregnancy, with all of its dangers for the mother and infants.
How it works: A man donates his sperm. The survivor may choose someone that is known personally or much more commonly, the man or couples chooses a sperm donor who has worked with a donor sperm from a sperm bank. may be used. The donor may be similar to the man in ethnic background, coloring, etc. Most sperm donors in the United States prefer to remain anonymous, but many give the bank information about their hobbies and personalities. Their family and personal health histories are analyzed carefully to minimize the chance of an inherited disease. The semen is used as in IUI to create a pregnancy.
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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.