Cancer and treatment for cancer can impact one’s fertility. Some cancers can interfere with fertility by affecting hormones, and sometimes cancer treatment can lead to infertility. Some men must have parts of their reproductive system removed as part of surgery to treat cancer. Others have radiation therapy aimed near the testicles or take chemotherapy drugs that damage the body’s sperm production. Since sperm cells divide rapidly, they are often killed by radiation or by chemotherapy drugs that target fast-growing cancer cells.  

• Many men have low sperm quality at the time of a cancer diagnosis. Quality means the number of sperm (count), their swimming power (motility), and their shape (morphology). About 10% of men newly diagnosed with cancer have no sperm cells in their semen. 

• Since sperm cells are dividing rapidly, they are more at risk than most other cells in the body to be affected by radiation or chemotherapy drugs that target fast-growing cancer cells. 

• It is difficult to predict for any individual man whether sperm production will recover after cancer treatment. Chances depend on his fertility before cancer and the type of cancer treatment he receives. 

• Usually, cancer treatments leave some undamaged spermatogonia (the stem cells needed to produce fresh, mature sperm) in the testicles. However, high doses of radiation to the testicle or very toxic chemotherapy can sometimes kill all of the spermatogonia, making a man permanently infertile. If just a few stem cells are left, in can take up to 5 years for some sperm production to recover. 

• Surgeries at high risk of damaging a man’s fertility include removing both testicles (no more sperm); the prostate and seminal vesicles (no more semen); or surgery damaging the nerves involved in male orgasm (dry climax with no semen). 

• Radiation is most likely to damage fertility if it is aimed at or near the testicles. Radiation to the testicles for childhood leukemia, pelvic radiation for prostate, rectal, or bladder cancer, or radiation to the whole body to prepare for a stem cell transplant have a high risk of damaging fertility. Radiation to the brain can also disrupt the hormone system that controls sperm production in the testicles. 

• Chemotherapy containing drugs of the alkylating or platinum type is the most likely to damage a man’s fertility. The combination of drugs and individual dosages predict recovery of sperm production. Recovery of sperm takes place over 1 to 5 years after treatment. High doses of chemotherapy to prepare for a bone marrow or stem cell transplant often cause permanent infertility. 

• Radiation therapy or chemotherapy can damage the DNA in sperm cells. The DNA can repair itself, but the process can take time.  If you are considering trying to conceive, discuss with your doctor the appropriate amount of time to wait based on your individual cancer treatment. 

Banking Sperm Before Cancer Treatment 

About 90% of men over the age of puberty diagnosed with cancer have sperm cells in their semen. They can store sperm before cancer treatment by freezing samples of semen in a special lab called a sperm bank. The procedure is not always covered by health insurance and can cost hundreds to thousands of dollars. There is a later  expense when a man is ready to use his sperm in infertility treatment, such as intrauterine insemination or in vitro fertilization (IVF). Some charitable organizations help couples with the costs of sperm banking or infertility treatment when a man has had cancer.  

• Collecting semen samples does not have to delay cancer treatment by more than a day or two at most. If interested, let your oncologist know as soon as possible to discuss if a delay in treatment is appropriate for you.  

• Sperm should be banking should ideally take place before starting any cancer chemotherapy or any radiation therapy that is aimed at or near the pelvic area. 

• Some men only decide to bank sperm after they have finished cancer treatment and their cancer returns. Sperm banking can also be done at this time, especially if it has been at least 6 months since a man's last chemotherapy or pelvic radiation treatments. 

• It is usually possible to collect and process semen in a local laboratory and then send it to a sperm bank for storage. Some sperm banks use kits for at-home sperm collection with express mail 

• Sperm banks usually suggest a man collect his sample by self-stimulation (masturbation). If a man is unable to use this method because of religious or other concerns, he may be able to collect semen during intercourse using a special silicone condom, or an infertility specialist can use special medical procedures to get sperm samples. 

• Sperm banks test men for sexually transmissible infections (STIs) before storing their semen. Men who test positive for HIV, Hepatitis B, or some other viruses may not be able to store semen in many banks, but some offer special, separate storage for an added fee. 

• Typically, there is a legal agreement that one must sign with a laboratory about what they would want done with their samples in the event of death. Options include allowing a spouse or parent to use the sperm, destroying the samples, or donating them to research. 

What If You No Longer Can Produce Sperm by Ejaculation? 

Sometimes after cancer treatment semen is made but shoots backwards into the bladder at orgasm. If doctors think you have this condition, called retrograde ejaculation, they may prescribe pills to temporarily restore normal ejaculation, allowing a semen sample to be collected. Another treatment involves taking special tablets to take to make urine less acid. Then a man stimulates himself to climax at the lab. Immediately afterwards, he either urinates or is catheterized, so that the lab can separate out the sperm cells before they can be damaged by the urine. The purified sperm cells can then be frozen for future fertility treatment. In some men, nerve damage essentially paralyzes the prostate and seminal vesicles, so semen and sperm cells do not collect before orgasm. These treatments are less likely to work in that case. 

Electroejaculation is a medical procedure that can often trigger ejaculation of semen in men with spinal cord injuries, men with retrograde ejaculation, or men who cannot reach an orgasm with sexual stimulation. A special stimulator is put into the anal canal, and an electrical signal triggers ejaculation. The sample is collected, analyzed, and stored. A man is put under anesthesia because otherwise the procedure would be painful but can almost always go home the same day of the procedure. Electroejaculation, requires special equipment and training, and is only available at some infertility clinics. It is successful about half of the time. 

For men who no longer have a prostate or seminal vesicles, or who cannot collect sperm cells in any other way, a minor surgery can help. Sperm cells can be collected directly from the vas deferens (tubes that transport sperm cells to the urinary tube just before ejaculation), the epididymis (the storage area for sperm at the top of each testicle), or the sperm-producing areas of the testicles themselves. Occasionally a specialist can collect the sperm cells by just putting a needle into these areas, but that can cause scarring, especially if it needs to be done more than once. More commonly, a man is put under anesthesia, and the sperm cells are collected during an outpatient surgery.  

Saving Fertility in Young Boys

Boys under the age of puberty do not make enough sperm to freeze for the future. Some boys of 10 or 11 are beginning to produce sperm. Doctors look for signs that puberty is starting. If sperm banking is not going to be possible, some families freeze small pieces of tissue from the testicles in the hopes that it will be useful in the future for making sperm. However, freezing testicular tissue to preserve a boy’s fertility is still experimental. It should only be done as part of a research study approved by an institutional review board (panel that reviews the ethics of research in a hospital or university). Resources for Help with Cancer-Related Infertility 

• The Alliance for Fertility Preservation (https://www.allianceforfertilitypreservation.org/) is a nonprofit organization that provides a comprehensive directory of US programs offering fertility services to cancer patients (Fertility Scout), a list of states that mandate insurance coverage for fertility preservation, and links to all programs that help cancer patients with the costs of fertility preservation 

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