Male Fertility Preservation Before Cancer Treatment

Being told you have cancer can be scary and emotional, especially if you may want to have children. Not being able to have children (infertility) can be a short-term or long-lasting result of some cancer treatments. There are successful options for male cancer patients who want to preserve their fertility and father a baby. Before you start your cancer treatment, talk with your doctor or other member of your health care team to learn if your fertility may change, and your options for preserving it. Let's talk about your choices and the questions you should ask.

How Does Cancer Treatment Impact Fertility in Men?

A lot of things must take place for a couple to make a baby, and cancer treatments can sometimes get in the way of that occurring. Below are some common cancer treatment choices used to care for select urologic health issues. These treatments may impact men and their chance of naturally fathering a child.

What is Fertility?

For men, fertility means being able to get a woman pregnant. Common treatments for cancer like chemotherapy, radiation and surgery can impact a man's chance of this taking place. Other factors like age, where the cancer is located and the type of cancer can also have an effect on a man's chance of naturally fathering a child.

Surgery

Surgery offers the best chance for removing many types of cancer, especially those that have not spread to other parts of the body. But it can also cause infertility if done in certain parts of the reproductive system. It is important to talk with your doctor about the types of surgery listed below and how they may impact your sex life and chances for fathering a child.

Surgery for Testicular Cancer

The surgical removal of a testicle is done for nearly all men with testicular cancer. Sometimes taking out lymph nodes in the belly and pelvis (retroperitoneal lymph node dissection; RPLND) may also be a part of the treatment program. Most men with one testicle can still father a child. In the rare case when a man has testicular cancer in both testicles and they are both removed, he will not be able to naturally father children. But sperm banking before treatment should be discussed and has a high chance of success. For men in need of a RPLND, methods are used to preserve ejaculation. But some men will not be able to release semen from the body after surgery. All other traits of the sexual experience (e.g. sex drive, erections, and sexual peak) remain unchanged. For more facts about testicular cancer, visit:
www.UrologyHealth.org/TesticularCancerFS

Surgery for Prostate Cancer

For men who have prostate cancer, one treatment choice is to surgically remove the prostate gland and seminal vesicles. This is known as a radical prostatectomy. The seminal vesicles work with the prostate to make the semen that carries the sperm out of a man's penis. Because the gland and seminal vesicles are taken out, the sperm is no longer able to physically make it out of the man's body to fertilize the woman's egg. If you are thinking about surgery for prostate cancer and would like to have more children, talk to you doctor before surgery about sperm banking. For more facts about prostate cancer, visit:
www.UrologyHealth.org/ProstateCancer

Surgery for bladder cancer

Most bladder cancer surgeries are done by placing a tool into the bladder and taking out the tumor(s). For invasive bladder cancers, the most common treatment choice is to take out the whole bladder, prostate, and seminal vesicles (radical cystoprostatectomy). After that surgery, a man would not be able to naturally father children. Sperm banking before surgery is something to discuss if you would like to have children.

Radiation

Radiation treatments use high-energy rays to kill cancer cells. Below are radiation types that may impact a man's chance to father a child:

Radiation for testicular cancer

Radiation for testicular cancer most often targets lymph nodes in the back of the belly. Very rarely, is it used on the testicle itself. Most doctors suggest a period of time (1-2 years) after radiation before attempting to father a child.

Radiation for prostate cancer

There are two main types of radiation for prostate cancer. One is called brachytherapy and the other is known as external beam radiation. Both can cause short-term or long-lasting problems with fertility. It is best to ask your radiation oncologist about this. For more facts about radiation for prostate cancer visit:
www.UrologyHealth.org/PCRadiation

Chemotherapy

Chemotherapy works by killing cells in the body that are splitting very quickly. Since sperm cells split quickly, they are most often harmed by chemotherapy. The risk of chemotherapy causing infertility depends on a patient's age, the type of drugs being used and the doses being given. Talk to your cancer doctor about your specific situation.

Hormone Therapy

Hormone therapy is a type of treatment used sometimes by itself, or with other treatments, to care for men with prostate cancer. Hormone therapy is also known as androgen deprivation therapy (ADT). Hormone therapy works by stopping the male sex hormones, such as testosterone, from being made. Testosterone feeds prostate cancer cells. But when cancer cells no longer have the male sex hormone to feed them, their growth will slow. Hormone therapy for prostate cancer often harms the making of sperm. This will limit the chance for a man to fertilize a woman's egg.

Fertility Preservation Options For Men, Before Treatment

Fertility preservation is when cancer patients take steps to protect their chance for fathering a baby. Men may wish to speak to a fertility expert to explore options that might be right for them. Below are three types of fertility preservation methods to discuss.

Sperm Banking

This is one of the most successful and least costly choices for men. Sperm banking is when you freeze your sperm. The sperm stay frozen until you need them, even if it's many years later. With freezing, sperm often do not get damaged.

Shielding Testicles During Radiation

This is when the radiation cancer doctor (radiation oncologist) uses a lead tool to surround the testicles during radiation treatment. This lowers the chance of harming the sperm by lowering the radiation dose to that area.

Sperm Extraction

If a man cannot ejaculate sperm or has limited sperm in his semen, it's possible he may still have sperm somewhere in his testicles. With sperm removal, a health care provider removes pieces of the testicle tissue. If the tissue has sperm, then the sperm can be used to fertilize a woman's egg. Or, it can be frozen and used at a later time.

When to Talk to Your Doctor

If fertility is a worry for you, be sure to talk about it with your doctor. If able, you'll have this talk before you start your cancer treatment. But if you've started your cancer treatment, you may still have options.

Questions to Ask Your Doctor...

1. What window of time do I have before I need to start cancer treatment?
2. Will any of my cancer treatments affect my fertility? If so,
what are my best options to preserve my fertility?
3. Will the available choices to preserve my fertility impact
my cancer treatment?
4. Will my health care plan cover some or all of the fertility
preserving options?
5. Do any of the options raise my risk for the cancer coming back?

If your doctor says your cancer treatment won't impact fertility...

Is there any chance the treatment could change to something where my fertility would be damaged and what do we do in that situation?

For more facts about fertility preservation, visit www.Cancer.net or the American Society for Reproductive Medicine at www.asrm.org.