After treatment, most men recover some ability to produce sperm cells. If the sperm counts and movement (motility) are close to normal, men may be able to father a child through sexual intercourse (natural conception). If only a few sperm are present in the semen, men may need to use infertility treatment methods, such as intrauterine insemination or in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI).
Even when men have no sperm in samples of their semen, small areas of the testicle may still make sperm. In this case, a surgeon using a microscope can take several samples of tissue to look for sperm to use in IVF-ICSI. This is called testicular sperm extraction, or TESE for short, and was mentioned earlier (see “Sperm extraction” under “Experimental options” in the previous section "Preserving fertility in men before cancer treatment").
Other options for men who need help with fertility after cancer treatment are listed here.
For men with loss of the prostate and seminal vesicles
If you have had prostate or bladder cancer, surgery was probably done to remove your prostate gland and the seminal vesicles (these organs produce most of the fluid for semen). This means that your body no longer makes semen. Also, the ends of the vas deferens (small tubes running from each testicle to the prostate) are generally cut during this type of cancer surgery. This cut is very much like that done for a vasectomy, so there is no way for the sperm to get outside your body. With enough mental or physical sexual excitement, you should still be able to have the pleasurable feeling of orgasm (climax), but it will be a “dry” orgasm.
If there is no semen coming from the penis during orgasm, conceiving a child during sex is not an option. But there are ways that sperm can be taken out and used to fertilize an egg. An infertility specialist can take sperm from the epididymis (the tiny coiled tubes at the top of the testicles where sperm cells ripen) or use TESE, as described above.
For men who have dry orgasm because of damage to nerves during cancer treatment
Some men have dry orgasm after removal of lymph nodes as part of treatment for colon cancer or testicular cancer. This is because the surgery to take out the lymph nodes damages the nerves that control ejaculation. For some men in this situation, the prostate and seminal vesicles are completely paralyzed. They normally squeeze and relax rhythmically as a man’s climax begins, but nerve damage can keep this from happening. But if you still have your prostate and seminal vesicles, several treatments may work.
If nerve damage is mild, the prostate and seminal vesicles may still work normally. Often, though, the valve that is supposed to block semen from getting into the bladder doesn’t close the way it should. If this valve stays open, semen shoots backward into the bladder instead of out through the penis during a man’s climax. This is called retrograde ejaculation. When the problem is just retrograde ejaculation, medicines can be taken for it. If the medicine works, normal ejaculation of semen is restored. The seminal vesicles contract, the internal valve at the bladder entrance closes, and semen is ejaculated from the penis at orgasm. In the United States, the most common medicine used to restore emission is ephedrine sulfate. Because it does not help everyone and may only work for a few doses, ephedrine sulfate is usually prescribed only for the fertile week of the woman’s cycle.
Another option for retrograde ejaculation is taking live sperm cells from urine a man produces just after a climax. The man is given medicine to make his urine less acidic, which causes less damage to his sperm. Usually the man is asked to use self-stimulation to reach orgasm at the urology clinic. His urine is collected just after orgasm, either through urination or catheterization. The sperm cells are separated and put in a sterile solution to use in infertility treatment.
If none of these options work, another choice is to put a man under anesthesia (drugs are used to put him into a deep sleep) and a special electrical probe is used in the anal canal to trigger an ejaculation of semen through the penis. Since this procedure, called electro-ejaculation, can cause scar tissue to form, it is not used often. It must be done with a special machine that is only available in some infertility clinics.
For men who don’t produce sperm
Using donor sperm (donor insemination) is the simplest and least expensive way for men who are infertile after cancer treatment to become a parent. Major sperm banks in the United States collect sperm from young men who go through a detailed screening of their physical health, family health history, educational and emotional history, and even some genetic testing. Sperm donors are chosen for their high sperm counts and motility. They are also tested for sexually transmitted diseases, including the human immunodeficiency virus (HIV) that causes AIDS and the hepatitis viruses B and C. Couples may be able to choose a donor who will remain anonymous or one who will be willing to have contact with the child later in life. Anonymous donor sperm usually costs less.
Insemination usually is done in the doctor’s office. The purified sperm sample is placed directly into the woman’s uterus through a tiny, flexible tube. If needed, the woman’s doctor might prescribe hormones to ripen more than one egg, which will increase the chance of a pregnancy. Success rates are good, and most women under age 35 without fertility problems get pregnant in an average of 3 to 6 cycles. The cost of donor sperm varies, but averages about $500 to $600 a cycle, which includes the cost of the insemination. This does not include the cost of hormones for the woman. Be sure to ask for a list of all fees and charges before insemination, since these differ from one sperm bank to another.
Adoption
Issues for cancer survivors interested in becoming parents by adoption were discussed previously. See the section called “Adoption” under “Fertility options for women after treatment.”
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