Chemotherapy

During puberty (usually around age 13 to 14), a boy's testicles start making sperm, and they normally will keep doing so for the rest of his life. Since sperm cells divide rapidly, they are an easy target for damage by chemotherapy (chemo). The higher the dose of chemo, the longer it takes for sperm production to get back to normal, and the more likely it is to stop. Permanent infertility results if all the stem cells in the testes are damaged to the point that they can no longer produce maturing sperm cells. The most damage is done when men are treated with both chemo and radiation therapy to the abdomen (belly) or pelvis.

The risk of the chemo causing infertility varies depending on the type of drug and the doses used. After chemo treatment, sperm production slows down or may stop altogether. Some sperm production usually returns in 1 to 4 years, but can even take up to 10 years. If sperm production has not recovered within 4 years, it is less likely to ever recover. Men older than 40 may also be less likely to recover their fertility, but age seems to be a less important factor in men than in women.

Bone marrow or stem cell transplant

Bone marrow or stem cell transplant usually involves high doses of chemo and sometimes radiation before the transplant. This often permanently prevents a man from making sperm. Talk with your doctor or nurse about this risk before starting treatment.

Radiation therapy

If a man gets radiation to the testicles, his fertility can be affected. Radiation at high doses kills the stem cells that produce sperm. Radiation is aimed directly at the testicles to treat some types of childhood leukemia. Young men with seminoma, a type of cancer of the testicle, may have radiation to the groin area, very close to their remaining testicle. Even when a man has another type of cancer in the abdomen (belly) or pelvis, his testicles may still end up getting enough radiation to harm his sperm production.

Sometimes radiation to the brain may affect the pituitary gland. The pituitary gland signals the testicles to make hormones. Interfering with these signals can affect sperm production and cause problems with fertility.

Surgery

Surgery offers the greatest chance of cure for many types of cancer, especially those that have not spread to other parts of the body. The following types of surgery are among those used to treat some men with cancer:

Testicular surgery

The surgical removal of a testicle is called an orchiectomy. This is a common treatment for testicular cancer. As long as a man has one healthy testicle, he may continue to make sperm after surgery. But some men with testicular cancer have poor fertility because the remaining testicle is not truly normal. Less than 5% of men develop cancer in both testicles.

Testicle removal (both testicles)

Some men with prostate cancer that has spread beyond the nearby area may have both testicles removed as a way to stop testosterone production and slow the growth of prostate cancer cells. These men can no longer father a child unless they bank sperm before their surgery.

Prostate or bladder surgery

For men who have prostate cancer that has not spread beyond the gland, one of the treatments is surgery that removes the prostate gland and seminal vesicles (called radical prostatectomy). The prostate and seminal vesicles are the parts of a man's body that produce semen. Whether the prostate is removed through a cut in the abdomen (belly) or in the perineum (area behind the testicles and in front of the anus), this surgery leaves men with no semen. The surgery done to treat bladder cancer is much like a radical prostatectomy, except that the bladder is also removed along with the prostate and seminal vesicles. The testicles still make sperm, but the vas deferens (path to the upper urinary tube) is cut. With sexual stimulation, many men still can have all the feeling of orgasm, but no fluid comes out of the penis. The sperm cannot get to the outside. Recently, a few men who had radical prostatectomy have had sperm cells retrieved from their testicles in a minor surgery. The sperm can be used by an infertility treatment specialist to fertilize the partner's egg in the lab. The fertilized embryo is then placed into the woman's uterus.

Surgery that interferes with ejaculation

A few types of cancer surgery can damage nerves that are needed to ejaculate semen. They include removing lymph nodes in the pelvis, which may be part of the surgery for testicular cancer and some operations for colon cancer. Nerves are often damaged when removing lymph nodes, and this causes problems with ejaculation. After these operations, a man still makes semen, but it does not come out of the penis at orgasm (climax). Instead it either shoots backward into his bladder (called retrograde ejaculation) or does not go anywhere. Infertility specialists can gather semen from these men using several types of treatments including certain drugs, electrical stimulation of ejaculation, or sperm aspiration surgery.

Other treatments

Hormone therapies used to treat prostate or other cancers can affect your ability to have a child. The effect of some of the newer treatments on fertility, like vaccines, immune therapies, or biological response modifiers, is not yet known. Before you start treatment, it is always best to talk to your doctor, nurse, or other health care professional about its possible affect on your sexual function and fertility.

Go back to Fertility and Cancer: What Are My Options?

Last Medical Review: 07/23/2009
Last Revised: 07/23/2009