Preserving fertility in men before cancer treatment

Discuss your fertility options carefully with your doctor before treatment. In some cases, you and your doctor may decide to try more than one method to preserve your fertility — keeping in mind that no method is perfect. Be sure that you understand the risks and chances of success of any fertility option you try. Married men and others with long-term partners may want to include them in these discussions and the decision-making.

Radiation shielding

Fertility may sometimes be saved in men who are getting radiation treatments that use modern techniques to focus the rays on a very small area. For some getting radiation to the pelvis, the testicles can be protected with a lead shield.

Seed implants for prostate cancer do not give a large dose of radiation to the testicles, and most men will remain fertile or recover sperm production. These men should use birth control after treatment if they do not want to father a child.

Radiation for prostate cancer from a machine outside the body (external radiation) is more likely to cause permanent infertility, even if the testicles are shielded. Whole body radiation used before bone marrow transplant also usually causes life-long infertility.

If you are getting radiation near your testicles, the risk of harming the sperm is uncertain. Doctors often advise men to avoid getting a woman pregnant during and for some weeks after treatment.

Talk with your cancer team about any plans for radiation treatments and the risk of infertility with the treatment you will get. Depending on your future plans, you may wish to bank sperm to raise the odds of a successful conception later on.

Sperm banking

Sperm banking is a fairly easy and successful way for men who have gone through puberty to store sperm for future use. It’s usually offered routinely for younger men before cancer treatment, but if you know you might want to father a baby later, don’t wait to ask about it. Many men can store sperm even if they have reduced sperm quality or quantity. This option can also work for boys as young as 12 or 13, as long as they have gone through puberty.

In sperm banking, a man provides one or more samples of his semen. This is usually done in a private collection room at a sperm bank facility or hospital. The man ejaculates (has a climax) through masturbation or with the help of a partner. The semen is collected in a sterile cup. If a man is staying close to a sperm bank or lab, he can collect a sample and bring it in quickly, usually within an hour, keeping it at room temperature during that time.

If a man lives far from any lab or sperm bank, he might be able to use a mail-in kit. Some banks provide these kits. The man collects his sample at home, mixes it with a special protecting chemical, and express mails it to the sperm bank right away. You can find sperm banks online (see the “To learn more” section at the end of this document).

Once the sperm bank gets the sample, they test it to see how many sperm cells it contains (this is the sperm count), what percentage of them are able to swim (which is called motility), and how many have a normal shape (called morphology). The sperm cells are then frozen and stored.

Sperm banking is an option for men who want to have children after completing cancer treatment. It’s also a good option for a man who thinks he might want children in the future, but isn’t sure. By storing his sperm, he can decide later. If the sample is not used, it can be discarded or donated for research.

Sperm donation problems

Some men have trouble when they try to donate sperm. Doctors are sometimes able to help men who have trouble with self-stimulation in a pressured situation, or who do not ejaculate normally. For those men, the doctor may be able to collect semen using electrical stimulation or microscopic surgery while the man is under anesthesia (given drugs to make him sleep during the surgery).

Collecting sperm during sex can be a problem because bacteria may mix in with the sample. But if a man cannot collect any other way, some labs will accept a sample gathered in a special silicone collection condom that is worn during sex.

Young teens often feel very nervous going to the sperm bank to give a semen sample. Having a parent in the waiting room, even a supportive mom or dad, seems to make it even more difficult. It’s often better to have an older brother or adult friend to go with the teen instead.

Successes using frozen sperm

The success rates of infertility treatments using frozen sperm vary and depend on the quality of the sperm after it’s thawed. In general, sperm collected before men’s cancer treatment is just as likely to start a pregnancy as sperm from men without cancer. Sperm banking has resulted in thousands of pregnancies, without unusual rates of birth defects or health problems in the children. Once sperm is stored, it’s good for many years. In one case, a man treated for cancer fathered a healthy baby with sperm that had been frozen for 28 years.

Keeping in touch with your sperm bank

It’s important to stay in contact with the sperm bank so that yearly storage fees are paid and your address is updated. Once a couple is ready to have a child, the frozen sperm is sent to their infertility doctor.

Intrauterine insemination

If the thawed sample contains at least 2 million motile (actively swimming) sperm, it can be used for intrauterine insemination. The thawed sperm are washed and concentrated, and put in a sterile solution. When the woman is at her most fertile time of the month, this fluid is placed in her uterus by a doctor or nurse who threads a tiny tube (called a catheter) through the small opening in her cervix. This usually just takes a few minutes in a doctor’s office. Sometimes the woman takes hormones to ripen more than 1 egg before the sperm is put in her uterus. This is called super-ovulation.

Sperm injection

Even a few sperm cells that survive freezing and thawing may be enough to conceive if the sperm is actually injected into the egg. This injection technique is called IVF-ICSI, which stands for in vitro fertilization with intracytoplasmic sperm injection. Sometimes it’s just called ICSI for short.

The woman takes hormone shots for about 3 weeks to ripen multiple eggs. These eggs are then taken out in a minor surgery. In the lab, one healthy-looking sperm is injected into each egg. About 3 in 5 of the fertilized eggs will develop into embryos. These embryos can either be put back into the woman’s uterus during that cycle or frozen for future use. Good infertility treatment programs get about 1 live birth out of out of 3 cycles of IVF-ICSI.

Most cancer survivors have low sperm counts and decreased sperm motility after treatment. If there are no banked sperm samples, IVF-ICSI can be a good way to deal with these sperm changes.

Limitations of sperm banking

Fast growing cancers: If you have a fast-growing cancer like acute leukemia (AML or ALL), you may be too ill to take time to store a semen sample before starting cancer treatment.

Infectious diseases: Many sperm banks do not accept samples from men who have HIV or hepatitis B, but some do have special storage areas for a slightly higher fee. A woman who tries to get pregnant with sperm from a man who has HIV or hepatitis B must be told about the risks. The infection risk to the woman can be greatly lowered by using advanced infertility treatments, as long as there are expert doctors using careful risk reduction methods. But if the woman becomes infected, there’s some risk that the baby can become infected, too.

Costs: The average cost of sperm banking is often more than $1,500, which includes 3 sperm donations and a few years of storage. Costs vary from center to center, so it’s important to compare costs at different centers. Many sperm banks offer financing and payment plans for cancer patients.

Experimental options

Sperm extraction

Epididymal sperm aspiration and testicular sperm extraction (TESE) are investigational options for men who do not have mature sperm cells in their semen, either before or after cancer treatments. Both require minor surgery done by a specialist. In micro-epididymal sperm aspiration, a tiny opening is made in the epididymis (the coiled tubes that sit on top of the testicle), and sperm are taken out with a needle. In TESE, tiny pieces of tissue are removed from the testicles and checked for sperm cells. If mature sperm are found, they can be used immediately for IVF-ICSI or frozen for future use. Insurance rarely covers the cost of this treatment. Since these sperm must be used with IVF-ICSI, the cost of that treatment must be added.