Fertility and Men With Cancer

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Preserving fertility in men with cancer

The following chart shows current options for preserving fertility before, during, and after cancer treatment. Ideally, fertility discussions should take place before treatment, but we know this is not always the case.

You can use this information to learn more and then discuss your fertility options with your doctor. In some cases, you and your doctor might decide to use more than one option to try to preserve your fertility, especially if one option has a low or unknown success rate. Be sure that you understand the risks and chances of success of any fertility option you are interested in, and keep in mind that no method works 100% of the time. Married men and those with long-term partners might want to include them in these discussions and decisions.

This chart can help you learn more about your current options. After the chart we discuss the details of the listed options in alphabetical order.

Fertility options for men with cancer

Before treatment

During treatment

After treatment

Sperm banking

Radiation shielding

Adoption+

Testicular sperm extraction (TESE) or epididymal sperm aspiration*

 

Collecting sperm from urine*

Testicular tissue freezing*

 

Donor sperm

   

Natural pregnancy

   

Electro-ejaculation*

   

Using banked sperm – see Sperm banking

   

Testicular sperm extraction (TESE) or epididymal sperm aspiration*

* Experimental

+ May be available at any point in time

Adoption

Adoption is usually an option for anyone who wants to become a parent. Adoption can take place within your own country through a public agency or by a private arrangement, or internationally through private agencies. Some agencies specialize in placing children with special needs, older children, or siblings.

Most adoption agencies state that they do not rule out cancer survivors as potential parents. But agencies often require a letter from your doctor stating that you are cancer-free and can expect a healthy lifespan and a good quality of life. Some agencies or countries require a period of being off treatment and cancer-free before a cancer survivor can apply for adoption. Five years seems to be an average length of time.

There’s a lot of paperwork to complete during the adoption process, and at times it can seem overwhelming. Many couples find it helpful to attend adoption or parenting classes before adopting. These classes can help you understand the adoption process and give you a chance to meet other couples in similar situations. The process takes different lengths of time depending on the type of adoption you choose. Most adoptions can be completed in 1 to 2 years.

Costs of adopting vary greatly, from less than $4,000 (for a public agency, foster care, or special needs adoption) up to $50,000 (for some international adoptions, including travel costs).

You may be able to find an agency that has experience working with cancer survivors. Some discrimination clearly does occur both in domestic and international adoption. Yet, most cancer survivors who want to adopt can do so.

Collecting sperm from urine

Sometimes the nerves that are needed to ejaculate semen or close the valve at the bottom of the bladder are damaged during cancer surgery. When this happens, the man still makes semen, but it doesn’t come out of the penis at orgasm. Instead, it shoots backward into his bladder (called retrograde ejaculation). This is not painful or harmful, though the urine may look cloudy afterward because there’s semen in it.

Fertility specialists may be able to collect sperm from the urine of these men and use them to fertilize their female partner’s eggs in the lab through in vitro fertilization (in IVF, mature eggs are removed from a woman’s ovaries, joined with sperm in the lab, and then put in a woman’s uterus to develop.)

Donor sperm

Using donor sperm (also called 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. They are also tested for sexually transmitted diseases, including HIV (the virus that causes AIDS) and the hepatitis B and C viruses. Couples may be able to choose a donor who will remain anonymous or one who is willing to have contact with the child later in life. Anonymous donor sperm usually costs less.

Intrauterine insemination with donor sperm usually is done in the doctor’s office. The purified sperm sample is put right 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 $200 to $700 a sample, which does not include the cost of the insemination or the cost of hormones for the woman. Be sure to ask for a list of all fees and charges, since these differ from one sperm bank to another (see “Insurance and financial concerns” in the section called “Other fertility-related issues to think about”).

Electro-ejaculation

This is still an experimental procedure, and only a few successful pregnancies have been reported.

After some cancer surgeries, a man still makes semen, but it doesn’t come out of the penis at orgasm (climax). In these cases, fertility specialists may be able to collect sperm using electrical stimulation of ejaculation, or electro-ejaculation.

Another possible use of this technique is in young cancer patients who cannot produce semen samples (for sperm banking) with the aid of masturbation, but at this time this is not a common practice.

Drugs are used to put you into a deep sleep for this procedure. Then a probe is put into the rectum and a low voltage electrical current is used to stimulate ejaculation. The semen collected can then be used for either intrauterine insemination (where the sperm are put into the woman’s uterus to fertilize an egg naturally) or for IVF (in vitro fertilization – where mature eggs are removed from a woman’s ovaries, joined with the sperm in the lab, and then put in a woman’s uterus to develop).

Electro-ejaculation can cause scar tissue to form, so it’s not used often. It must be done with a special machine that’s only available in some infertility clinics.

Natural impregnation

You might be able to make a woman pregnant both during and after cancer treatment. But during and for some time after treatment, a man’s sperm may have a higher risk of genetic damage.

Your medical team may recommend waiting anywhere from 1 to 5 years before trying to have a child. The exact length of time is not known and depends on the type of cancer and the treatment used. It’s best to have this discussion with your medical team and your partner before going on with a pregnancy plan.

Radiation shielding

Fertility may sometimes be saved in men who are getting radiation treatments that focus the rays on a very small area. For some getting radiation to the pelvis, the testicles can be protected with a lead shield. If radiation is aimed at one testicle (as for some testicular cancers), the other testicle can be shielded.

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 type of treatment you will get. You might want to bank sperm to raise the odds of successful conception later on.

Sperm banking

Sperm banking is the only well-established method of fertility preservation for men. It’s a fairly easy and successful way for men who have gone through puberty to store sperm for future use. It’s usually offered to young men before cancer treatment, but if you know you might want to father a baby later, don’t wait to ask about it. Your doctor can refer you to a sperm bank or you can find one online (see the “To learn more” section at the end of this document).

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. Semen can be collected every 24 to 48 hours. This is usually done in a private 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 protective chemical, and express mails it to the sperm bank right away.

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 might want to have children after completing cancer treatment, even if they aren’t sure now. By storing sperm, they can decide later. If the samples are not used, they 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 (see “Electro-ejaculation” – above) or microscopic surgery (see “Testicular sperm extraction and epididymal sperm aspiration” – below).

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 condom that’s 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, can 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 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 decades.

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 fertility specialist.

Using sperm for 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 put 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 to increase the chance of pregnancy. This is called super-ovulation.

Using sperm for in vitro fertilization

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.

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.

Many 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 or may not have time to store semen samples 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 about $25 to $35 a month, which covers 3 sperm donations and 5 years of storage. Insurance coverage may be available and banking costs vary greatly, so it’s important to compare different centers. Many sperm banks offer financing and payment plans for people with cancer.

Testicular sperm extraction and epididymal sperm aspiration

Epididymal sperm aspiration and testicular sperm extraction (TESE) are experimental fertility options for collecting sperm in 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 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.

With either technique, if mature sperm are found, they can be used right away (for IVF-ICSI, described above) or frozen for future use.

Testicular tissue freezing

Testicular tissue freezing is an experimental procedure for young boys who have not reached puberty. At this time there are no proven fertility-preserving methods for these boys and this is the only option. But this is still a new approach, and there have been no reported live births resulting from this technique so far.

In this procedure, tissue from the testicles is collected with a thin needle. (This is usually done while the patient is getting anesthesia for another needed procedure, such as surgery to put in a vascular access device.) It’s expected that the tissue will contain stem cells that will later produce mature sperm. The tissue is frozen with the hope that in the future, it can be used to treat infertility. The thawed tissue might be grafted on to the young man’s testicle or stem cells might be taken out and injected into the testicle, which might allow him to make his own sperm.

One concern is that tissue taken from a boy with cancer before treatment could re-introduce cancer cells and possibly cause a return of the disease.

The average cost of testicular tissue freezing varies from one center to another, so you will want to ask about the freezing and annual storage costs as well as removal and transplant expenses. A few centers may be doing research studies that pay for the costs.


Last Medical Review: 11/06/2013
Last Revised: 11/06/2013