How Cancer Treatments Can Affect Fertility in Men

A lot of things must take place for a couple to make a baby.  A “body system malfunction” can change a man's fertility and affect his ability to father a child.Here are some things that can happen:

  • Hormone production can be disrupted
  • Testicles may not make healthy sperm or any sperm at all
  • The process of sperm ejaculation can be disrupted

Cancer, or more often cancer treatments, can interfere with some parts of the reproductive process and affect your ability to have children. Different types of treatments can have different effects.

How chemotherapy can affect male fertility

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. Cancer treatment during childhood, however, can damage testicles and affect their ability to produce sperm .

Chemotherapy (chemo) works by killing cells in the body that are dividing quickly. Since sperm cells divide quickly, they are an easy target for damage by chemo. Permanent infertility can result if all the immature cells in the testicles that divide to make new sperm (spermatogonial stem cells) are damaged to the point that they can no longer produce maturing sperm cells.

The risk of the chemo causing infertility varies depending on:

  • The patient’s age. For example, men older than 40 may be less likely to recover their fertility after treatment.
  • The type of drug(s) used. Some drugs are more likely to affect fertility than others (see lists below).
  • The doses of drugs given. The higher the doses of chemo, the longer it takes for sperm production to get back to normal after treatment, and the more likely it is to stop.

After chemo treatment, sperm production slows down or might stop altogether. Some sperm production usually returns in 1 to 4 years, but it can take up to 10 years. If sperm production has not recovered within 4 years, it’s less likely to return.

Chemo drugs that are linked to the highest risk of infertility in males include:

  • Actinomycin D
  • Busulfan
  • Carboplatin
  • Carmustine
  • Chlorambucil
  • Cisplatin
  • Cyclophosphamide (Cytoxan®)
  • Cytarabine
  • Ifosfamide
  • Lomustine
  • Melphalan
  • Nitrogen mustard (mechlorethamine)
  • Procarbazine

Higher doses of these drugs are more likely to cause permanent fertility changes , and combinations of drugs can have greater effects. The risks of permanent infertility are even higher when males are treated with both chemo and radiation therapy to the belly (abdomen) or pelvis.

Some drugs, such as those listed here, have a lower risk of causing infertility in males, as long as they are given in low to moderate doses:

  • 5-fluorouracil (5-FU)
  • 6-Mercaptopurine (6-MP)
  • Bleomycin
  • Cytarabine (Cytosar®)
  • Dacarbazine
  • Daunorubicin (Daunomycin®)
  • Doxorubicin (Adriamycin®)
  • Epirubicin
  • Etoposide (VP-16)
  • Fludarabine
  • Methotrexate
  • Mitoxantrone
  • Thioguanine (6-TG)
  • Thiotepa
  • Vinblastine (Velban®)
  • Vincristine (Oncovin®)

Talk to your doctor about the chemo drugs you will get and the fertility risks that come with them. 

How targeted and immune therapies can affect male fertility

Targeted drugs attack cancer cells differently from standard chemo drugs. These drugs have been used a lot more in recent years, but little is known about their effects on fertility or problems during pregnancy. The small amount of data available on a group of targeted drugs called tyrosine kinase inhibitors (TKIs), such as imatinib (Gleevec®), suggest that pregnancies started by young males getting TKIs are probably not at an increased risk of complications or birth defects. Still, there’s not enough research available to know that it’s safe to start a pregnancy while taking these drugs. At this time, the recommendation is if you are taking TKIs talk to a doctor before starting a pregnancy.

Males taking thalidomide or lenalidamide have a high risk of causing birth defects in a fetus exposed to these drugs, which can stay in semen for a few months after treatment ends. Oncologists recommend that males and any sexual partner who is able to get pregnant use extremely effective forms of birth control, for example a condom for the man and a long-acting hormone contraceptive or IUD for the woman.

See Targeted Therapy and Cancer Immunotherapy to learn more about these cancer treatments.

How hormone therapy can affect male fertility

Some hormone therapies used to treat prostate or other cancers can affect sperm production and your ability to have a child. These drugs can also cause sexual side effects, such as a lower sex drive and problems with erections, while patients are taking them. The decrease in sperm production and the sexual side effects usually start to improve once these drugs are stopped.

How bone marrow or stem cell transplant can affect male fertility

Having a bone marrow or stem cell transplant usually means the patient will receive high doses of chemo and sometimes radiation to the whole body before the procedure. In most cases, these procedures have the side of effect of permanently preventing a man from making sperm. This results in life-long changes to fertility.  (See Chemotherapy and Radiation Therapy for more on these parts of the transplant process.) If you'd like to learn more, see Stem Cell Transplant for Cancer.

How radiation therapy can affect male fertility

Radiation treatments use high-energy rays to kill cancer cells. Radiation aimed directly at testicles, or to nearby pelvic areas can affect a male's fertility. Radiation at high doses kills the stem cells that produce sperm.

Radiation is aimed directly at the testicles to treat some types of testicular cancer and childhood leukemia. Young males 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 gets radiation to treat a tumor in his abdomen (belly) or pelvis, his testicles may still end up getting enough radiation to harm sperm production.

Sometimes radiation to the brain affects the hypothalamus and pituitary gland. The hypothalamus and pituitary gland work together to produce two important hormones called LH and FSH.  These hormones are released into the bloodstream and signal the testicles to make testosterone and also to produce sperm.  When cancer or cancer treatments interfere with these signals, sperm production can be decreased and infertility can occur. 

You may be fertile when you’re getting radiation treatments, but your sperm may be damaged by exposure to the radiation. 

For this reason, it is important to talk to your doctor about how long you should wait to resume unprotected sexual activity or try for a pregnancy. Current recommendations range from 6 months to 2 years after treatment is completed, and your doctor will be able to consider your circumstances and give you more specific information about how long you should wait.

You can get more details about this type of treatment in Radiation Therapy:.

For men getting radiation for prostate cancer

Brachytherapy: Seed implants for prostate cancer do not give a large dose of radiation to the testicles, and many men will remain fertile or recover sperm production.

Talk to your doctor about important instructions to follow during and after brachytherapy.  Certain instructions include:

  • Avoid sexual intercourse
  • Use birth control
  • Limit close contact with pregnant woman and children for a certain amount of time

External radiation: Radiation for prostate cancer from a machine outside the body is more likely to cause permanent infertility, even if the testicles are shielded. (See Radiation shielding in Preserving Fertility in Men With Cancer for more on this.)

How surgery can affect male fertility

Surgery offers the greatest chance of cure for many types of cancer, especially those that have not spread to other parts of the body. But surgery on certain parts of the reproductive system can cause infertility. See Cancer Surgery for more information on this cancer treatment.The following types of surgery may affect a man’s fertility:

Surgery for testicular cancer

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 can continue to make sperm after surgery. (Less than 5% of males develop cancer in both testicles). But some with testicular cancer have poor fertility because the remaining testicle is not truly normal. For this reason, sperm banking before the testicle is removed is now recommended for those interested in saving their fertility . 

Testicle removal (both testicles) for prostate cancer

Some with prostate cancer that has spread beyond the nearby area may have both testicles removed to stop testosterone production and slow the growth of prostate cancer cells. This surgery is called a bilateral orchiectomy. These males cannot father children unless they banked sperm before surgery.

Prostate Cancer has more information on treatment.

Surgery to remove the prostate (radical prostatectomy)

For prostate cancer that has not spread beyond the gland, surgery to remove the prostate gland and seminal vesicles is one of the treatment options. The prostate and seminal vesicles together produce semen. The prostate is usually removed by one of two approaches. A robotic radical prostatectomy is performed using a robot to operate through several very small openings in the abdomen. Surgery removes the prostate gland and leaves males with no semen production and no ejaculation of sperm after the surgery. With sexual stimulation, males can still have orgasm, but no fluid comes out of the penis. Prostate surgery also can damage the nerves that allow a man to get an erection, This means he might not be able to get an erection sufficient for sexual intercourse. This is a very treatable condition, and patients can get more information on these issues in Prostate Cancer.

Even if a patient can get an erection, if there’s no semen coming from the penis during orgasm, he cannot conceive a child during sex. The testicles still make sperm, but the the tubes (vas deferens) that deliver sperm from the scrotum to the urethra are cut and tied off during removal of the prostate gland. This blocks the path of sperm. However, even after removing the prostate gland, there still are ways to get sperm from the testicle. See Preserving Fertility in Men With Cancer to learn more about this.

Surgery to remove the bladder ( radical cystectomy)

Surgery to treat some bladder cancers is much like a radical prostatectomy, except the bladder is also removed along with the prostate and seminal vesicles. This procedure is called radical cystectomy

Because this surgery removes the bladder and prostate gland, there is no semen production and no ejaculation of sperm after the surgery.  With sexual stimulation, males can still have orgasm, but no fluid comes out of the penis.

Surgery to remove the bladder also can damage the nerves that allow a man to get an erection, causing erectile dysfunction (ED). This means he cannot get an erection sufficient for sexual penetration. This is a very treatable condition, and you can get more information on these issues in Bladder Cancer.

Even if you can get an erection, if there’s no semen coming from the penis during orgasm, you cannot conceive a child during sex. The testicles still make sperm, but the upper urinary tube for sperm (vas deferens)  are cut and tied off during removal of the bladder and prostate gland. This blocks the path of sperm. However, even after removal of the bladder and prostate gland, there are ways to remove sperm from the testicle or its sperm storage area and use them to fertilize eggs. See Testicular sperm extraction and epididymal sperm aspiration to learn more about this.

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 belly (abdomen), which may be part of the surgery for testicular cancer and some colorectal cancers. Nerves are often damaged when lymph nodes are removed, and this can cause problems ejaculating. Sometimes surgery can permanently damage the nerves to the prostate and seminal vesicles that normally cause these organs to squeeze and relax to move the semen out of the body.

When these operations affect the nerves, a man still makes semen, but it doesn’t come out of the penis when he has an orgasm (climax). Instead it can flow backward into his bladder (called retrograde ejaculation) or goes nowhere.

In cases of retrograde ejaculation, medicines can sometimes restore normal ejaculation of semen. At orgasm, the internal valve at the bladder entrance closes, the prostate contracts and semen is ejaculated from the penis at orgasm. In the United States, pseudoephedrine sulfate (Sudafed) is the most common medicine used to restore normal ejaculation. Because it does not help everyone and may only work for a few doses, pseudoephedrine sulfate is usually taken only for the fertile week of the woman’s cycle.

Fertility specialists can sometimes gather sperm from these males using several types of treatments including electrical stimulation of ejaculation (see Electroejaculation or sperm aspiration surgery in Preserving Fertility in Men With Cancer.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: November 6, 2016 Last Revised: June 28, 2017

 

 

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