Cancer and fertility for men
This section is about fertility (the ability to have children) and how it can sometimes be affected by cancer treatment. It talks about the effects of cancer treatment on men’s fertility and the possible ways of preserving it.
Being told you have cancer and that treatment may make you infertile is often overwhelming. Sometimes the prospect of losing your fertility can be as difficult to accept as the cancer diagnosis itself. You may find it helpful to talk to someone about how you feel.
Talking to your medical team about infertility
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It’s important to talk to your cancer specialist or specialist nurse about the risk of infertility before your treatment starts. This is an important discussion, so take time to think about what questions you want to ask so you can get all the information you need. If you have a partner it’s a good idea to include them too.
If you’re having treatment that’s likely to make you infertile, you should be offered the opportunity to have some of your sperm stored before treatment starts - this is called sperm banking. This may make it possible for you and a partner to have a child later on, even if your treatment makes you infertile.
Your cancer specialist can arrange a referral to a fertility clinic very quickly and so sperm banking won’t usually cause a significant delay to your cancer treatment. Sometimes however, treatment has to start immediately, so it may not always be possible.
The cancer itself can sometimes affect your sperm. For example, some men with testicular cancer have problems with their sperm count when they’re diagnosed. Treating the cancer can help to improve this.
If you’ve already had cancer treatment and are having problems with fertility, but didn’t have sperm stored, talk to your cancer specialist. They can refer you and your partner to a fertility expert for advice.
It’s not just problems with sperm that can affect fertility - some cancer treatment can affect your ability to get an erection. There are different ways to improve these problems. Talk to your cancer specialist or specialist nurse about any concerns you have about your fertility.
From puberty the testicles begin to produce and store millions of sperm. Sperm production is controlled by hormones such as testosterone. Testosterone is also needed to control your sex drive and your ability to get an erection.
Usually, you need to have sex for a woman’s egg to be fertilised by a sperm. This involves getting an erection and ejaculating sperm into a woman’s vagina. The sperm can then fertilise the woman’s egg.
Cancer treatments and fertility
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The main treatments for cancer are chemotherapy, radiotherapy, surgery and hormonal therapy .
These treatments affect fertility in different ways. Some stop or slow down sperm production, while others may cause problems in getting an erection and/or ejaculating normally.
If low testosterone levels are contributing to infertility, you can have testosterone replacement therapy. There are also drugs and different techniques that can be used to help you get and keep an erection.
You can read more about this in our section on sexuality and cancer.
We don’t know exactly what effect new chemotherapy drugs or drugs belonging to a new type of cancer treatment called biological therapies have on fertility. Ask your cancer specialist for information about how your treatment is likely to affect your fertility.
After your cancer treatment you can have samples of your sperm tested regularly to find out if you’ve started to produce healthy sperm again.
Chemotherapy can cause infertility by slowing down or stopping your sperm production. For most men this will be temporary, but it can be permanent for others. The effect on your fertility, and whether it’s temporary or permanent, depends on the following:
The drugs you have - Some chemotherapy drugs have a higher risk of causing infertility than others.
The dose - Higher doses of chemotherapy, especially with stem cell transplants, are more likely to affect fertility.
Whether you have a combination of drugs - A combination of different drugs given together may be more likely to affect fertility than if one drug is given on its own.
In some cases it may be possible to choose a chemotherapy treatment that’s less likely to affect your fertility. Your cancer specialist will explain if this is an option for you.
After your chemotherapy, it may take two years or more for your fertility to return to normal. Any problems you have with sperm production will not stop you from getting an erection or enjoying sex.
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells. It can slow down or stop sperm production, or reduce testosterone.
Radiotherapy to the pelvis
Radiotherapy to the pelvic area close to the testicles can lead to infertility, which may be temporary or permanent. If radiotherapy is given directly to the testicles it will cause permanent infertility.
Radiotherapy can also reduce the amount of testosterone that’s produced. This can lower sex drive and the ability to get an erection, but can be treated by taking testosterone replacement therapy.
The risk of infertility is generally related to the dose of radiotherapy given to the pelvic area. It may take up to five years for your fertility to come back. If you’re not producing sperm after this time, it’s unlikely that your fertility will return.
Total body irradiation (TBI)
TBI is given to some men who have leukaemia or lymphoma, and usually causes permanent infertility.
Radiotherapy to the brain
Radiotherapy to the brain that includes the pituitary gland at the base of the brain can sometimes affect fertility. The pituitary gland controls the hormones that stimulate the testicles to produce testosterone.
Other types of radiotherapy
Radioactive iodine is a type of radiotherapy used to treat thyroid cancer. It doesn’t usually affect fertility.
Radiotherapy to areas of the body that we haven’t mentioned here won’t cause infertility.
Hormonal therapy is usually used to treat prostate cancer and sometimes breast cancer in men. Side effects can include loss of sex drive and problems getting or keeping an erection. These effects often return to normal after stopping the treatment, but some men may find that these problems carry on after it finishes. There are different techniques that may help improve these problems - your cancer specialist can give you more information.
You can read more about this in our section on sexuality and cancer.
Some operations to the pelvic area or to the spine may damage nerves and blood vessels, making it impossible to get an erection.
A particular operation sometimes used to treat men with testicular cancer may affect fertility. It’s called a retroperitoneal lymph node dissection and is used to remove lymph nodes in the tummy area (abdomen). It may cause a problem called retrograde ejaculation, which is when sperm and semen go backwards into your bladder instead of coming out of your penis when you ejaculate. This doesn’t affect your ability to have an erection or an orgasm.
Having a testicle removed for testicular cancer shouldn’t affect your ability to have children. But if both testicles are removed, which occasionally happens if the cancer comes back, this causes permanent infertility.
While having chemotherapy or radiotherapy, it’s important to use contraception to avoid getting your partner pregnant. The treatments may damage your sperm and possibly harm a baby conceived at this time, although this isn’t proven.
There isn’t any evidence that cancer treatments harm children who are fathered after treatment. But doctors often advise you to carry on using contraception for about a year after treatment. You can talk this over with your cancer specialist or specialist nurse. It may take years for some men’s fertility to come back. But because it could come back without you knowing, don’t assume you can’t get a partner pregnant. If you don’t want to father a child, you’ll need to use contraception until your specialist advises you that infertility is permanent.
Preserving your fertility
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It can be difficult to predict whether treatment will affect your fertility or if it will return to normal after treatment. Even if your chances of becoming infertile are low, you may still be advised to store sperm. This can then be used in the future, along with fertility treatments, to help you and your partner have a child. Freezing and storing sperm is a safe technique that has been successfully carried out for many years.
Your cancer specialist or specialist nurse can discuss this with you and refer you to a fertility clinic before your treatment starts. Most clinics will make sure you’re seen very quickly. Sometimes it may not be possible to store sperm because cancer treatment needs to start straight away. Storing sperm after treatment starts is generally not advised.
The NHS often pays for sperm banking for men with cancer, but in some hospitals you may have to pay for it yourself. The standard storage period for sperm is 10 years. Only in certain circumstances can the storage period be exceeded by up to a maximum of 55 years. The staff at the fertility clinic will explain this to you. Before sperm samples are stored you’ll have to sign a consent form that states how it is to be used.
Collecting and storing sperm
You’ll probably be asked to provide 2-3 samples of sperm over a week by masturbation. This takes place in a private room and your partner can be with you if you prefer. Understandably, you may find this difficult and embarrassing, but the clinic staff will be sensitive and make sure your privacy is protected.
You’re usually advised not to have sex for a couple of days before collecting each sample. This helps to make sure there’s enough healthy sperm to fertilise an egg. Sometimes it may be possible to provide a sample produced at home. This is usually only possible if you can deliver it to the fertility clinic within 30-45 minutes of producing the sample.
Even if you aren’t producing enough sperm, or your treatment started quickly and you couldn’t provide all the samples, your sperm can still be frozen and stored.
New ways of collecting sperm
In men who can’t produce sperm, it may be possible to take a small amount of fluid or tissue from the testicle (sperm extraction). There may still be sperm in the fluid or tissue that can be used with fertility treatment to try to get your partner pregnant.
The fluid or tissue that’s removed is examined for sperm in the laboratory. Sperm can then be removed, frozen and stored for future use. This may be done for men who have problems with sperm production even before their treatment starts, and after treatment for men who haven’t had sperm stored. This is a fairly new technique - your fertility specialist can give you more information about it.
Freezing testicular tissue
Researchers are trying to find out if removing and freezing testicular tissue that may later be re-implanted can preserve fertility in boys who haven’t yet reached puberty. This technique is highly experimental and doctors don’t yet know the risks associated with it. It’s only available in a couple of centres in the UK and no babies have been born in this way.
After cancer treatment
When you’re ready to start a family, the stored sperm can be directly inserted into your partner’s womb (artificial insemination) or more usually used for in vitro fertilisation (IVF). During IVF, your partner’s eggs are mixed with your sperm in a laboratory to see if an egg fertilises and becomes an embryo. The embryo is then transferred into your partner’s womb.
A technique known as ICSI (intra-cytoplasmic sperm injection), which involves injecting a single sperm directly into an egg, may be used. It increases the chances of fertilising eggs more than if IVF is used on its own. As a result, samples with low numbers of sperm, of any quality, are worth freezing. This is helpful when there isn’t enough time to collect all the samples because cancer treatment has to start quickly or if the cancer has slowed sperm production.
Unfortunately, there aren’t any guarantees that stored sperm will be able to fertilise an egg and achieve a pregnancy. Your fertility expert will discuss this with you before your sperm is stored. However, many couples have had babies as a result of storing sperm and fertility treatments.
Using frozen, stored sperm has been carried out for many years and there don’t appear to be any risks to the child. ICSI is still too new a treatment for us to know about any long-term risks to children born as a result of this. Removing sperm directly from the testicle is also a new technique and we don’t known enough about any long-term risks. Your fertility specialist can give you more information.
Using donated sperm
If the cancer treatment has made you permanently infertile and you weren’t able to store sperm beforehand, you and your partner may want to think about using donated sperm. Choosing to use donated sperm can be a difficult decision. You and your partner will be offered counselling about the implications for you and any potential children.
There’s a shortage of sperm donors in the UK so you may have to wait to find a suitable one. It may not be funded by the NHS in some areas of the UK. The staff at the fertility clinic can discuss this with you.
Everyone who donates sperm is carefully selected. Usually a donor will be matched as closely as possible for eye and hair colour, physical build and ethnic origin. The donor has to be fit and healthy with no medical problems and will be tested for infectious diseases such as HIV, and Hepatitis B and C.
Testosterone replacement therapy
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Some treatments, such as radiotherapy to the pituitary gland at the base of the brain, may cause a reduction in testosterone levels.
In testicular cancer, it’s rare to have both testicles removed, but if this does happen, you’ll be given testosterone replacement therapy straight away. Occasionally after surgery to remove one testicle, the remaining testicle doesn’t produce enough testosterone by itself.
A reduction in testosterone levels can develop slowly, affecting your ability to get an erection and reducing your sex drive years after treatment. It can also cause other problems such as thinning of the bones (osteoporosis), tiredness and a low mood. Your doctor can measure your testosterone levels regularly with a blood test to monitor this.
Testosterone replacement therapy will help to reduce these problems. It is given for life as a patch that’s applied to the skin (transdermal), a gel rubbed into your skin, or as an implant or injection into a muscle. Your cancer specialist can give you more advice about this.
Infertility can be very distressing to live with. Having children is an important part of many people’s lives. It may seem especially hard when you’re already coping with cancer. The uncertainty of not knowing whether your fertility will come back or not can also be hard to deal with.
Some men find it helpful to talk things over with their partner, family or friends. Others might prefer to talk to a trained counsellor. Your GP or cancer specialist can arrange this for you. Many hospitals also have specialist nurses who can offer support, and fertility clinics usually have a counsellor you can talk to. You might find it helpful to talk to our cancer support specialists.
Being unable to have children doesn’t define who you are. Talking to other men in a similar position may help you feel less isolated. Some organisations can arrange this as well as specialist advice and counselling. Or you can talk to people online. Our online community is a good place to talk to other men who may be in a similar situation.
This section has been compiled using information from a number of reliable sources, including:
Royal College of Physicians, The Royal College of Radiologists, Royal College of Obstetricians and Gynaecologists. The effects of cancer treatment on reproductive functions: Guidance on management. 2007. Report of a Working Party. London: RCOG.
Lee SJ, et al. American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients. Journal of Clinical Oncology. 2006. 24: 2917–31.Jeruss JS. Preservation of Fertility in Patients with Cancer. New England Journal of Medicine. 2009. 360 (9): 902–911.
Assessment and treatment for people with fertility problems. 2004. National Institute for Health and Clinical Excellence (NICE).
Guidelines are constantly being updated and those noted above may have been revised since this information was produced. For further references, please see the general bibliography.