How cancer treatment can affect fertility

The main treatments for cancer are chemotherapy, radiotherapy, surgery, hormonal therapy and targeted therapy. These can affect your fertility in different ways. Treatments can:

  • stop or slow down sperm production
  • cause problems with erections or ejaculation
  • affect hormone (testosterone) production.

Doctors may not be able to tell you exactly how your fertility will be affected. But your planned treatment can help give them an idea. Sometimes, it may be possible to reduce the effects of treatment on your fertility.

Cancer and cancer treatment can also cause problems with how you feel about sex. It can be hard to talk about this but your cancer doctor or specialist nurse can give you advice.

It’s still important to use contraception during cancer treatment and for a time after. This is because the treatments may damage the sperm, which can affect a baby that’s conceived at this time. Your cancer doctor will tell you how long you need to use contraception for.

After cancer treatment, you can have your sperm tested to find out if you are producing healthy sperm again.

Cancer treatments and fertility

Doctors may not be able to predict exactly how your fertility will be affected. But your planned treatment can help give an idea of your individual risk. Sometimes, it may be possible to reduce the effects of treatment on your fertility.

The main treatments for cancer are chemotherapy, radiotherapy, surgery, hormonal therapy and targeted therapy. These can affect your fertility in different ways. Treatments can:

  • stop or slow down sperm production
  • cause problems with erections or ejaculation
  • affect hormone (testosterone) production.

Cancer and cancer treatment can also change how you feel about sex. It’s not unusual to have difficulties with sex drive and getting an erection during or after cancer treatment. It can be hard to talk about this but your cancer doctor or specialist nurse can give you advice about treatments that might help.

We have more information about coping with sexual difficulties that may be useful.

I wanted to deal with it on my own and I had all the natural feelings of loss of manliness, worry about “performing”, worry about fertility and recurrence. My other half was great but I know she struggled to know what to do. But she was always there for me.

Jason


Contraception during cancer treatment

It’s important to use contraception during cancer treatment and for a time after it. This is because the treatments may damage the sperm, which can affect a baby that’s conceived at this time. Your cancer doctor will tell you for how long you need to use contraception.

It’s difficult to predict when fertility will recover. This could happen without you being aware of it. If you don’t want to have a child, keep using contraception unless doctors tell you that the infertility is permanent.

Being able to get an erection and ejaculate does not always mean that you are fertile. Sometimes the semen may not have sperm in it. After cancer treatment, you can have your sperm tested to find out if you are producing healthy sperm again.


Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It can affect fertility by slowing down or stopping sperm production. For most men this is temporary, but for others it can be permanent.

It will depend on:

  • which drugs you have – some chemotherapy drugs affect fertility more 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 – different drugs given together may be more likely to affect fertility than a single drug.

After chemotherapy, it may take two years or more for your fertility to return to normal. Problems with sperm production should not stop you from getting erections or enjoying sex.

In some situations, it may be possible to choose a chemotherapy treatment that’s less likely to affect your fertility. Your cancer doctor will explain if this is an option for you.


Radiotherapy

Radiotherapy treats cancer by using high-energy rays to destroy cancer cells. It can cause fertility problems by:

  • affecting sperm production
  • reducing testosterone
  • causing problems with erections.

Your risk of infertility depends on the dose and type of radiotherapy and the exact area being treated. Fertility may return slowly or not at all. It can 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.

Radiotherapy to the pelvis

Radiotherapy destroys cancer cells in the treated area, but it can also affect some surrounding healthy tissue.

Radiotherapy to the pelvis can reduce the amount and quality of sperm you produce. This may be temporary or permanent. When you ejaculate, you may notice that only a small amount of fluid comes out. Some men stop producing any semen at all, which is known as a dry ejaculation.

If you have radiotherapy directly to the testicles, it will cause permanent infertility. You may still produce semen when you ejaculate but it won’t contain sperm.

Radiotherapy to the pelvis may also reduce the amount of testosterone you produce. This can affect sperm production, your sex drive and your ability to get an erection (erectile dysfunction). You can take testosterone replacement therapy to treat this. This can help with erections but it won’t mean that you produce sperm again.

Some men develop problems with erections because radiotherapy has damaged nerves or blood vessels to the penis. Although you may feel embarrassed, you should talk to your doctor if you’re having problems. There are treatments that can help with this.

Sometimes the radiographer may use special ‘shielding cups’ to cover and protect the testicles during radiotherapy to nearby areas. Or you may have intensity modulated radiotherapy (IMRT). This is a specialised way of giving radiotherapy that shapes the beams to fit the outline of tumours more precisely. This means less damage to areas near the tumour. Your cancer doctor can explain if these treatments are suitable for you.

Total body irradiation (TBI)

TBI is radiotherapy given to the whole body before a donor stem cell or bone marrow transplant. This usually causes permanent infertility. Your cancer specialist will talk to you about this before you agree to treatment.

Radiotherapy to the brain

Radiotherapy to the pituitary gland at the base of the brain can sometimes affect fertility. The pituitary gland releases hormones called gonadotrophins that stimulate the testicles to produce testosterone and sperm.

After radiotherapy, your pituitary gland may stop producing gonadotrophins. This may happen some months or even years after radiotherapy. Some men have gonadotrophin replacement injections if they are trying to start a family.

Radioactive iodine

Radioactive iodine is a type of radiotherapy used to treat thyroid cancer. It doesn’t usually affect fertility, although there is a slightly increased risk for men who have several treatments with radioactive iodine.

Radiotherapy to areas of the body not mentioned here won’t cause infertility.


Surgery

Surgery can reduce sperm and testosterone production, or cause problems with erections and ejaculation. Operations that can affect your fertility include:

  • removing the testicles
  • removing the prostate gland
  • some types of surgery to the pelvic area or the tummy area (abdomen)
  • removing the pituitary gland.

Surgery to the testicles

Having one testicle removed for testicular cancer shouldn’t affect your fertility. You may still be able to have a child naturally. However some men with testicular cancer already have problems producing sperm. If this is still a problem after surgery, fertility treatments can help.

Having both testicles removed, for example if testicular cancer comes back, causes permanent infertility.

Surgery to the prostate gland

Prostate cancer may be treated with surgery. If your prostate gland is removed, you will still make sperm, but it won’t come out through your penis. It will be absorbed back into the body.

You may also have problems with erections or lose interest in sex after prostate surgery. Although you may feel embarrassed, doctors who deal with prostate cancer are very used to talking about these issues and will be able to give you advice. There are treatments that can help with this.

Other surgery to the pelvic area or abdomen

Men with testicular cancer or sometimes other types of cancer may have surgery to remove lymph nodes in the tummy area (abdomen). This operation is called a retroperitoneal lymph node dissection. It can cause nerve damage that makes sperm go backwards into the bladder instead of coming out through the penis when you orgasm. This is called retrograde ejaculation. The sperm are then passed out harmlessly in the urine. Fortunately, new surgical techniques mean that this problem is now less common.

Other operations to the prostate, bladder, bowel, penis or spine can damage nerves and blood vessels to the penis. This may cause problems with erections and ejaculation.

Surgery to the pituitary gland

Surgery may be used to remove a tumour in the pituitary gland at the base of the brain. The pituitary gland releases hormones called gonadotrophins that stimulate the testicles to produce testosterone and sperm.

Surgeons try to leave some of the gland when removing the tumour, but this isn’t always possible. Removing the whole pituitary gland affects hormone levels and the testicles stop producing testosterone and sperm. Some men have gonadotrophin replacement injections if they are trying to start a family.


Hormonal therapy

For some types of cancer, hormones encourage the cancer cells to grow. Hormonal therapies prevent this and can slow down or stop cancer cells growing. Doctors may use it to treat prostate cancer or breast cancer in men. Side effects can include loss of sex drive and problems getting or keeping an erection. These often return to normal after stopping treatment, but some men continue to have problems.

There are different techniques that may help improve these problems. Your cancer or fertility doctor can give you more information about this.


Targeted therapy

Targeted therapies are a newer type of cancer treatment. They are also called biological therapies and are used to treat many different cancers. It’s not yet known exactly what effect they have on fertility. If you are treated with a targeted therapy, your cancer doctor can tell you about possible risks to your fertility.

Although I didn’t want more children, I didn’t want cancer to make the decision that I couldn’t have more children.

Darren

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Getting support

You might find it helpful to talk to family, friends or healthcare professionals about fertility.