How treatment can affect fertility

Cancer treatments can affect fertility in different ways. You will be able to have your sperm tested after your treatment to see if you are producing healthy sperm.

  • Chemotherapy can slow down or stop sperm production. The effect it has will depend on the drugs you are having. You should still be able to get an erection and enjoy sex.
  • Radiotherapy can affect sperm production. It can also cause problems with erection and can reduce the levels of the male hormone, testosterone. Different types of radiotherapy have different effects on fertility.
  • Surgery can cause problems with erections and ejaculation, and can also reduce the levels of the male hormone, testosterone.
  • Hormonal therapy reduces the level of testosterone. This can cause a loss of sex drive and problems with erections.

These issues are permanent for some men, but temporary for others. Your doctor will be able to talk to you about any possible problems in your situation.

Cancer treatments and fertility

The main treatments for cancer are chemotherapy, radiotherapy, surgery, hormonal therapy and targeted therapy.

They affect fertility in different ways. Some treatments can:

  • stop or slow down sperm production
  • damage the cells (germ cells) that produce sperm
  • damage nerve endings or blood vessels in the pelvic area, leading to problems with erections or ejaculation
  • affect hormone (testosterone) production.

After treatment, you can have your sperm tested regularly to find out if you’ve started to produce healthy sperm again.

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.


Effects of chemotherapy on fertility

Chemotherapy can cause infertility by slowing down or stopping sperm production. For most men this is temporary, but for others it can be permanent. The effect 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.

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.

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.


Effects of radiotherapy on fertility

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

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

Radiotherapy to the pelvis

Radiotherapy destroys cancer cells in the treated area, but it can also affect some surrounding healthy tissue. Radiotherapy to the pelvic area close to the testicles can lead to infertility, which may be temporary or permanent. Sometimes the radiographer may use special ‘shielding cups’ to cover and protect the testicles from radiation.

Intensity modulated radiotherapy (IMRT) might be used. This is a specialised way of giving radiotherapy which shapes the beams to fit the outline of tumours more precisely. This means lower doses can be given to the healthy tissue surrounding the tumour. This can reduce the risk of damage and side effects.

If you have radiotherapy directly to the testicles, it will cause permanent infertility by affecting sperm production. It may also reduce the amount of testosterone you produce, which can affect your sex drive and your ability to get an erection.

After pelvic radiotherapy, the amount of semen you produce is reduced. This means that, when you ejaculate, you may notice that only a small amount of fluid comes out. Radiotherapy may also affect the quality of the sperm in the semen. Some men don’t produce any semen at all, and this is known as a dry ejaculation.

Some men develop problems with erections (erectile dysfunction) after radiotherapy to the pelvis. This may be due to nerve damage or narrowing of the blood vessels to the penis. Although you may feel embarrassed, you should talk to your doctor if you’re having problems. There are treatments for erectile dysfunction caused by pelvic radiotherapy.

Radiotherapy can also reduce the amount of testosterone that’s produced. This can lower your sex drive and ability to get an erection. You can taketestosterone replacement therapy to treat this. However this therapy might affect your sperm production. If you want to have children, speak to your fertility doctor before starting it.

The risk of infertility is generally related to the dose of radiotherapy given to the pelvic area. Fertility may never return or might return slowly. 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.

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 can talk to you about this.

Radiotherapy to the brain

Radiotherapy to the pituitary gland at the base of the brain can sometimes affect fertility. The pituitary gland controls the hormones (gonadotrophins) that stimulate the testicles to produce testosterone.

Low levels of testosterone can be treated by replacement therapy.  But this therapy might affect your sperm production. Sometimes gonadotrophin injections can be used to stimulate the testicles to start producing sperm again. If you want to have children, speak to your fertility doctor before starting replacement therapy.

Other types of radiotherapy

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


Effects of surgery on fertility

Surgery can affect fertility by causing problems with erections, ejaculation or by reducing testosterone.

Surgery to the testicles

Having one testicle removed for testicular cancer shouldn’t affect your fertility. But having both testicles removed, which may happen if the cancer comes back, causes permanent infertility.

Men with testicular cancer may have a retroperitoneal lymph node dissection. This is an operation to remove lymph nodes in the abdomen (tummy). It may cause a problem called retrograde ejaculation. This is when your semen and sperm go backwards into your bladder instead of coming out of your penis when you orgasm. However, this is becoming less common as surgeons use new nerve-sparing techniques to help protect the nerves. It doesn’t affect your ability to get an erection or have an orgasm.

Surgery to the pelvic area or abdomen

Some operations to the pelvic area or to the spine may damage nerves and blood vessels, making it impossible to get an erection.

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 controls the hormones that stimulate the testicles to produce testosterone and sperm.

Surgeons try to remove the tumour while leaving some of the gland but this isn’t always possible. When the whole gland is removed, this affects the hormones. Gonadotrophin (hormone) injections may be used to stimulate the testicles to start producing sperm again.


Effects of hormonal therapy on fertility

Doctors may use hormonal therapy to treat prostate cancer and breast cancer in men. It works by lowering the level of testosterone which can help stop cancer cells growing. 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.

You can read more about this in our section about sexuality and cancer.

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Getting support

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