In men, fertility means being able to make a woman pregnant. For this to happen, a woman’s egg needs to be fertilised by a man’s sperm.
The parts of your body that allow you to do this are called your reproductive system. In men this includes the testicles, the penis and the prostate gland.
The pituitary gland at the base of your brain is also important for fertility. It releases hormones (chemical messengers) that control how your reproductive system works.
Fertility in men depends on:
- having healthy sperm
- being able to get an erection and to ejaculate (come)
- hormone levels.
The testicles begin to make and store sperm from puberty onwards. This process is controlled by hormones produced by the pituitary gland and by the testicles. The testicles make the main male hormone testosterone. This hormone is also important for sex drive and getting an erection.
Normally, you need to have sex to fertilise a woman’s egg. This involves getting an erection and ejaculating in a woman’s vagina. The fluid released is called semen. Semen contains millions of sperm from the testicles and fluid from the prostate gland. One of the sperm may fertilise an egg which may then grow into a baby.
Some people need to have fertility treatment to have a baby. This is also called assisted conception.
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.
- 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 or make it physically difficult to have sex. We have more information about coping with sexual difficulties that may be useful.
Which cancer treatments 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:
Chemotherapy can affect fertility by slowing down or stopping sperm production. For most men this is temporary, but for others it can be permanent. Some chemotherapy drugs affect fertility more than others. Higher doses of chemotherapy are more likely to affect fertility. Different drugs given together may be more likely to affect fertility than a single drug.
After chemotherapy, it may take 2 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 is less likely to affect your fertility. Your cancer doctor will explain if this is an option for you.
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. Radiotherapy to other areas of the body will not cause infertility. Fertility may return slowly or not at all. It can take up to five years for your fertility to come back. If you are not producing sperm after this time, it is unlikely that your fertility will return.
Types of radiotherapy which may affect fertility include:
Surgery can reduce sperm and testosterone production, or cause problems with erections and ejaculation. Operations that can affect your fertility include:
Men with testicular cancer or sometimes other types of cancer may have surgery to remove lymph nodes in the tummy area (abdomen). It can cause nerve damage that makes sperm go backwards into the bladder instead of coming out through the penis when you orgasm. The sperm are then passed out harmlessly in the urine. 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.
Hormonal therapies 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 therapies are a newer type of cancer treatment. It is 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.
Contraception during cancer treatment
It is 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 conceived at this time. Your cancer doctor will tell you how long you need to use contraception for.
It is difficult to predict when fertility will recover. This could happen without you being aware of it. If you do not 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.
It is important to talk to your cancer doctor or nurse about fertility before you start cancer treatment. If treatment might make you infertile, your doctor should talk to you about having your sperm stored before treatment starts. This is called sperm banking.
You and a partner may be able to use the stored sperm to have a child in the future, if cancer treatment makes you infertile.
Your cancer doctor can refer you to a fertility clinic straight away. This means that having your sperm stored should not delay your cancer treatment. But in some situations, treatment must start quickly. In this case there may not be time for sperm banking.
Questions you could ask your medical team
- How will my fertility be affected?
- Are there ways to protect my fertility during cancer treatment?
- Can I store sperm or testicular tissue?
- What type of contraception should I use during cancer treatment?
- What fertility treatments will help in my situation?
It can be difficult to predict if cancer 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 be referred to a fertility doctor before treatment starts, and you may be advised to store (bank) sperm. Your sperm can then be used in the future to help you and a partner try to have a child.
Freezing and storing sperm is a safe technique that has been successfully used for many years. There is no lower age limit for sperm banking, as long as you have reached puberty and are producing sperm.
Most fertility clinics will make sure that you are seen before cancer treatment starts. But some men do not have time to store sperm as treatment needs to start straight away. Storing sperm after treatment starts is usually not advised. Your cancer doctor or specialist nurse can discuss this with you.
Some religions may not agree with certain fertility treatments. If this is an issue for you, you may want to discuss it with your partner, family or religious adviser. You can also talk in confidence with a trained counsellor or social worker.
Before sperm samples are stored, you will be asked to sign a consent form that explains how your sperm will be used. If you are under 16, your parent or guardian may be asked to sign some forms too.
You will have a blood test to check for infectious diseases such as hepatitis and HIV. This is standard procedure for all men storing sperm.
Usually, you provide sperm samples by masturbation in a private room in the fertility clinic. If you have a partner, they can be with you. You may find this embarrassing, but the fertility clinic staff will be sensitive and are used to this.
Sometimes,it may be possible to collect a sample at home and take it to the clinic. This can only be done if you can keep the sample warm and deliver it to the fertility clinic within 30 to 45 minutes.
If possible, you provide two or three samples over a week. But if you can only give one sample before cancer treatment starts, that may still be enough. You are usually advised not to have sex or masturbate for a couple of days before collecting each sample. This allows more sperm to be collected.
Some men are unable to produce samples by masturbation. But it may be possible for a specialist doctor to take a small amount of sperm straight from the testicle.
You will have a local anaesthetic and sedation, or a general anaesthetic, to make it more comfortable. Sperm extraction can be done in two ways:
Percutaneous epididymal sperm aspiration (PESA)
A fine needle is passed into the testicle to withdraw (aspirate) some fluid.
Testicular sperm extraction (TESE)
Tiny pieces of tissue (biopsies) are taken from the testicles.
The fluid or tissue that is removed is looked at under a microscope in a laboratory. Any sperm is removed, frozen and stored for future use.
This may be done before cancer treatment starts, or sometimes after treatment for men who have not had sperm stored.
Urinary sperm retrieval
If you have retrograde ejaculation, you still produce sperm. But your sperm and semen go backwards into your bladder instead of out of your penis when you orgasm.
Sometimes doctors are still able to collect your sperm. You will be given a drink that makes your urine less harmful to your sperm. You will be asked to pass urine and then masturbate. After you ejaculate, you will have to pass urine again. The sperm is quickly collected from the urine, prepared and stored.
The NHS provides sperm storage for men with cancer. But in private clinics you may have to pay for it yourself.
Sperm is usually stored for 10 years. But for men affected by cancer, it can be stored for up to 55 years. The staff at the fertility clinic will explain this to you.
Your sample will be frozen and stored in a tank of liquid nitrogen. This is called cryopreservation.
Even if the number of sperm is low, your sample can still be frozen, stored and used later.
Freezing testicular tissue
Researchers are looking into removing and freezing testicular tissue from boys who have not reached puberty. It is hoped that the tissue can later be re-implanted to preserve their fertility. Researchers are also looking into whether they can produce sperm from these cells in a laboratory.
These techniques are experimental and doctors do not yet know the risks involved. Only a couple of centres in the UK offer this service.
Worrying about your fertility may seem especially hard when you are already coping with cancer. You may find it helps to talk things over with your partner, family or friends. If you prefer to talk to a counsellor, your GP or cancer doctor can help to arrange this. Many hospitals also have specialist nurses who can offer support, and fertility clinics will have a counsellor you can talk to.
Talking to other men in a similar position may help you feel less isolated. Macmillan’s Online Community is a good place to start. You can also talk things over with our cancer support specialists free on 0808 808 00 00.