Preserving your fertility

It’s sometimes difficult to know whether cancer treatment will affect your fertility. Your doctors may advise you to store some sperm, even if you have a low chance of becoming infertile. Your sperm can be used after cancer treatment to help you and a partner have a child.

If you decide to store sperm, you will have to sign a consent form. You will usually be asked to provide samples of your sperm by masturbating. This will be in a private room at the fertility clinic. Sometimes you can provide a sample produced at home.

If you can’t provide a sample of sperm, there are still options for storing sperm. It may be possible to take fluid or tissue straight from the testicle. Doctors may be able to collect sperm from your urine if you have retrograde ejaculation. Researchers are looking into other ways of preserving fertility. Speak to your doctors about these options, as they can tell you if they are suitable for you.

Options for preserving your fertility

It can be difficult to predict if 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 (bank) sperm. Freezing and storing sperm is a safe technique that has been successfully used for many years. There is no lower age limit for this, as long as you have reached puberty and are producing sperm.

Your sperm can then be used in the future, along with fertility treatments, to help you and your partner have a child.

Your cancer doctor 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. But 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.

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.

'I always knew I wanted children and I was gutted when I finally went to freeze sperm and I only managed to store one sample. But there are many ways to have children.'

Fertility in men

Collecting and storing sperm

Before sperm samples are stored you’ll be asked to sign a consent form that states how your sperm is to be used. If you are under 16, your parent or guardian may be asked to sign some forms too.

You will have some blood taken for testing for infectious diseases such as hepatitis and HIV. This is standard procedure for all men storing sperm.

You’ll probably be asked to provide sperm samples by masturbation. This takes place in a private room in the clinic. If you have a partner, they can be with you if you want. You will be asked to provide two or three samples over a week. Understandably, you may find this difficult and embarrassing, but the clinic staff will be sensitive.

You’re usually advised not to have sex or masturbate for a couple of days before collecting each sample. This allows more sperm to be collected. Sometimes it may be possible to provide a sample produced at home. This can only be done if you can deliver it to the fertility clinic within 30–45 minutes of producing the sample.

Sperm extraction

For men who can’t produce sperm through masturbation, it may be possible to take a small amount of fluid or tissue straight from the testicle. This 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 (TESA) – tiny bits of tissue (biopsies) are taken from the testicles and examined for sperm under a microscope.

These procedures will be done by a specialist doctor. You will have a local anaesthetic and sedation, or general anaesthetic.

The fluid or tissue that’s removed is examined for sperm in the laboratory. Any sperm can then be removed, frozen and stored for future use. This can 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.

Urinary sperm retrieval

If you have retrograde ejaculation you will still produce sperm. But your sperm and semen will 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 pass urine again. The sperm can then be quickly collected from your urine.

Freezing testicular tissue

Researchers are looking into removing and freezing testicular tissue from boys who haven’t yet 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 don’t yet know the risks involved. Only a couple of centres in the UK offer this service.

Storing sperm

The NHS provides sperm storage for men with cancer, but in private clinics you may have to pay for it yourself. The standard storage period for sperm is 10 years. 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. This is also possible if you started treatment quickly and couldn’t provide all the samples.

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Getting support

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