Men's options after cancer treatment

Sunday 1 June, 2014

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On this page: Natural conception | Using fertility treatments | Donor sperm | Key points

Related pages: Men's fertility and cancer treatment | Men's options before cancer treatment

When cancer treatment is finished, you will have your semen analysed to check if it contains sperm, and the quality of the sperm and its movement (motility). See assessing your fertility.

Sometimes men who temporarily stop producing sperm recover the ability to produce it. However, if it isn’t restored over time, you are considered permanently infertile. You may feel a sense of loss – the information in the emotional impact section may help.

If you aren’t sure what you want to do but are still fertile, you may want consider banking some sperm. However, this is generally recommended before cancer treatment starts. Your fertility specialist will advise you about this.

Natural conception

Your medical team might advise you to try for a baby naturally after finishing cancer treatment. Sexual intercourse is more likely to lead to conception if sperm counts and motility are close to normal.

Your ability to conceive this way may also be partly dependent on your partner – for example, an older woman may be less fertile. Your fertility specialist will talk to you about factors to consider.

If you would like to try and conceive naturally, speak with your cancer specialist first. You may be advised to wait six months to two years before fathering a child. The length of time depends on the type of cancer and treatment.

Dry orgasm and retrograde ejaculation

Some men no longer ejaculate semen after treatment for prostate, colon or testicular cancer. This is known as dry orgasm. It may occur because your prostate gland and seminal vesicles were removed in a radical prostatectomy, or because lymph node removal damaged the nerves that control ejaculation.

If you have dry orgasm, you will not be able to conceive a child through sexual intercourse. However, it may be possible to have testicular sperm extraction.

If you have mild nerve damage, the prostate and seminal vesicles may still function and produce semen. It’s possible that semen can go backwards into the bladder instead of out through the penis during orgasm (retrograde ejaculation).

If retrograde ejaculation is your only problem, you may be given medication to contract the internal valve of the bladder. This forces semen out of the penis, as normal, and it may make it possible for you to conceive naturally.

Using fertility treatments

If you are producing sperm, you may be able to use fertility treatment to conceive a baby. This may be effective even if you are producing a limited amount.

Intrauterine insemination (sperm injection or IUI)

During this procedure, frozen sperm are thawed, washed and put in a sterile solution. Samples must contain at least 2 million active sperm after thawing to be used for IUI.

When your female partner is ovulating, a small tube (catheter) is threaded into her uterus through the cervix to place the sperm near the fallopian tube.

If IUI is successful, fertilisation occurs and the woman has a positive pregnancy test within a few weeks.

Intracytoplasmic sperm injection (ICSI)

IVF procedures are done to extract an egg from a woman, then a single sperm is injected directly into the egg. This is a newer technique, so ask the fertility specialist if it is an option.

Testicular sperm extraction may also be used after cancer treatment if you can’t ejaculate or if the semen ejaculated doesn’t contain sperm.

Donor sperm

Using donor sperm is the simplest and least expensive way for a man who is infertile after cancer treatment to become a parent.

Sperm donors are men who have voluntarily contributed sperm to a fertility centre. Personal information is collected about donors, including:

  • 2–4 generations of family medical history
  • details about their educational background, hobbies, skills and occupation
  • health information, including ethnicity, drug use and blood type.

Samples are thoroughly screened for genetic diseases or abnormalities, sexually transmitted infections (STIs) and overall quality, then quarantined for a certain period of time.

When you use the sperm, insemination is usually done in the fertility specialist’s office. The sample is inserted directly into the woman’s uterus (IUI). Before this process, the woman may be given hormones to prepare her body and increase the chances of pregnancy.

Counselling: donor tissue

There are social, legal and moral considerations when using donor sperm.

For example, people conceived with donor sperm may want to know the identify of the donor. However, access to this information depends on where and when the person was conceived. Laws about accessing identifying information about sperm donors vary from state to state.

A donor’s sperm could be used to assist multiple families, which means genetic siblings may be created.

These are complex issues so you will probably be advised to speak with a fertility counsellor or lawyer.

Key points

  • A semen analysis can give you information about the quality of sperm and its movement. Sperm count may improve over time.
  • Some men are able to father a child naturally. You might be advised to wait a certain period before fathering a child.
  • You may be able to use fertility treatment to conceive using your own semen. This might include intrauterine insemination (sperm injection or IUI) or intracytoplasmic sperm injection (ICSI).
  • Some men use donor sperm to conceive a child.

Reviewers: Prof Martha Hickey, Head of Obstetrics and Gynaecology, University of Melbourne, VIC; Franca Agresta, Clinical Research Manager, Melbourne IVF, VIC; Alyssa White, National Publications Project Manager, Cancer Council NSW; and Georgia Mills, Cancer Survivor.
Updated: 01 Jun, 2014