Men's fertility and cancer treatment

Sunday 1 June, 2014

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On this page: Avoiding conception during treatment | Chemotherapy | Radiotherapy | Surgery | Other treatments | Key points

Related pages: Men's options before cancer treatment | Men's options after cancer treatment


This page provides an overview of how cancer treatments can affect men’s fertility. Generally, sperm production is more affected in men who have:

  • a high dose of chemotherapy
  • both chemotherapy and pelvic/abdominal radiotherapy
  • prostate surgery.

Avoiding conception during treatment

Some cancer treatments, such as chemotherapy or radiotherapy, may harm an unborn baby or cause birth defects. Talk to your doctor or nurse about whether you need to take specific precautions (such as practising abstinence or using contraception) to avoid conceiving during treatment.

Sometimes men don’t take precautions because they think they aren’t making sperm and are infertile. However, any sperm you produce is more likely to be damaged, and this could result in birth defects in children that are conceived.

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The drugs are sometimes called cytotoxics.

Although it can be an effective cancer treatment, chemotherapy often causes side effects to healthy cells in the body, and can damage the sperm.

The extent of the damage to the sperm is determined by:

  • the type of drug/s you receive
  • the dosage and duration
  • the combination of medications you receive
  • your age (if you are over 40, you may be less likely to recover your fertility).

There are also risks that chemotherapy may alter the genetic make-up of the sperm, or cause problems with their ability to move up the fallopian tubes for fertilisation.

During and after chemotherapy, sperm production may reduce or stop. The higher the dose of chemotherapy, the longer it takes for sperm production to get back to normal, and the more likely it is to permanently stop.

If sperm production stops, it may resume, but this often takes 1–4 years. It’s unlikely to resume if it doesn’t improve after a few years, but for some men, it has taken up to a decade to improve.

Permanent infertility results if the cells in the testicles are damaged to the point that they can no longer produce healthy, mature sperm.

For more information about cancer treatments, including chemotherapy, radiotherapy and surgery, call 13 11 20 for free booklets or see treatments and side effects.

Radiotherapy

Radiotherapy is the use of high-energy radiation to kill or damage cancer cells. It can be given externally, through a machine directing invisible rays toward the body, or internally, through tiny radioactive implants inserted into the body (brachytherapy).

Whether or not radiotherapy affects sperm production depends on its location (proximity to the testicles or brain) and dose (measured in grays). A dose as low as 0.1 gray can negatively affect a man’s fertility.

  • Radiation to a man’s testicles or groin area is most likely to kill or damage cells that make sperm. External radiotherapy is aimed directly at this region to treat some childhood leukaemias and testicular cancers. Men who have another type of cancer in the lower abdomen/pelvis, such as rectal or anal cancer, may also be exposed to enough radiation to harm sperm production.
  • Treatment directed to the brain can also affect the pituitary gland, which makes hormones to signal sperm production.
  • If you have brachytherapy seed implants, the testicles receive a relatively small dose of radiation. Sperm production may be affected, but most men recover. Some men remain fertile throughout this treatment.
"I was okay with a lot of things, but the idea of not being able to father children really affected me. That was when it all started to get very serious, in terms of my thinking." – Elliott

Surgery

Having surgery to the reproductive organs or to the organs in the surrounding area (such as the bladder), may impact on your ability to father a child.

Testicular surgery

Treatment for testicular cancer often involves removal of a testicle (orchidectomy). Usually, only one testicle is removed. If the remaining testicle is healthy, you may continue to make sperm after surgery, but this will depend on if you have further treatment with chemotherapy or radiotherapy.

If the remaining testicle doesn’t produce enough testosterone, you can have hormone replacement therapy (supplements) to stimulate sperm production.

Rarely, both testicles are removed to treat testicular cancer (bilateral orchidectomy). You will still be able to get an erection and ejaculate, but there will be no sperm in the semen and you will be infertile.

Prostate surgery

If you have prostate cancer that hasn’t spread, you may have an operation to remove the prostate gland and seminal vesicles (radical prostatectomy).

During a radical prostatectomy, the vas deferens are cut, so there is no way for semen to get from the testicles (where it’s produced) to the urethra. You may still have erections and the pleasurable feelings of orgasm, but no longer ejaculate semen out of the penis. This is called a dry orgasm (see below).

Surgery can also damage or remove nearby nerves, which may affect your ability to get an erection. The impact of the operation depends on the quality of your erections before surgery.

Bladder surgery

If you have bladder cancer, all or part of the bladder may be removed (cystectomy). During this time, the prostate and seminal vesicles may also be removed, causing infertility.

Nerve damage and ejaculation

Some types of surgery can damage nerves that are needed to get an erection or ejaculate semen. This can affect men who have an operation to treat prostate, testicular or colon cancer, or men who have lymph nodes removed from the pelvis.

After the operation, semen is still produced, but it isn’t ejaculated out of the penis normally. Instead, it may not move, or it could go backwards into the bladder. This is called retrograde ejaculation (see below). 

Problems with getting and maintaining erections is known as erectile dysfunction or impotence. Before treatment, your doctors will discuss if you are likely to have nerve damage that causes these problems. Medication or aids can help to restore erectile function.

Other treatments

Other common cancer treatments may include hormone treatments, bone marrow or stem cell transplants, immune therapies, vaccines and biological response modifiers.

Testosterone and other hormones can be affected. This may cause infertility, or it could have the opposite effect. For example, men with breast cancer who are taking the drug tamoxifen (an anti-oestrogen drug) may experience increased sperm production.

Stem cell transplants often require high doses of chemotherapy and possibly radiotherapy. This is given before transplantation to destroy cancer cells in the body and weaken the immune system so that it will not attack a donor’s cells during the transplant. This can permanently affect your sperm production. Talk to your fertility specialist about this before treatment, as there may be some things you can do, such as banking sperm.

The effects of some newer treatments on fertility and pregnancy are not yet known. It is important to discuss your fertility options with your cancer or fertility specialist.

"Prior to the diagnosis, my partner and I were working long hours in demanding jobs. Thinking about the cancer and the possibility that we might not have kids led us to both change jobs and take a step back. We talked about our life plans and goals. Not only did this bring us closer, but it made our outlook on life more balanced." – Isham
Tell your cancer story.

Key points

  • You will probably be advised to avoid conceiving during cancer treatment.
  • Chemotherapy is drug treatment that can damage sperm. Sperm production may reduce or stop, and it can take years to resume.
  • Radiotherapy, given externally or internally, may damage the reproductive organs or pituitary gland, which makes hormones to signal sperm production.
  • Surgery to the reproductive organs or surrounding area may affect sperm production, and the ability to get an erection and ejaculate.
  • Other treatments, including hormone treatments and bone marrow transplants, can also have an impact.

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