Types of cancer treatment on fertility
Cancer treatments may affect male fertility in different ways.
Chemotherapy uses drugs to kill or slow the growth of cancer cells. These drugs travel throughout the body and are designed to affect fast-growing cells such as cancer cells. This means they can also damage other cells that grow quickly, including the reproductive cells.
Chemotherapy drugs can lower or stop sperm production for a while. Sperm production often returns to normal, but this may take several years. The drugs may also reduce the ability of sperm to move or alter the sperm’s genetic make-up. The risk of infertility depends on:
- the drugs used – some types of chemotherapy drugs are more likely to damage sperm production than others
- the dose you are given – the risk of damage to sperm increases with higher doses and longer treatment times
- your age – the quality of sperm decreases with age and you are less likely to recover fertility if you are over 40.
The effects of chemotherapy on sperm production may be temporary or permanent. Chemotherapy can cause permanent infertility if the cells in the testicles are too damaged to produce healthy, mature sperm again.
If you are treated with both chemotherapy and radiation therapy (chemoradiation), the risk of infertility is higher.
Radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow and multiply. It can be delivered from inside or outside the body. Radiation therapy may cause infertility. The risk of infertility will vary depending on the area treated, the dose and number of treatments.
- External radiation therapy to the pelvic area (for prostate, rectal, bladder or anal cancer and some childhood leukaemias) or near the testicles may affect sperm production. This often returns to normal after a few months. Depending on the dose and the area of the pelvis treated, you may also have problems getting and keeping erections, and ejaculation may be painful for a few weeks after treatment.
- Radiation therapy to the brain may damage the pituitary gland, affecting the production of sperm and sex drive.
- Brachytherapy seed implants used for prostate cancer may affect sperm production, but many men recover.
Some cancer treatments, such as chemotherapy or radiation therapy, may affect sperm and cause birth defects. As you may still be fertile during treatment, you will need to use contraception or not have penetrative sex to avoid conceiving during treatment.
Surgery aims to remove the cancer from the body. Surgery to remove part or all of a sex organ or organs in the surrounding area (such as the bladder), may affect your ability to conceive a child.
Removal of the testicles (orchidectomy) – most men who have had one testicle removed can go on to have children naturally. However, men with testicular cancer have lower fertility rates than the general population. The urologist may advise you to store some sperm at a sperm banking facility before the surgery, just in case you have fertility problems in the future.
In some rare cases, both testicles are removed (bilateral orchidectomy). This causes permanent infertility because you will no longer produce sperm. You will still be able to get an erection.
Removal of the prostate (prostatectomy) – during surgery to remove the prostate and seminal vesicles, the tubes from the testicles (vas deferens) are sealed. This causes permanent infertility because you will not be able to ejaculate semen during orgasm. This is known as a dry orgasm.
The prostate lies close to nerves and blood vessels that are important for getting erections. These may be damaged during surgery, but the impact on erections depends on the strength of your erections before surgery. In some cases, semen may go back towards the bladder instead of forward into the penis (retrograde ejaculation).
Removal of the penis (penectomy) – part or all of the penis may be removed to treat penile cancer. The part of the penis that remains may still get erect with arousal and may be long enough for penetration. It is sometimes possible to have a penis reconstructed after surgery, but this is still considered experimental and would require another major operation.
Nerve damage – surgery for bladder, prostate or testicular cancer may damage the nerves used for getting and keeping an erection (erectile dysfunction). This may last for a short time or be permanent. It may be possible for the surgeon to use a nerve-sparing surgical technique to protect the nerves that control erections. This works best for younger men who had strong erections before the surgery. However, problems with erections are common even with nerve-sparing surgery.
The hormone testosterone helps prostate cancer to grow. Slowing the body’s production of testosterone and blocking its effects (hormone therapy) may slow the growth of the cancer or even shrink it. This may cause infertility. Males with breast cancer who are taking the drug tamoxifen (an antioestrogen drug) may experience increased sperm production.
Stem cell transplant – high-dose chemotherapy and, possibly, radiation therapy are given before the transplant to kill the cancer cells in the body. The risk of permanent infertility after high-dose chemotherapy or radiation therapy is high.
Immunotherapy and targeted therapy – the effects of these newer treatments on fertility and sperm production vary depending on the drug you take. It is important to discuss the potential impact of these drugs with your cancer or fertility specialist.
Managing side effects of surgery
Dry orgasm – you will not be able to conceive a child without medical assistance. You may be able to have a procedure to retrieve some sperm from the testicles (testicular sperm extraction).
Retrograde ejaculation – you may be given medicine to help the semen move out of the penis as normal. This may make it possible for you to conceive naturally. Your fertility specialist can also collect some ejaculated sperm from the urine, which can be used to fertilise eggs during IVF.
Erection problems – if surgery has damaged the nerves that help control erections, there are several medical options you can try. These include prescription medicine and erectile aids which may make it possible for you to conceive naturally. If you are not able to have sexual intercourse, you may be able to have testicular sperm extraction to help you conceive.
Learn more about sexuality, intimacy and cancer
Fertility outcomes after treatment
Semen production often returns to normal after a few months and some males are able to conceive after cancer treatment without medical assistance. Erectile function can also continue to improve for up to three years after treatment has finished.
For other males, the effect on sperm production and ability to have erections is permanent and causes infertility. It may take time to accept this. You may find it helpful to speak to your partner, family or friends, or a professional counsellor or psychologist about how you are feeling. You can also call our compassionate cancer nurses on 13 11 20 for support.
Fertility and Cancer
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Expert content reviewers:
Dr Ying Li, Gynaecologist and Fertility Specialist, RPA Fertility Unit, Royal Prince Alfred Hospital, NSW; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s Hospital and Prince of Wales Hospital, NSW, and Lead Clinician for Youth Cancer NSW/ACT; Paul Baden, Consumer; Dawn Bedwell, 13 11 20 Consultant, Cancer Council Queensland; Maurice Edwards, Special Counsel, Watts McCray Lawyers, NSW; Helena Green, Clinical Sexologist and Counsellor, InSync for Life, WA; Dr Michelle Peate, Program Leader, Psychosocial Health and Wellbeing Research (emPoWeR) Unit, Department of Obstetrics and Gynaecology, Royal Women’s Hospital, The University of Melbourne, VIC; A/Prof Kate Stern, Gynaecologist and Reproductive Endocrinologist and Head, Fertility Preservation Service, Royal Women’s Hospital Melbourne, The University of Melbourne, VIC; Prof Jane Ussher, Chair, Women’s Health Psychology, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, NSW; Renee Van Den Bosch, Consumer.
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The information on this webpage was adapted from Fertility and Cancer - A guide for people with cancer, their families and friends (2020 edition). This webpage was last updated in March 2022.