Male options before cancer treatment
It’s ideal to discuss fertility options with your specialist before cancer treatment begins. Some choices, such as sperm banking and radiation shielding, are well-established ways to preserve fertility.
The option that is right for you depends on the type of cancer you have and your personal preferences. Ask your cancer specialist how long you have to consider your options. In many cases, you can wait a week or two before starting cancer treatment.
Fertility treatments carry some risks and your doctor should discuss these before you go ahead. Keep in mind that no method works all of the time.
If you didn’t have an opportunity to discuss your options before starting cancer treatment, you can still consider your fertility later. Your choices after treatment will depend on whether you are able to produce sperm.
Preserving fertility in males
Sperm banking or sperm freezing (cryopreservation)
- What this is – collecting, freezing and storing sperm. This is the standard way of preserving fertility in males.
- When this is used – when you want to store sperm for the future – samples can be stored for up to 20 years.
- How this works – the procedure is performed in hospital or in a sperm bank facility (also called an andrology unit). Samples are collected in a private room where you can masturbate or have a partner sexually stimulate you and then ejaculate into a jar. It’s recommended that you provide 2–3 samples – you may need to visit the clinic more than once to ensure an adequate amount of semen is collected. The sperm is then frozen until needed, and when you are ready to have a child, the frozen sperm is thawed and used to fertilise an egg using IVF.
- Other considerations – if you collect semen at home, you must keep the sample close to body temperature and get it to the sperm bank facility within an hour. If you want to collect semen during sex, you must use a special condom you can get from the sperm bank facility. If you are unable to ejaculate, there are medical ways to encourage ejaculation. If you are unable to produce a sample of semen, sperm may be collected using testicular sperm extraction. Sperm can also be collected from men with retrograde ejaculation.
You may feel nervous and embarrassed going to a sperm bank, or worry about achieving orgasm and ejaculating. The medical staff are used to these situations and you can also bring someone with you.
Legal limits on how long sperm can be stored are different in each state and territory – your fertility clinic can advise about time limits and the cost of storage.
- What this is – protecting the testicles from external beam radiation therapy with a shield.
- When this is used – if the testicles are close to where radiation beams are directed (but are not the target of the radiation), they can be protected from the radiation beams.
- How this works – protective lead coverings called shields are used.
- Other considerations – this technique does not guarantee that radiation will not affect the testicles, but it does provide some level of protection.
Testicular sperm extraction (TESE)
- What this is – a method of looking for sperm inside the testicular tissue. It is also called surgical sperm retrieval.
- When this is used – when you can’t ejaculate or when there is not enough sperm in the semen sample.
- How this works – under anaesthetic, a fine needle is inserted into the epididymis or testicle to find and extract sperm (testicular aspiration). If no sperm is found, your specialist may do an open biopsy to retrieve a larger tissue sample. The collected sperm is frozen and can later be used to fertilise eggs during IVF.
- Other considerations – rarely, no sperm is found in the testicular tissue.
Male options after cancer treatment
After cancer treatment, your medical team will analyse a sample of your semen to assess how many sperm you are making, how healthy they look and how well they move. Depending on the results of these tests, your options include:
- conceiving naturally
- artificial insemination or IVF using your own sperm frozen before treatment or fresh sperm collected after treatment
- testicular sperm extraction, if you can’t ejaculate normally or there is no sperm in the semen
- banking sperm after treatment ends, if you are still fertile
- using donor sperm
- using a surrogate to carry an embryo created with your own or donor sperm.
You may be able to get your partner pregnant naturally after finishing cancer treatment. This will only be possible if your semen production returns to normal and you are making healthy, active sperm. As fertility declines with age, it will also depend on the age of you and your partner.
The pituitary gland produces hormones that tell the testicles to produce sperm. If cancer treatment has damaged the pituitary gland, you may be able to have medical treatment to trigger the production of sperm. This is called sperm induction.
If treatment has permanently affected your ability to produce sperm and have erections, you will no longer be able to conceive naturally. Your medical team will do tests to assess your fertility and check your general health. Depending on the treatment you’ve had, they may advise you to wait six months to two years before trying to conceive. Discuss the timing and suitable contraception with your specialist.
Intrauterine insemination (IUI)
Also called artificial insemination, this technique increases the chance that the sperm will fertilise an egg by placing the sperm directly into the uterus.
The sperm may be fresh or it may have been frozen before treatment. To be used for IUI, sperm samples must be of reasonable quality. The sample is washed and the faster-moving sperm are separated from the slower sperm.
Insemination is usually done in a fertility clinic. Once your partner is ovulating, the sperm are inserted into their uterus through the cervix using a small, soft tube (catheter). This takes only a few minutes and may cause some mild discomfort to your partner. You should know in a few weeks whether fertilisation took place.
In-vitro fertilisation (IVF)
IVF uses either sperm collected and frozen before treatment or fresh sperm to fertilise an egg outside of the body. Intracytoplasmic sperm injection (ICSI) is a specialised type of IVF in which a single, good-quality sperm is injected into an egg.
If you are infertile after cancer treatment, using donor sperm is another way to become a parent. Laws vary across Australia and may change. Talk to your fertility specialist for specific advice about your situation.
Accessing donor sperm
You can ask a friend or family member to donate sperm, or you can get sperm from someone you don’t know. Fertility clinics in Australia may have access to donor sperm or you can advertise for your own donor.
There is a lot of demand for donor sperm so you may have to go on a waiting list. You may also be able to use sperm from overseas. However, there are strict rules about importing donor sperm into Australia.
Using donor sperm
Sperm donors have voluntarily contributed sperm to a fertility clinic. They are not paid for their donation, but may receive reimbursement for travel or medical expenses. The donors are usually aged 21–45.
All donors are required to complete health tests and go through a counselling process. Personal information is also collected, including:
- 2–4 generations of family medical history
- details about their ethnicity, educational background, hobbies, skills and occupation
- health information, including infectious diseases status, drug use and blood type.
Samples are screened for genetic diseases or abnormalities, sexually transmitted infections (STIs) and overall quality, then quarantined for several months. Before the sperm is cleared for use, the donor is checked again for infectious diseases.
The sperm is frozen and stored in liquid nitrogen in individual containers. When the sperm is ready to be used, insemination is usually done in a fertility clinic. The sample is thawed to room temperature and inserted directly into the uterus using IUI or combined with an egg using IVF.
Some states and territories may have a limit on the number of people who can have children from the same sperm donor, including the donor’s partner. Talk to your fertility clinic for more information.
Finding information about the donor
In Australia, clinics can only use sperm from donors who agree that people born from their donation can find out who they are. This means that the donor’s name, address and date of birth are recorded. All donor-conceived people are entitled to get identifying information about the donor once they turn 18.
In some states, a central register is used to record details about donors and their donor-conceived offspring. Parents of donor-conceived children, and donor-conceived people who are over the age of 18, can apply for information about the donor through these registers.
In other states and territories, people who want information about their donor can ask the clinic where they had treatment. It is important to discuss possible issues for donor-conceived children with a fertility counsellor.
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.