When cancer treatment is finished, your semen will be analysed to check the number of sperm, the quality of the sperm, and their ability to move (motility). See Assessing fertility after treatment for more details.
Sometimes men who temporarily stop producing sperm recover the ability to produce it. However, if sperm production isn't restored over time, you are considered permanently infertile. You may feel a sense of loss - the information in Emotional impact section may help.
If you aren't sure what you want to do but are still fertile, you may want to consider banking some sperm. However, it is generally recommended that this is done before cancer treatment starts. Your fertility specialist will advise you about this.
Your medical team might advise you to try for a baby naturally after finishing cancer treatment. Your fertility specialist will talk to you about factors to consider, including:
- if sperm counts and motility are close to normal
- the age of your partner - for example, an older woman may be less fertile.
If you would like to try to 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 the treatment you had.
Intrauterine insemination (IUI)
Also called artificial insemination, this technique may be used if you have a low sperm count after treatment. Frozen sperm are thawed, washed and put in a sterile solution. To be used for IUI, samples must contain at least 2 million active sperm after thawing. The faster-moving sperm will be separated from the slower sperm.
Once a woman is ovulating, the sperm are inserted into her uterus through the cervix using a small, soft tube (catheter). The procedure takes only a few minutes and may cause some mild discomfort.
If IUI is successful, fertilisation occurs and the woman will have a positive pregnancy test within a few weeks.
Intracytoplasmic sperm injection (ICSI)
This is a specialised type of IVF. In intracytoplasmic sperm injection (ICSI), a single sperm is injected directly into an egg.
Using IVF, an egg is extracted from a woman and a good quality sperm is selected. The sperm is then injected into the egg. A fertility specialist can provide you with more information.
Testicular sperm extraction may also be an option after cancer treatment if you can't ejaculate or if the semen ejaculated doesn't contain sperm.
If you are infertile after cancer treatment, using donor sperm is another way to become a parent. You can access sperm in two ways:
- known donation - this is where the donor and recipient know each other, e.g. a friend or family member
- clinic donation - the recipient does not know the donor. Most fertility clinics in Australia have access to sperm, or you can find your own donor. You may also be able to use sperm from overseas. All donors have to go through the same health and counselling laws required under Australian law.
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 name, address and date of birth of donors are recorded.
All donor-conceived people are entitled to access identifying information about the donor once they turn 18.
In some states, a central register records 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.
If you'd like to use donor sperm, discuss the possible issues for donor-conceived children with a fertility counsellor.
Using donor sperm
Sperm donors are men who have voluntarily contributed sperm to a fertility clinic. They are not paid for their donation, but may receive payment for travel or medical expenses. The men are usually between 21 and 45 years old.
Personal information is collected about donors, 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 rescreened for infectious diseases. The sperm is then 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 woman's uterus using the IUI process. Before this process, the woman may be given hormones to prepare her body and increase the chances of pregnancy.
Key points about men and fertility
Fertility and cancer treatments
- Chemotherapy is drug treatment that can reduce or stop sperm production, which can take years to return to normal.
- Radiation therapy, given externally or internally, may damage the reproductive organs or the pituitary gland, which makes hormones to trigger sperm production.
- Surgery to reproductive organs or nearby areas may affect sperm production, and the ability to get an erection and ejaculate.
- Hormone therapy and stem cell transplants can also have an impact on fertility.
- You will be advised to avoid conceiving during cancer treatment and for a period of time afterwards.
Fertility options before cancer treatment
- Sperm banking involves freezing a sample for later use. It is the easiest and most effective method.
- Testicles can be shielded during radiation therapy to reduce the chance of the radiation causing harm.
- Testicular sperm extraction may look for sperm inside the testicular tissue.
Fertility options after cancer treatment
- Some men are able to conceive a child naturally. You might be advised to wait a certain period before fathering a child.
- Techniques include intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI).
- Some men use donor sperm to conceive a child.
Expert content reviewers:
Dr Yasmin Jayasinghe, Paediatric Gynaecologist, Royal Children's Hospital Melbourne, Co-chair Fertility Preservation Taskforce, Melbourne, and Senior Lecturer, Department of Obstetrics and Gynaecology, University of Melbourne, VIC; Dr Peter Downie, Head, Paediatric Haematology-Oncology and Director, Children's Cancer Centre, Monash Children's Hospital, and Director, Victorian Paediatric Integrated Cancer Service, VIC; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Aaron Lewis, Consumer; Pampa Ray, Consumer; Dr Sally Reid, Gynaecologist, Fertility SA and Advanced Gynaecological Surgery Centre, Visiting Consultant, Women's and Children's Hospital, and Clinical Senior Lecturer, School of Paediatrics and Reproductive Health, The University of Adelaide, SA; A/Prof Kate Stern, Head, Fertility Preservation Service, The Royal Women's Hospital and Melbourne IVF and Head, Endocrine/Metabolic Clinic, Royal Women's Hospital, and Co-chair, AYA cancer fertility preservation guidance working group, VIC.