Men's options after cancer treatment

Sunday 1 May, 2016

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On this page: Natural conception | Intrauterine insemination (IUI) | Intracytoplasmic sperm injection (ICSI) | Donor sperm | Key points

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

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 your fertility.

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 about the emotional impact.

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.

Natural conception

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)

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, a small, soft 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 will have a positive pregnancy test within a few weeks.

Intracytoplasmic sperm injection (ICSI)

This is a specialised type of IVF. Intracytoplasmic sperm injection (ICSI) involves injecting a single sperm 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. If ICSI is an option for you, the fertility specialist will provide you with more information.

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

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, laws about collecting donor information vary between states and territories. In most cases, donors are required to be open donors. This means they must provide their name, address, date of birth, medical history, including genetic test results.

All donor-conceived people are entitled to access identifying information about the donor once they turn 18.

In some states and territories, a central register has been established, allowing people under 18 to apply for non- identifying information about their donor parent. Other states and territories require the clinics to maintain the data.

If you’d like to use donor sperm, speak with a fertility counsellor or lawyer who can discuss the implications for donor-conceived children.

Using donor sperm

Sperm donors are men who have voluntarily contributed sperm to a fertility centre. 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 vials.

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

  • 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.

Reviewers: Prof Roger Hart, Medical Director of Fertility Specialists of Western Australia and Professor of Reproductive Medicine, School of Women’s and Infant Health, University of Western Australia, WA; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s and Prince of Wales Hospitals, Director of the Sydney Youth Cancer Service, NSW; Brenda Kirkwood, 13 11 20 Consultant, Cancer Council Queensland, QLD; Dr Michael McEvoy, Director of Clinical Services, Flinders Fertility, SA; Eden Robertson, Research Officer, Behavioural Sciences Unit, Sydney Children’s Hospital, NSW; Kayla Schmidt, Consumer; A/Prof Kate Stern, Head of Fertility Preservation Service, The Royal Women’s Hospital and Melbourne IVF, Head Endocrine and Metabolic Service, Royal Women’s Hospital and Clinical Director, Melbourne IVF, VIC; and Prof Jane Ussher, Centre for Health Research, Western Sydney University, NSW.

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