Men's options before cancer treatment

Sunday 1 May, 2016

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On this page: Options for preserving fertility | Harry's story | Key points

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

This page has information about ways a man can preserve his fertility before starting cancer treatment. It’s ideal to discuss your options with your cancer or fertility specialist at this time. See talking about fertility for ways to start a conversation.

Some choices, such as sperm banking and radiation shielding, are well-established ways to preserve fertility. Others, such as testicular sperm extraction, are still being researched and may not be available to all men. The different choices depend 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 cancer treatment, you can still consider your fertility later. Your choices after treatment will depend on whether you are able to produce sperm. See men’s options after cancer treatment for detailed information.

"All my life I had wanted to be a father. I didn’t want cancer to ruin my chances, so I stored my sperm before treatment started. I think of this as a bit of an insurance policy." – Zac

Options for preserving fertility

Sperm banking or sperm freezing (cryopreservation)
What this is

The freezing and storing of sperm after masturbation.

Sperm banking is one of the easiest and most effective methods of preserving a man’s fertility.

When this is used

To delay the decision about having children, if you’re not yet sure what you want.

Samples can be stored for years, or even decades. Check the time limits with the fertility centre, pay any annual fees, and keep your contact details up to date.

Once you are ready to start a family, the frozen sperm is sent to your fertility specialist.

How this works

The procedure is performed in hospital or in a sperm bank facility (often known as an andrology unit).

Samples are collected in a private room where you can masturbate or have a partner sexually stimulate you, and you then ejaculate into a jar.

Sometimes you may need to visit the clinic more than once to ensure an adequate amount of semen is collected.

Special considerations

If you live near a sperm banking facility, you may be able to collect a sample at home and deliver it to the laboratory within the hour. Sperm must be kept at room temperature during this time.

If you are unable to get an erection or produce a sample through masturbation, other options include testicular biopsy or testicular stimulation techniques. You may be able to collect semen during sex using a special silicone condom.

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. You can also bring someone with you, if you would like.

Radiation shielding
What this is
Protecting the testes from external radiotherapy with a shield.
When this is used

If the testes are close to where external radiotherapy is directed (but they 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.

Special considerations

This technique does not guarantee that radiation will not affect the testes, but it does provide some level of protection.

Testicular sperm extraction
What this is

A method of looking for hidden sperm inside the testicular tissue. Also called surgical sperm retrieval.

When this is used

If you don’t or are unable to ejaculate or the semen ejaculated doesn’t contain sperm.

How this works

You will be given a general anaesthetic and a fine needle will be inserted into the epididymis or testicle to find and extract sperm. This is called testicular aspiration. Collected sperm is frozen and, when needed, used to fertilise eggs during IVF.

Special considerations

Not known at this time.

Harry’s story

"When I was 25, I’d been feeling quite ill – I had back pain, night sweats and weight loss. I was diagnosed with advanced Hodgkin lymphoma.

The doctors recommended I bank sperm immediately, because fertility would be an issue post-treatment. Fertility wasn’t my main concern. However, my partner – now wife – and I were together at that point, so we knew it could be an issue for us down the track.

My chemotherapy regimen was aggressive, but the cancer went into remission. The chemo permanently reduced my testosterone levels. I’ve taken supplements for years, and I will be on them for quite some time. However, the supplements didn’t restore my fertility.

Years later, my wife and I tried artificial insemination using my banked sperm. When that didn’t work, we tried IVF. The first cycle was unsuccessful. We told ourselves if a second IVF cycle didn’t work, we were going to give up for a while. Being told we were pregnant was one of the happiest days of our lives.

We now have a beautiful child, and we’ve decided we don’t want to do more IVF – it’s financially and emotionally draining. Even though we have no intention of using it, my remaining sperm is still stored. We were advised to keep it until my wife reaches a certain age – I guess in case we change our minds.

At times, I’ve felt responsible for everything. My wife is a healthy woman and probably capable of conceiving a pregnancy naturally, but she had to go through IVF. Our son asks why he can’t have a sibling. But it’s something we’ve accepted.

We feel blessed now with one child – the result was worth everything we went through."

Key points

  • Sperm banking involves freezing a sample for later use. It is the easiest and most effective method.
  • Testicles can be shielded during radiotherapy to reduce the chance of the radiation causing harm.
  • Testicular sperm extraction may look for hidden sperm inside the testicular tissue. 

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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