The most common treatments for cancer are chemotherapy, radiation therapy, surgery and hormone therapy. They can affect fertility in a variety of ways.
After cancer treatment, you may want to do some tests to see how your fertility has been affected. However, some people prefer not to know – it is up to you.
You may decide to wait until you feel physically and emotionally prepared to know the results – this may be months or even years later. A partner, friends, family or your medical team might provide support to you when you receive the results.
Topics on this page:
- Radiation therapy
- Avoiding pregnancy during treatment
- Hormone therapy
- Other treatments
- Options before treatment
- Options after treatment
- Assessing fertility after treatment
Chemotherapy uses drugs to kill or slow the growth of cancer cells. These are called cytotoxic drugs. Chemotherapy drugs kill fast-growing cells such as cancer cells. The drugs can also affect other cells that grow quickly, such as the reproductive cells.
In men, chemotherapy may reduce or stop the production of sperm. The drugs may also affect the ability of the sperm to move up the fallopian tubes (motility) and alter the sperm’s genetic make-up.
The risk of infertility depends on several factors:
- the type of chemotherapy drug/s used – damage to sperm production is more common with drugs in the alkylating class
- the dose and duration of chemotherapy treatment – this will affect how long it takes sperm production to return; in some cases, it may stop. It may start again, but this often takes several years. For some men, sperm production can take up to a decade to improve or it may be permanent.
- your age – less likely to recover your fertility if you are over 40.
Chemotherapy can cause permanent infertility if the cells in the testicles are too damaged to produce healthy, mature sperm again.
Radiation therapy (also called radiotherapy) uses x-rays to kill cancer cells or damage them so they cannot grow and multiply. It can be delivered externally by external beam radiation, or given internally.
The risk of infertility depends on the area treated, the dose (measured in grays) and the number of treatments.
- External radiation therapy to the pelvic area for prostate, rectal, bladder or anal cancer and some childhood leukaemias may affect sperm production.
- Radiation therapy to the brain may damage the area that controls hormone production (pituitary gland), which affects the production of sperm and affects sex drive.
- Brachytherapy seed implants used for testicular cancer may affect sperm production, but most men recover.
Avoiding pregnancy during treatment
Some cancer treatments, such as chemotherapy or radiation therapy, may harm an unborn baby or cause birth defects. As you might be fertile during treatment, you will need to use contraception or practise abstinence to avoid conceiving during treatment.
Surgery aims to remove the cancer from the body. If surgery removes part or all of a sex organ or if it removes organs in the surrounding area (such as the bladder), your ability to conceive a child will be affected.
- Removal of the testicles (orchidectomy) – After having one testicle removed (orchidectomy), the remaining testicle will make enough sperm for you to father a child, unless the sperm is unhealthy. If the remaining testicle doesn’t produce enough testosterone, you can have hormone replacement therapy (supplements) to stimulate sperm production.
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 gland and seminal vesicles, the vas deferens are cut, so the semen cannot travel from the testicles to the urethra.
The impact of the operation on erections depends on the quality of your erections before surgery. You may still have erections and the pleasurable feelings of orgasm, but no longer ejaculate semen during climax (dry orgasm), or semen may go backwards towards the bladder instead of forwards (retrograde ejaculation). See below for tips on managing side effects of surgery.
- Removal of lymph glands (retroperitoneal lymph node dissection or lymphadenectomy) – 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 good quality erections before the surgery. Problems with erections are common for 1–3 years after nerve-sparing surgery.
Managing side effects of surgery
- Dry orgasm – If you are experiencing a dry orgasm, you will not be able to father a child through sexual intercourse. However, it may be possible to have testicular sperm extraction.
- Retrograde ejaculation – To manage this side effect of surgery, you may be given medicine to contract the internal valve of the bladder. This forces the semen out of the penis, as normal, and it may make it possible for you to conceive naturally.
- Erectile dysfunction – Having difficulty getting and maintaining an erection is known as erectile dysfunction or impotence. Before treatment, your doctors will discuss whether you are likely to have nerve damage that causes this problem. Medicine or aids can help to restore the ability to get and keep an erection.
Hormones that are naturally produced in the body can cause some types of cancers to grow. The aim of hormone therapy is to reduce the amount of hormones the tumour receives to help slow down the growth of the cancer.
In men, testosterone helps prostate cancer grow. Slowing the body’s production of testosterone and blocking its effects may slow the growth of the cancer or even shrink it. This may cause infertility. Men with breast cancer who are taking the drug tamoxifen (an anti-oestrogen drug) may experience increased sperm production.
Other treatments for cancer include stem cell transplants, immunotherapy and targeted therapies.
Stem cell transplants often require high doses of chemotherapy and, possibly, radiation therapy. This is given before the transplant to destroy cancer cells in the body and weaken the immune system so that it will not attack a donor’s cells during the transplant. High-dose chemotherapy or radiation therapy can permanently affect sperm production.
The effects of immunotherapy and targeted therapies on fertility and pregnancy are not yet known. It is important to discuss your fertility options with your cancer or fertility specialist.
Options before treatment
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.
What this is: Protecting the testes from external radiation therapy with a shield.
When this is used: If the testes are close to where external radiation therapy 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. Testicular sperm extraction may also be used after cancer treatment if you can’t ejaculate or if the semen ejaculated doesn’t contain sperm.
Options after 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).
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 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)
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.
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 clinic 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.
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 described on page 48. Before this process, the woman may be given hormones to prepare her body and increase the chances of pregnancy.
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.
Assessing fertility after treatment
After treatment, you may be able to have an erection and achieve ejaculation, but this doesn’t necessarily mean you are fertile.
Semen analysis (sperm count) – This test can show if you are producing sperm and, if so, how many there are, how healthy they look, and how active they are.
You will go into a private room and masturbate until you ejaculate into a small container. The semen sample is sent to a laboratory for analysis. The results will help the fertility specialist determine whether you are likely to need assistance to conceive.
If you stored sperm in a sperm bank before cancer treatment, your doctor can use it as a baseline comparison to the post-treatment analysis of your sperm sample.