In this section we look at how cancer treatments affect men’s fertility. The most common treatments for cancer are chemotherapy, radiation therapy, surgery and hormone therapy.
Learn more about:
- Radiation therapy
- Avoiding pregnancy during treatment
- Hormone therapy
- Other treatments
Chemotherapy uses drugs to kill or slow the growth of cancer cells. These are called cytotoxic drugs and they are designed to affect fast- growing cells, such as cancer cells. This means they 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 drugs 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 to In some cases, sperm production may stop. It may start again, but this often takes several years. For some men, the changes to sperm production can be permanent
- your age – you are less likely to recover fertility if you are over
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 will vary depending on the area treated, the dose 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 pituitary gland, which affects the production of sperm and affects sex drive.
- Brachytherapy seed implants used for testicular and prostate cancers may affect sperm production, but many men recover.
Some cancer treatments, such as chemotherapy or radiation therapy, may affect sperm and 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 help make more sperm.
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. You will still feel the muscular spasms and pleasure that accompany an orgasm, but you will not ejaculate during climax (dry orgasm).
The prostate lies close to nerves and blood vessels that are important for getting erections. These may be damaged during surgery, but the impact on erections depends on the quality of your erections before surgery. In some cases, semen may go backwards towards the bladder instead of forwards (retrograde ejaculation).
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. However, problems with erections are common for 1–3 years after nerve-sparing surgery.
Managing side effects of surgery
Dry orgasm – If you are experiencing 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.
Erection problems – Difficulty getting or maintaining an erection is known as erectile dysfunction or impotence. Before surgery, your doctor will discuss whether you are likely to have nerve damage that causes this problem. Medicine or aids can help improve problems. Couples may also experiment with types of sexual pleasure that don’t need penetration, such as oral sex, masturbation or sensuous massage.
For more on this, see Sexuality, Intimacy and Cancer.
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 therapy.
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 therapy on fertility and pregnancy are not yet known. It is important to discuss your fertility options with your cancer or fertility specialist.