A testicular cancer diagnosis often raises concerns about future family planning. Understanding how the cancer and its treatments affect fertility is crucial. This article discusses the impact of testicular cancer on conception and available options for fertility preservation and treatment.
How Testicular Cancer and Its Treatments Affect Fertility
Testicular cancer can impact male fertility even before treatment begins. Studies indicate that men diagnosed with testicular cancer often have impaired sperm concentration and overall sperm count. This reduced fertility may stem from the tumor’s direct effect or underlying factors like cryptorchidism.
Orchiectomy, the primary treatment, involves surgically removing the affected testicle. If only one testicle is removed, the remaining healthy testicle often compensates, allowing many men to maintain fertility. However, if both testicles require removal, a man becomes infertile as he can no longer produce sperm.
Chemotherapy can significantly affect sperm production. Drugs like cisplatin can temporarily or permanently damage the cells responsible for creating sperm. The impact depends on the specific drugs, dosage, and treatment duration, with higher doses increasing infertility risk. While some men recover sperm production months or even years after chemotherapy, others may face long-term or permanent infertility.
Radiation therapy, if directed at the pelvic area or the remaining testicle, can harm sperm-producing cells. Even with testicular shielding, which uses a protective cover to minimize radiation exposure, a small risk of damage remains. Fertility impairment is dose-dependent; lower doses may allow for recovery of sperm production, but higher doses can lead to long-term or permanent infertility.
Retroperitoneal lymph node dissection (RPLND) can affect fertility by damaging nerves involved in ejaculation. This can lead to retrograde ejaculation, where semen flows backward into the bladder. While nerve-sparing techniques have reduced this complication, it can still make natural conception difficult, though it does not prevent erections.
Fertility Preservation Before Treatment
Proactive fertility preservation is often recommended before testicular cancer treatment. Sperm banking, or cryopreservation, is the most established method. This process involves collecting and freezing sperm samples for future use.
Sperm banking is advised as soon as possible after diagnosis and before treatment. This ensures stored sperm are not affected by damaging therapies like chemotherapy or radiation. Even with a low sperm count due to cancer, banking sperm provides a viable option for future conception.
Stored sperm can be preserved for many years without degradation, allowing for biological fatherhood after treatment. While it doesn’t guarantee pregnancy, sperm banking significantly increases the chances of having biological children if natural conception becomes difficult. Healthcare providers emphasize this option due to the potential for treatment-induced infertility.
Conception Options After Treatment
After testicular cancer treatment, couples have several conception options, depending on post-treatment fertility. A comprehensive fertility assessment, including semen analysis, is recommended to determine sperm count and quality. This evaluation guides the choice of the most suitable conception method.
Natural conception may be possible if the man’s fertility has recovered or was minimally affected, and his sperm parameters are viable. For reduced sperm count or quality, assisted reproductive technologies (ART) offer solutions. Intrauterine Insemination (IUI) is an option if sperm count is low but sufficient for direct placement into the uterus.
When sperm count is very low or quality is poor, In Vitro Fertilization (IVF) combined with Intracytoplasmic Sperm Injection (ICSI) is frequently used. With IVF/ICSI, a single sperm from a fresh or banked sample is directly injected into an egg. This technique is valuable for men with few viable sperm or retrograde ejaculation. If no viable sperm can be obtained, using donor sperm remains an option.
Safety Considerations for Pregnancy and Offspring
A common concern is whether testicular cancer or its treatments increase the risk of birth defects or genetic abnormalities in offspring. Research indicates no significant increased risk of birth defects or genetic mutations in children conceived after successful treatment. The consensus is that once treatment is complete and the father is healthy, the risk to the child is not elevated.
Healthcare providers recommend a waiting period after chemotherapy or radiation therapy before attempting conception. This period, often six months to a year, allows damaged sperm cells to clear and the father’s health to stabilize. This precaution ensures that sperm used for conception are healthy and mature.
There is no evidence that conceiving a child after testicular cancer treatment increases the father’s risk of cancer recurrence. Conception and pregnancy do not negatively impact the father’s long-term health or increase his susceptibility to cancer returning. Couples should discuss timing and concerns with their oncology and fertility specialists.