Testicular cancer, a condition primarily affecting younger men, can significantly impact a man’s ability to father children. While advancements in treatment have led to high cure rates, concerns about fertility are common among those diagnosed. This article explores how testicular cancer and its treatments can affect fertility and outlines available options for preserving reproductive capabilities.
How Testicular Cancer Itself Affects Fertility
Testicular cancer can directly interfere with sperm production and quality. More than half of men with testicular cancer may experience low sperm counts (oligospermia) or even no sperm (azoospermia) before any treatment begins. This reduction is often due to the tumor’s direct damage to the affected testicle’s tissue, which creates sperm.
The cancer can also affect the healthy testicle, even if it is not directly cancerous. This impact can stem from hormonal changes, as the cancerous testicle might disrupt the hormonal balance necessary for sperm development in both testes. Additionally, the body’s immune response to the tumor might inadvertently affect sperm production throughout the reproductive system.
Infertility as a Side Effect of Treatment
Treatment for testicular cancer often involves surgery, chemotherapy, or radiation therapy, each of which can affect fertility. Removing one testicle (orchiectomy) typically does not cause infertility if the remaining testicle is healthy and functioning. However, if both testicles are affected and need to be removed, the individual becomes infertile.
Chemotherapy, a common treatment, can cause temporary infertility in most patients by impacting rapidly dividing cells, including sperm-producing cells. The degree and duration of this effect depend on the specific drugs, their dosage, and treatment length. High-dose chemotherapy, for example, carries a higher risk of causing permanent infertility.
Radiation therapy, used when cancer spreads to lymph nodes, can also affect sperm production. While efforts are made to shield the unaffected testicle with a lead barrier, a small risk of damage remains. This exposure can reduce sperm count, though the effects are often temporary. Another surgical procedure, retroperitoneal lymph node dissection (RPLND), removes lymph nodes in the abdomen. This can sometimes damage nerves controlling ejaculation, leading to retrograde ejaculation where semen enters the bladder instead of exiting the penis. While sperm are still produced, this makes natural conception difficult without assisted reproductive techniques.
Options for Preserving Fertility
Given potential fertility impairment, discussing preservation with a healthcare provider before treatment is recommended. Sperm banking (cryopreservation) is the most common and effective method for preserving fertility. This involves collecting and freezing semen samples for future use in assisted reproductive technologies.
Ideally, sperm banking should occur before cancer treatment begins to ensure the highest quality samples. The process typically involves providing a semen sample through masturbation at a clinic. Clinics often recommend collecting two to three samples on different days to maximize the quantity and quality of stored sperm, depending on how quickly treatment needs to start. If a sample cannot be produced through masturbation, sperm can sometimes be retrieved directly from the testicle or epididymis using a needle or small tissue sample.
What to Expect for Future Fertility
Fertility recovery after testicular cancer treatment varies among individuals. It depends on factors such as treatment type and dosage, the remaining testicle’s health, and age at diagnosis. For many, especially after chemotherapy, fertility can gradually return, often within months to two years after treatment.
Complete fertility recovery is not guaranteed; some men may experience persistently low sperm counts or permanent infertility. Regular follow-up with healthcare professionals, including semen analysis, can assess sperm count and viability after treatment. Discussing ongoing fertility concerns with a doctor is important, as they can provide guidance and explore further family building options.