Prostatectomy is the surgical removal of the prostate gland, most commonly performed to treat prostate cancer. It also treats severe benign prostatic hyperplasia (BPH), a non-cancerous prostate enlargement causing urinary difficulties. The surgery removes diseased tissue and prevents cancer spread.
Where Sperm is Produced
Sperm production (spermatogenesis) occurs within the testicles. These glands are located in the scrotum. Inside, seminiferous tubules continuously generate new sperm cells.
Immature sperm then travel to the epididymis, a coiled tube on each testicle, where they mature and are stored. The prostate gland, a walnut-sized gland below the bladder, produces a fluid component of semen but not sperm cells. This fluid nourishes and transports sperm during ejaculation.
How Prostate Removal Affects Fertility
Although sperm production continues after prostatectomy, removing the prostate gland significantly impacts natural conception. The prostate and seminal vesicles (which contribute fluid to semen) are removed during surgery. These structures are essential for creating the fluid volume that carries sperm out during ejaculation.
Without seminal fluid, ejaculation typically results in a “dry orgasm,” where no semen is expelled, though orgasm sensation may occur. This is called anejaculation. During radical prostatectomy, the vas deferens, tubes transporting sperm from the epididymis to the ejaculatory ducts, are often cut and sealed. This blocks sperm from exiting the body, even if seminal fluid were present.
Thus, despite ongoing healthy sperm production, anatomical changes from prostate removal prevent natural sperm release. Natural conception is generally not possible for men after prostatectomy. The fertility impact stems from altered reproductive system plumbing, not failed sperm generation.
Options for Fertility After Prostate Removal
For men after prostatectomy who desire biological children, several medical interventions can overcome the barrier to natural conception. Since sperm production continues, these methods retrieve sperm directly from the testicles. One common technique is Testicular Sperm Aspiration (TESA), which uses a needle to extract sperm directly from the testis.
Another method is Microdissection Testicular Sperm Extraction (micro-TESE), an advanced surgical procedure using a microscope to locate and remove sperm-producing tubules from the testicle. Retrieved sperm cannot be used for natural conception and require Assisted Reproductive Technologies (ART). In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) is typically employed. During ICSI, a single sperm is injected directly into an egg, increasing fertilization likelihood. These techniques offer a pathway for biological fatherhood after prostate removal.