Testicular cancer can significantly impact a man’s fertility, a concern for many patients. The effects on the ability to have children can arise directly from the cancer itself or as a consequence of the treatments used to combat the disease. Understanding these potential impacts is an important part of managing the diagnosis and planning for future family considerations.
How Testicular Cancer Itself Affects Fertility
Even before medical treatment, testicular cancer can reduce a man’s fertility. A cancerous testicle may disrupt the balance of hormones that regulate sperm production. This can lead to abnormal levels of hormones such as testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), all involved in spermatogenesis.
The tumor can directly impair the affected testicle’s sperm production. The body’s response to cancer, including systemic inflammation and elevated oxidative stress, can negatively influence sperm quality and quantity. The tumor might also cause physical obstructions or inflammation that hinder sperm transport. These factors often result in men with testicular cancer having lower sperm concentration and total sperm counts before treatment.
Treatment Effects on Fertility
Treatments for testicular cancer are effective but can affect fertility. Surgical removal of the affected testicle, known as orchiectomy, is an initial step. If cancer is present in only one testicle, the remaining healthy testicle can produce enough sperm and testosterone to maintain fertility. However, if the remaining testicle is compromised or if both testicles require removal, fertility will be affected.
Chemotherapy drugs destroy rapidly dividing cells, including sperm-producing cells in the testes. The impact on sperm production depends on the specific drugs, dosage, and treatment duration. Temporary infertility is common, but sperm production can recover over time, though for some, damage may be permanent. Recovery can take months to several years, with higher doses or more cycles potentially delaying or preventing spermatogenesis recovery.
Radiation therapy can impair or destroy sperm production. The testes are sensitive to radiation, and even low doses can affect spermatogenesis. Modern radiation techniques shield the remaining testicle to minimize damage, but some risk persists from scattered radiation. Radiation can cause temporary and, in some cases, permanent infertility.
Preserving Fertility
Given the potential impact of testicular cancer and its treatments on fertility, fertility preservation measures are recommended. Sperm banking, or cryopreservation, is the primary method for post-pubertal males. This process involves collecting and freezing sperm samples before cancer treatment begins.
Sperm banking offers a way to safeguard future biological parenthood, especially before high-risk treatments like chemotherapy or radiation. The process involves providing semen samples, which are then assessed, processed, and stored in liquid nitrogen. Even a single sample can be sufficient for future assisted reproductive technologies. Men should discuss this option with healthcare providers as early as possible, ideally before treatment.
Fertility Post-Treatment
After testicular cancer treatment, assessing fertility involves semen analysis and hormone tests to evaluate sperm count, motility, and hormonal balance. For many men, after certain chemotherapy regimens, sperm production can recover over time, though this can vary among individuals. This recovery period may range from months to several years.
If natural conception proves challenging after treatment, assisted reproductive technologies (ART) offer pathways to parenthood. These options include In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). If sperm was banked prior to treatment, it can be used with these techniques. Even with low sperm counts or if sperm production has not fully recovered, methods like testicular sperm extraction (TESE) can sometimes retrieve sperm directly from the testes for use with ART. Many testicular cancer survivors are able to have children, either naturally or with the aid of these methods.