Testicular cancer is the most common cancer affecting young men, typically between the ages of 15 and 35. This diagnosis often brings immediate concerns about future fertility and the ability to have children. While the disease and its treatments can affect a man’s reproductive capabilities, various options exist to help individuals achieve parenthood after treatment. This article explores these impacts and the available paths forward for those hoping to start or expand their families.
How Testicular Cancer and Its Treatments Affect Fertility
Testicular cancer can directly impact fertility. Between 6% and 24% of men with a diagnosis produce no sperm, and about 50% have lower than usual sperm counts. This reduced production is attributed to the tumor’s presence affecting testicular function or other related factors.
Surgical removal of the affected testicle, known as orchiectomy, is a common treatment. If only one testicle is removed, fertility is often maintained as the remaining testicle can produce sufficient sperm and testosterone. However, if both testicles are removed, permanent infertility results. In some instances, even with one testicle remaining, its function might be compromised, leading to reduced fertility.
Chemotherapy, a systemic treatment using drugs to destroy cancer cells, poses a risk to male fertility. These drugs target rapidly dividing cells, including sperm cells and their precursors, leading to a temporary reduction in sperm count and quality. While fertility often recovers within months or up to two years after chemotherapy, permanent infertility can occur, especially with high-dose regimens.
Radiation therapy, used to treat certain stages of testicular cancer by targeting affected lymph nodes, can also impair fertility. Although the remaining testicle is shielded during radiation, a risk of damage from scattered radiation exists. Radiation can kill sperm-producing stem cells, causing temporary or permanent infertility. Doctors often advise a waiting period after radiation to allow sperm recovery.
Another surgical procedure, retroperitoneal lymph node dissection (RPLND), which removes lymph nodes in the abdomen, can also affect fertility. This operation carries a risk of damaging nerves that control ejaculation, leading to a condition called retrograde ejaculation. In retrograde ejaculation, semen flows backward into the bladder instead of exiting the penis, making natural conception difficult. While this does not prevent an erection, it results in a “dry orgasm.”
Fertility Preservation Methods
Given the potential impact of testicular cancer treatments on fertility, proactive measures to preserve reproductive capabilities are recommended. Sperm banking, also known as sperm cryopreservation, is the standard and most effective method for men. This process involves collecting and freezing semen samples for future use.
Sperm banking involves providing semen samples through masturbation at a fertility clinic. To maximize sperm count, abstaining from sexual intercourse or masturbation for two to four days before collection is advised. After collection, semen is processed, a protective solution is added, and sperm is cooled to -196°C for storage in liquid nitrogen. Though some sperm may die during freezing, surviving sperm remain viable for many years, potentially up to 50 years.
Sperm banking should be done before starting any cancer treatment that could compromise fertility, such as chemotherapy or radiation therapy. However, even if treatment has begun, it might still be possible to bank sperm within the first few days. Before banking, blood tests are performed to screen for infections like HIV and hepatitis B and C. A consent form is also required, outlining storage duration and conditions for future use.
While sperm banking is the most common approach, other less common or experimental methods for fertility preservation exist, particularly for pre-pubertal boys who cannot produce sperm samples. For post-pubertal men, sperm cryopreservation remains the primary and most established method to safeguard future paternity.
Paths to Parenthood After Treatment
Many men treated for testicular cancer can still achieve fatherhood, either through natural conception or with assisted reproductive technologies. Natural conception depends largely on the extent of treatment and recovery of testicular function. If only one testicle was removed, the remaining testicle compensates, and sperm production may return to sufficient levels for natural conception, sometimes within two years after chemotherapy. Regular semen analyses can help determine sperm count and viability after treatment.
For those who experience reduced fertility or permanent infertility after treatment, assisted reproductive technologies (ART) offer effective solutions using preserved sperm. In vitro fertilization (IVF) is an ART method where sperm and eggs are combined in a laboratory to create embryos. These embryos can then be transferred to the woman’s uterus to achieve pregnancy.
Intrauterine insemination (IUI) is another ART option, involving the direct placement of sperm into the uterus to facilitate fertilization. For cases where sperm quality is low, even with cryopreserved samples, intracytoplasmic sperm injection (ICSI) can be used. ICSI involves injecting a single sperm directly into an egg, greatly increasing fertilization chances. These technologies can utilize sperm banked before treatment or fresh sperm if fertility has partially recovered. If sperm banking was not possible, surgical sperm retrieval techniques like testicular sperm aspiration (TESA) or testicular sperm extraction (TESE) can collect sperm directly from the testes for use with IVF or ICSI.
A common concern among individuals planning a family after cancer treatment relates to the health of children conceived. Current evidence suggests no increased risk of birth defects or genetic abnormalities in children conceived after testicular cancer treatment, including those involving chemotherapy or radiation. Doctors advise a waiting period, between 6 months and 2 years after completing chemotherapy or radiotherapy, before attempting to conceive. This allows for sperm recovery and mitigates potential risks.