Testicular cancer (TC) is the most common cancer affecting men between the ages of 15 and 35, yet it is highly curable with survival rates exceeding 95%. For young men facing this diagnosis, the ability to father children after treatment is a significant concern. This is valid because both the tumor and the necessary life-saving treatments can disrupt sperm production. Fortunately, cancer treatment does not automatically mean the end of reproductive possibility. Modern medicine offers multiple strategies to preserve fertility and alternative routes to building a family.
How Testicular Cancer and Treatment Affect Fertility
The ability to conceive can be compromised even before treatment begins. Over half of men with testicular cancer present with a low sperm count or poor sperm quality, likely due to the systemic effects of the cancer itself. Subsequent treatments further complicate fertility by directly targeting rapidly dividing cells, including the sperm-producing cells in the testicles.
The standard initial treatment, a radical orchiectomy to remove the cancerous testicle, typically does not cause infertility. The remaining healthy testicle usually produces sufficient sperm and testosterone. However, the most significant threat to fertility comes from subsequent treatments like chemotherapy and radiation, which are known to be gonadotoxic.
Chemotherapy drugs, particularly platinum-based agents such as cisplatin, are highly effective at killing cancer cells but also temporarily halt or drastically slow the production of new sperm. This often leads to temporary azoospermia in most patients. The extent of this damage is related to the specific drugs used and the total cumulative dose administered.
Radiation therapy used to target nearby lymph nodes can also affect sperm production, even when the remaining testicle is carefully shielded. Higher doses carry a greater risk of permanent infertility. A less common but severe complication is nerve damage from a retroperitoneal lymph node dissection (RPLND) surgery, which can result in retrograde ejaculation where semen travels into the bladder.
Fertility Preservation Strategies
Given the high risk that chemotherapy and radiation pose to the testes, patients should discuss fertility preservation with their oncology team immediately upon diagnosis. The most established and recommended proactive measure is sperm banking, or cryopreservation, which should ideally be done before any intensive treatment is started. This process involves collecting multiple semen samples over several days, which are then analyzed, frozen, and stored indefinitely in liquid nitrogen.
Sperm banking provides a crucial biological backup, ensuring that the patient has viable sperm available if post-treatment natural conception is unsuccessful. Even if a patient’s initial sperm count is low due to the cancer, it is usually still possible to collect and freeze enough sperm for future use with assisted reproductive techniques. Although this process may cause a short delay in treatment, the window of opportunity to bank sperm is limited.
For patients who need to start treatment immediately, or those who cannot produce an ejaculated sample, alternative methods exist to retrieve sperm directly from the testicle. Discussing the preservation options with a fertility specialist and the oncology team ensures that patients can make an informed decision.
Post-Treatment Fertility Recovery and Assessment
Once cancer treatment is complete, the focus shifts to monitoring the recovery of the sperm-producing cells. This recovery is highly variable and depends largely on the type and intensity of the treatment received. For those who underwent chemotherapy, the return of sperm production can be a gradual process, sometimes taking 18 months to two years, and occasionally even longer than five years.
The primary tool for assessing reproductive function after treatment is a semen analysis. This test measures the volume of the ejaculate, the concentration of sperm, and the motility and shape of the sperm cells. Physicians typically recommend a series of semen analyses starting several months after the end of treatment to track the progress of recovery.
A common concern after treatment is the safety of conception, specifically whether the treatments could have caused genetic damage to the sperm. Current evidence suggests that once a clearance period has passed, typically advised as about one year after the end of chemotherapy or radiation, there is no increased risk of birth defects or childhood malignancies in the offspring. This waiting period allows damaged sperm cells to be cleared from the reproductive system and for the production of new, healthy sperm.
Paths to Parenthood Following Impairment
For survivors who do not achieve a full recovery of natural fertility, several established paths to parenthood remain available. One of the most direct methods involves using the sperm that was cryopreserved before treatment, often through assisted reproductive technologies (ART). Even a small number of banked sperm can be used successfully with techniques such as in vitro fertilization (IVF) combined with intracytoplasmic sperm injection (ICSI).
If sperm banking was not possible or unsuccessful, donor sperm is an option. This allows a couple to experience pregnancy and childbirth, utilizing sperm from a screened donor. This medical approach is facilitated through fertility clinics and often uses intrauterine insemination (IUI) or IVF.
Non-biological family-building methods also represent viable pathways to parenthood. These options include both domestic and international adoption, as well as third-party reproduction such as surrogacy.