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Men & Cancer
How Cancer Treatment Affects Your Fertility

And What You Can Do About It

by Mary K. Samplaski, MD, and Rebecca Z. Sokol, MD, MPH

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Discuss you fertility preservation options with your doctor before starting cancer treatment.

When you first hear the words, “You have cancer,” family plan­ning and your future fertility are probably not top of mind.

Naturally, you’re likely more focused on things like treatment, survival, and prognosis. However, you may be glad to know that with modern treatment protocols, many cancers have excellent prognoses. Because of this, healthcare providers are beginning to broaden their focus to not only treat the cancer, but also address the long-term effects of cancer and its treatment.

One important long-term concern for many men who are diagnosed with can­cer is how cancer treatment may affect their ability to father children. Because the sperm-producing cells in the testicles are exquisitely sensitive to the effects of cancer treatments, these treatments can easily decrease sperm production. The extent to which fertility is affected gen­erally depends on the type of treatment received and can range from a low sperm count to no sperm production at all. These effects may be permanent or temporary. In addition, some cancer treatments can lead to low testosterone levels, which can affect male fertility by decreasing libido, erectile function, and sexual satisfaction.

How Chemotherapy Affects Fertility
The toxicity of chemotherapy treat­ment depends on the type of cancer being treated, the agent used, the dosage administered, the dosing interval, and other agents used simultaneously. Ther­apies are typically categorized from low risk to high risk according to how toxic they are to the testicles. However, no chemotherapeutic agent can be consid­ered truly without risk. It’s important to talk to your doctor about how your chemo treatment may affect your fertility.

The sperm-producing cells in the testicles are exquisitely sensitive to the effects of cancer treatments.

Author of Article photo

Dr. Mary Samplaski

For example, cisplatin is a mainstay in the treatment of cancers commonly seen in men of reproductive age, includ­ing testicular cancer and lymphoma. Low doses of cisplatin lower sperm counts below normal, and high doses severely suppress sperm production.

How Radiation Affects Fertility
Radiation therapy, either directly to the testes or through scatter exposure, can damage the testicles. The extent of this damage depends on the total radiation dose received, the radiation field, and the dosing schedule, with pre-pubertal boys being more sensitive than adults.

Very low doses of radiation have been shown to result in temporary absence of sperm in the semen, and moderate doses in permanent absence of sperm. Total body irradiation prior to stem cell trans­plantation is particularly toxic due to the high radiation doses required, causing permanent gonadal failure and fertility loss in approximately 80 percent of men.

Author of Article photo

Dr. Rebecca Sokol

How Surgery Affects Fertility
Surgery alone does not usually affect sperm production. However, abdominal or pelvic surgery for cancer may impair sexual or reproductive function. An obvi­ous example is the removal of a testicle as treatment for testicular cancer. Other examples include damage to the nerves or accessary structures responsible for erections or ejaculation during abdomi­nal or pelvic surgery. Newer surgical techniques have been implemented to minimize the risk of damage; however, there is currently no treatment that eliminates the risk completely.

How to Protect Your Fertility When You’ve Been Diagnosed with Cancer
The most common fertility preserva­tion option for men with cancer is semen cryopreservation, also known as sperm banking. Banking sperm prior to starting cancer treatment provides “insurance” for restoring your post-treatment fertil­ity, as the frozen sperm can later be thawed and used in a fertility procedure like IVF in order to achieve pregnancy.

Ideally, a man would need to make about six sperm deposits for each child he might want to have; therefore, you should begin to bank your sperm as soon as possible after cancer diagnosis. Likewise, it is crucial that you talk to your doctor about your fertility preser­vation options early on in the treatment planning process. Having this discussion with your doctor before starting cancer treatment is the best way to protect your ability to start or grow your family after your cancer has been treated.

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Dr. Mary Samplaski is an assistant professor of Urology and director of the Section of Male Infertility, Andrology, and Microsurgery in the Institute of Urology at the University of Southern California in Los Angeles, CA. Dr. Rebecca Sokol is a professor of Medicine, as well as Obstetrics and Gynecology, at USC’s Keck School of Medicine. She is also president of the American Society for Reproductive Medicine.

This article was published in Coping® with Cancer magazine, November/December 2015.