What You Can Do to Protect Your Fertility After a Cancer Diagnosis
by Mary K. Samplaski, MD
When you’re first diagnosed with cancer, family planning is probably not the first thing on your 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, doctors are now starting to address issues like fertility preservation before cancer treatment even begins. A time when fertility preservation techniques have the most chance of success.
Cancer & Your Fertility
Fertility refers to the ability to conceive children. Fertility issues in cancer survivors can be caused by the malignancy itself. But they are more commonly caused by cancer treatments, including chemotherapy, radiation, and surgery.
Cancer and its treatments affect fertility in men and women differently. In men, 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 slightly lowered 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 a man’s fertility by inhibiting libido, erectile function, and sexual satisfaction.
How Chemotherapy Affects Fertility
The extent to which chemotherapy affects fertility depends on the type of cancer being treated, the chemotherapeutic 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 is important that you talk to your doctor about how your chemotherapy treatment may affect your fertility. For example, cisplatin is often used to treat 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.
While there are no guarantees, freezing sperm prior to starting cancer treatment provides “insurance” that if sperm production is lost after cancer treatment, your fertility can be restored.
How Radiation Affects Fertility
Radiation therapy, applied either directly to the testicles 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
prepubertal boys being more sensitive to these effects than adults. Total body irradiation prior to stem cell transplantation is particularly toxic due to the high radiation doses required and may result in permanent testicular failure in approximately 80 percent of men undergoing the procedure.
How Surgery Affects Fertility
The act of surgery alone does not usually affect sperm production. However, abdominal or pelvic surgery for cancer may impair fertility or sexual function. An obvious example is the removal of a testicle as treatment for testicular cancer. Other examples include damage to the nerves or organs involved in erections or ejaculation. The good news is that, with modern surgical techniques, these risks are low. However, no technique completely eliminates the risk.
Preserving Fertility in Men with Cancer
The most common fertility preservation strategy for men is sperm cryopreservation, also known as sperm banking. While there are no guarantees, freezing sperm prior to starting cancer treatment provides “insurance” that if sperm production is lost after cancer treatment, your fertility can be restored, as the frozen sperm can later be thawed and used in a fertility procedure like IVF to achieve pregnancy. Generally, 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 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 once your cancer has been treated.
Dr. Mary Samplaski is an associate 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.
This article was published in Coping® with Cancer magazine, November/December 2021.