Cancer itself can reduce fertility. However, this is only the case for cancers that affect the reproductive organs, such as cancer of the testicles. Other cancers may not directly cause infertility. In most cases, infertility caused by the treatment for the cancer, such as chemotherapy or radiation, rather than the cancer itself.
Chemotherapy is designed to kill rapidly dividing cells throughout the body. Cancer cells divide rapidly, but so do sperm cells, making infertility a potential side effect of chemotherapy. Likewise, radiation therapy kills rapidly dividing cells, but only in or around its target area. If the radiation field includes the brain, it may affect fertility by damaging areas that control hormone production, such as testosterone. Radiation therapy aimed close to or at the pelvic area of the body can also cause infertility by directly damaging the testicles.
Surgery to remove part or all of the reproductive system can cause infertility as well.
It is important to understand that while cancer treatments can be very effective, they can cause side effects that impact your ability to reproduce.
Sperm banking or sperm cryopreservation is a simple way for men to preserve their fertility. Even boys, with parental consent, can provide a sperm sample for sperm cryopreservation. Conventional sperm banking is noninvasive and can be done quickly, in a matter of hours, so cancer treatment is not delayed. There are alternatives if sperm cannot be collected conventionally. A fertility expert can outline them for you.
Sperm can be frozen indefinitely. Damage to the sperm occurs during the freezing and/or thawing processes, not while it is frozen. As long as sperm are successfully frozen and are kept in proper conditions, they can survive for many years.
The sperm bank only releases the sperm to another cryobank or a physician with your authorization. No one else can authorize the release. Your sperm is your property. An advanced medical directive, or other legal paperwork, can help ensure that your sperm cannot be used without your consent or to give someone else the legal right to use your sperm.
There are ways your oncologist can protect your fertility during surgery or during cancer treatment. First, radiation oncologists can determine the dose of radiation needed to kill the cancer while minimizing the toxic effect on nearby normal tissues or sensitive tissues, such as the testicles and sperm. This procedure is called dose fractionation and it is standard practice at most radiation treatment facilities.
Radiation shielding is another method your oncologist can use during treatment to protect your fertility. During radiation treatment, special shields are placed over one or both of the testicles, which helps reduce the risk of damage to your fertility.
Although your oncologist can take certain measures to protect your fertility, it is important to take charge of your own fertility. Patients are the best advocates for their own health. Make sure to discuss how your cancer and your treatment will affect your fertility. Here are questions that may be helpful to ask your oncologist:
- Will my cancer treatments affect my fertility?
- Are there alternative ways to treat my cancer without compromising my fertility?
- What are my fertility preservation options?
- How much time do I have to preserve my fertility before I need to start my cancer treatments?
- What are the risks to my children based on my cancer and the treatment I receive?
- Can you refer me to a reproductive endocrinologist?
Research shows that sperm cells and the stem cells that create sperm can be genetically damaged from cancer treatments like chemotherapy and radiation. DNA integrity may be compromised even after a single treatment. As a result, it is strongly recommended that you bank your sperm before starting chemotherapy and radiation. There is no evidence to suggest that anesthesia has an effect on fertility, so you may bank sperm after surgery.
Most patients are told to wait two years. The suggested time frame is provided for several reasons. First, most cancers come back in the first two years. Second, sperm exposed to chemotherapy and/or radiation may suffer genetic damage. For sperm, much of this damage is believed to repair itself within two years. It is important to consult with your medical team to determine your individual circumstances before trying to conceive.
Before assuming that you have lost fertility due to treatment—or that you must now pursue alternative reproductive methods—it is important to determine your actual fertility. For a man who has completed cancer treatment, there is a wide variation in the length of time it takes to return to normal levels of sperm production. For some men, it may occur within a year; for others, it may take up to 10 years or even longer. As difficult as waiting may be, it’s important for you and your partner to be patient.
A fertility specialist can evaluate your fertility by collecting a semen sample and then testing your sperm levels as well as the motility, shape and appearance of your sperm. Measuring the levels of testosterone and follicle-stimulating hormone in your blood and semen also can reveal how well the testicles are functioning. The combination of this information allows fertility specialists to measure your overall fertility.