October 21, 2021 by John Fernandez
Men, Cancer and Fertility: Overcoming Challenges of Starting Families After Treatment
The most common cancers that affect men — primarily testicular and prostate cancers — can cause significant fertility problems that affect their ability to father biologic children, including the production of sperm.
Cancer treatments — including surgery, chemotherapy and radiation — can also diminish sperm counts and damage nerves needed for erection and ejaculation. Nonetheless, there are methods and procedures that can overcome these hurdles for men, many of whom recover their ability to father biologic children following surgery or extensive treatments, explains Ahmed Eldefrawy, M.D., urologic oncologist at Miami Cancer Institute, part of Baptist Health.
Testicular cancer primarily strikes young men between the ages of 15 and 40, with the average age at the time of diagnosis at 33, says the American Cancer Society. Many of these men may be starting families. If the cancer is caught early, orchiectomy — or the removable of the cancerous testicle — is a very viable option with a very good outcome. If cancer is localized, chemotherapy or radiation may not be needed, says Dr. Eldefrawy.
“After removing the testicle, obviously the sperm count will be low,” said Dr. Eldefrawy. “These patients have just one testicle removed, they have not gotten chemotherapy or any additional radiation or removing of the lymph nodes. So, the vast majority of these patients will see their sperm count improve significantly. And after one year, 50 percent of these patient will have normal sperm account.”
Trying to conceive naturally may take a while following successful testicular cancer treatment.
“It could take a year or even longer to be able to conceive,” said Dr. Eldefrawy. “So, if you have the time to try naturally, then that would be the answer, especially if the couple is young. And again, if you wait longer after treatment for testicular cancer, the sperm quality tends to improve.”
Factors That Affect Fertility
There are many factors that can influence sperm count or the ability to ejaculate, including the severity of the cancer, the surgery required, and the substantial follow-up treatments, primarily chemotherapy and radiation.
“The sperm count immediately declines after chemotherapy or radiation,” explains Dr. Eldefrawy. “In the case of radiation, it can take up to two years for patients to recover and go back to their normal sperm count. And, obviously, the dose of radiation is different. So, if the patient received a higher dose of radiation, it might take even longer to recover to the baseline sperm count.
The recovery from chemotherapy also depends on the doses and duration of treatment, and the chemotherapy agent that is used.
“But with chemotherapy, patients also tend to recover from it and have basically their regular baseline sperm count after several months or up to a year after getting the chemotherapy,” says Dr. Eldefrawy.
Prostate Cancer and Sperm Banking
Prostate cancer is the most common cancer among men in the U.S., and the second leading cause of cancer death in men after lung cancer. But the U.S. prostate cancer rate is on the decline, mostly because of the growing treatment options and targeted therapies. Despite the high rate of success in treating prostate cancer, most men cannot father biologic children naturally afterward.
One very common solution is sperm banking before treatment, in which semen containing sperm is frozen in liquid nitrogen. After thawing, sperm will regenerate and can be used for artificial insemination. Another option is to retrieve sperms from the testicle by a minor surgery and this can be done after treatment as the sperm production in the testicles will not be affected.
“It’s very curable and very treatable cancer, but unfortunately this cancer and any form of treatment will definitely affect fertility,” said Dr. Eldefrawy. “The two treatment options that has been around for many years and the gold standard until now is prostatectomy (removal of the prostate) and radiation therapy, and they can result in erectile dysfunction and loss of ejaculation completely.”
“These two approaches (sperm banking or surgical sperm retrieval) are the only possible methods to attain fertility,” he adds. “But, to have normal conception, such as ejaculation and normal fertility, is not possible after prostate cancer treatment, either after removing the prostate or following radiation.”
Bladder and Kidney Cancers
Two other cancers that may affect male fertility are bladder and kidney cancers. In bladder cancer, non-aggressive tumors do not pose a threat to male fertility. However, aggressive bladder cancers “which invade the muscle of the bladder requires the gold standard treatment — which is to remove the bladder,” said Dr. Eldefrawy.
When the bladder is removed, “we remove the prostate at the same time. And this usually results in erectile dysfunction and loss of ejaculation. So, fertility in this case will be only available by again extracting sperm from the testicle by minor surgery or sperm banking before surgery,” he adds.
Kidney cancer occasionally can affect very young patients and some who have genetic predisposition to develop kidney cancer, Dr. Eldefrawy said.
“Luckily, this is one of the cancers that does not affect fertility whatsoever,” adds Dr. Eldefrawy. “It’s a surgical disease where we remove the tumor if it’s localized and small, and we repair the kidney. We’re able to save the kidney for the most part, and these patients recover pretty well. And very, very rarely we would use chemotherapy for it.