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Cancer and Fertility: Information for Men

Some treatments for cancer can affect fertility. This resource describes your options for preserving fertility before treatment begins and building a family after treatment is completed.

Natural Conception of a Child

Many structures of the body are involved in conceiving a child (see figure). Once puberty begins, hormones from the pituitary gland in the brain stimulate the testes (testicles) to make sperm. It takes about 3 months for sperm to mature, after which they pass into the epididymis. When you are sexually excited, nerves stimulate the muscles in the vas deferens to push the sperm from the epididymis through the vas deferens. The sperm mix with fluids from the seminal vesicles and prostate gland to form semen. Muscles at the opening of the bladder close, and the semen is propelled out of the penis through the urethra. This is called ejaculation.

Male reproductive system Male reproductive system

If you ejaculate during sex with a female partner around the time of the month when she ovulates (releases a mature egg from the ovary), a single sperm may enter and fertilize the egg. If the fertilized egg begins to divide, an embryo is formed which can implant in the female’s uterus (womb). The cells continue to divide, forming a fetus that grows and develops during the 9 months of pregnancy.

Effects of Cancer and Cancer Treatment on Fertility

Some cancers are associated with a low sperm count, and some cancer treatments cause fertility problems. These include:
 
  • Inability to produce sperm
  • Damage to nerves and blood vessels needed for erection and ejaculation
  • Inability to produce hormones that stimulate sperm production
Not all cancer treatments cause fertility problems. It depends on:
 
  • Your fertility before treatment
  • The type of surgery you have
  • The type and dose of chemotherapy you receive
  • The dose of radiation you receive and the area of the body that is treated

Fertility problems from cancer treatment may be temporary or permanent. Some men regain the ability to produce sperm after treatment. This generally takes 1 to 3 years, but can sometimes take longer. Some men never regain their fertility.

Because of the many factors that affect fertility, it is difficult to predict how any one person will be affected by treatment. We cannot know for sure who will regain fertility after treatment is completed and who will not.

Some men ask if they should try to get their partner pregnant before starting treatment. This can create unnecessary pressure if you are not yet ready to start building your family. Fertility preservation before treatment, as described below, can enable you and your partner to attempt pregnancy when you are ready.

Preserving Your Fertility Before Treatment

Sperm banking

Sperm banking is the best option for you to preserve your fertility if you do not recover your ability to produce sperm. It involves collecting, freezing, and storing your sperm before you begin cancer treatment. Sperm can be stored for as long as you want, even for many years. Review the MSK resource Sperm Banking for details on what is involved and a list of local sperm banks.
 
Here are some key things you should know about sperm banking:
 
  • You will need to make an appointment at a sperm bank for your first appointment.
  • At your first appointment, you will be given paperwork to complete. You may also have blood drawn.
  • You will collect the specimen in a private room at the sperm bank. You will need to bring yourself to orgasm by masturbating. The liquid ejaculate that comes out of the tip of your penis contains the sperm. You will collect this in a sterile cup.
  • The sperm bank will analyze your semen, counting the number of sperm. They will divide the specimen into small vials and then will freeze and store the vials. Some sperm die during the freezing and thawing process. However, the sperm that survive are not damaged while they are frozen.
  • We suggest you collect 3 specimens before treatment, if possible. For the first collection, it is best if you do not have sex for 2 to 5 days before the collection. This includes intercourse and masturbation. Then skip 2 to 3 days between the other collections. This will help you collect the highest possible number of sperm.
    • If you do not have time to do 3 collections before your treatment is scheduled to begin, there are new techniques to fertilize eggs, even with very few sperm. So, it is still beneficial to collect even one specimen.
  • Most insurance companies do not cover the cost of sperm banking. The cost varies from one sperm bank to another. In the New York area, the cost ranges from $700 to $1,300 for 3 collections. Ask the sperm bank if they have any discount programs for cancer patients. If the sperm bank requires blood tests, this may add to the cost.
  • You will have to pay a yearly storage fee as long as you want the sperm bank to hold your sperm. We recommend you consider storing the sperm until you have completed building your family. If you are considering discarding your sperm, talk with your doctor first.
If you feel you cannot collect a specimen at the sperm bank, some sperm banks will allow you to collect it at home. They will give you a sterile cup for this. If you collect your specimen at home, you must keep it at body temperature and bring it to the sperm bank within 1 hour. Place the cup with the specimen in a sock and hold it close to your body. You cannot freeze the specimen and store it at home.
 
If you feel you cannot collect a specimen by masturbating, please tell your doctor or nurse. Reasons for this include feeling too sick, having too much pain, feeling too embarrassed or distressed, or not being able to masturbate because of religious or cultural beliefs or practices. You may be able to collect through a procedure called electroejaculation (EEJ). This is an outpatient procedure performed by a reproductive urologist (a doctor who specializes in male fertility). The procedure is done under anesthesia. A probe that is about 1 inch wide is placed in your rectum where it emits a mild electrical current. This causes you to ejaculate so your semen can be collected while you are asleep. The specimen will be brought to a sperm bank to be analyzed and frozen.
 
If the sperm bank does not find any sperm in your semen to freeze, you may be able to collect a specimen through a procedure called testicular sperm extraction (TESE). This is an outpatient procedure performed by a reproductive urologist. The procedure is done under anesthesia, while you are asleep. A very small incision is made in your scrotum. Your doctor will remove small pieces of tissue from your testes. The tissue is brought to a sperm bank, where they will look for sperm to freeze. 
 
If you are the parent of a boy who has not reached puberty, your son will not yet be producing mature sperm to collect and freeze. There are experimental options that may be available. If you are interested in learning more, ask your doctor if a referral to a reproductive urologist might be appropriate for your son.
 

Building a Family After Treatment

Below are common questions that people have about building a family after treatment.
 

How long must I wait after treatment to try to father a child?

The length of time to wait depends on your diagnosis and the treatment you received. In general, we suggest waiting at least 12 months after treatment before trying to have a child. However, some people may not need to wait this long, and others should wait longer. Please check with your doctor to find out how long he or she recommends that you wait. Waiting ensures that:
 
  • Sperm that have been damaged by your treatment are cleared from your body.
  • Your testes have recovered from the effects of treatment and are more likely to be producing fresh sperm. 
  • You have recovered from treatment and are in good health.

How will I know if I am fertile after treatment?

You can have a semen analysis done at a sperm bank to see if you are producing sperm and to analyze your sperm count, motility (ability to swim), and morphology (shape). Wait at least 1 year after you have completed treatment before having the semen analysis so that your testes have enough time to recover. If they do not find sperm in the specimen, remember that it can take a number of years for some men to start producing sperm again. If you want a more in depth evaluation, ask your doctor to refer you to a reproductive urologist.
 
Some men prefer to attempt pregnancy without having a semen analysis first. If your partner does not get pregnant after 3 to 6 months, you should consider having a semen analysis at that time. Your partner should also consider being evaluated by a reproductive endocrinologist (a gynecologist who specializes in fertility). Your options for building a family are based on the results of these fertility evaluations.
 

Will a child conceived after I have received cancer treatment be healthy?

It is important to use birth control during and after treatment to ensure you do not conceive with sperm that may have been damaged from exposure to chemotherapy or radiation. This could possibly affect the health of a child conceived from this sperm. However, there is no evidence that children conceived at least 12 months after completion of treatment are at increased risk for any birth defects or other health problems. Because of this, we assume that any sperm that have been damaged have been destroyed or repaired.
 
However, some cancers are hereditary, or passed down from parents to children. Ask your doctor or nurse if you have a hereditary cancer. If you do, ask to meet with a genetics counselor to learn more about these risks. Pre-implantation genetic diagnosis (PGD) is a technique that is used to test embryos for specific genetic disorders. You may want to request this if you or your partner has a hereditary cancer or some other genetic disorder.
 

Can I have a biologic child if I am fertile, but have a low sperm count?

Some men recover sperm production after cancer treatment but have a low sperm count (oligospermia) and may not be able to conceive naturally. However, you may still be able to have a biologic child through in vitro fertilization (IVF). There are several steps involved in IVF, including:
 
  • Ovarian stimulation: Your female partner will take hormone injections for about 10 days to stimulate a group of eggs in her ovaries to mature. 
  • Egg retrieval: While your partner is asleep under anesthesia, a very thin needle is passed through the wall of her vagina up to her ovaries to remove the mature eggs. This procedure takes 10 to 20 minutes.
  • Fertilization: The eggs are fertilized with your sperm in a laboratory. Because your sperm count is low, they may inject a sperm into each egg to increase the chances of fertilization (intracytoplasmic sperm injection, or ICSI). The fertilized eggs are kept in the laboratory for 3 to 5 days to make sure they start to divide and form healthy embryos. 
  • Embryo transfer: One or 2 embryos are placed in your partner’s uterus to attempt pregnancy. The others are frozen and stored for the future.

Can I have a biologic child if I am no longer fertile, but banked sperm before treatment?

To use the sperm you froze before treatment, you and your partner will need to work with a reproductive endocrinologist (a gynecologist who specializes in fertility). The technique recommended to fertilize her eggs will be based on the quality of the specimens you were able to freeze before treatment. These techniques include:
 
  • Intra-uterine insemination (IUI or artificial insemination): One or 2 vials of sperm are thawed and drawn up into a thin, soft catheter. This is placed in your partner’s uterus and the sperm are released. This is done around the time she ovulates (releases a mature egg). It takes most women 3 to 6 attempts at IUI before they are successful, so most patients who banked sperm will not have enough sperm to use this technique. However, this may be an option for you if your partner is young and has no fertility problems, and if you have many vials of sperm with a high sperm count with good motility.
  • In vitro fertilization (IVF): This technique is used by most people using their thawed sperm. There are several steps involved:
    • Ovarian stimulation: Your female partner will take hormone injections for about 10 days to stimulate a group of eggs in her ovaries to mature. 
    • Egg retrieval: While your partner is asleep under anesthesia, a very thin needle is passed through the wall of her vagina up to her ovaries to remove the mature eggs. This procedure takes 10 to 20 minutes.
    • Fertilization: The eggs are fertilized with your sperm in a laboratory. If you have a high sperm count with good motility, the sperm may be mixed with the eggs to fertilize on their own. The other option is to inject a sperm into each egg to increase the chances of fertilization (intracytoplasmic sperm injection, or ICSI). The fertilized eggs are kept in the laboratory for 3 to 5 days to make sure they start to divide and form healthy embryos. 
    • Embryo transfer: One or 2 embryos are placed in your partner’s uterus to attempt pregnancy. The others are frozen and stored for the future.

Can I have a biologic child if I am no longer fertile and did not bank sperm before treatment?

Even with no sperm in a semen sample, some people produce small amounts of sperm after cancer treatment. To try to obtain sperm to attempt pregnancy, you would need to see a reproductive urologist and undergo a procedure called testicular sperm extraction (TESE). This is an outpatient procedure done under anesthesia, while you are asleep. A very small incision is made in your scrotum. Your doctor removes small pieces of tissue from your testes. These are examined to search for sperm. If sperm are found, they can be used to attempt to fertilize your partner’s eggs. If you would like to learn more about this procedure, ask your doctor or nurse to refer you to a reproductive urologist.
 

What are my other options to build a family?

Some men do not have the opportunity to bank sperm before treatment or are unable to conceive using their frozen sperm. However, you can still build a family by using donor sperm or by adopting. 
 

 

Donor sperm

This involves using sperm from another man to impregnate your female partner. Young healthy men provide their sperm to a sperm bank for donation. Most donors are anonymous, but some may be willing to have the child contact them when they reach adulthood. You can select a donor based on various characteristics and traits that are shared on the sperm bank website. You may have a relative or friend who is willing to donate sperm for you. While this may be a good option for you, even with the best of intentions, problems can arise if expectations are not clearly defined. Sometimes, a relative or friend who wants to help will make an offer without understanding all that is involved. No matter how well you know the person, your donor should have psychological and medical screening, and you should both seek legal consultation. 
 
  • The first step is for you and your partner to see a reproductive endocrinologist. He or she can recommend particular sperm banks where you can obtain sperm. Once you select a donor, the frozen sperm will be sent to your reproductive endocrinologist.
  • Intra-uterine insemination (IUI or artificial insemination) is the most commonly used method for using donor sperm to achieve a pregnancy. It is planned for around the time your partner ovulates (releases a mature egg). One or 2 vials of sperm are thawed and drawn up into a thin, soft catheter. This is placed in your partner’s uterus and the sperm are released. It takes most women 3 to 6 attempts at IUI before they are successful.

Adoption

Having a history of cancer does not prevent you from being able to adopt, as long as you are healthy now, and ideally have been cancer-free for at least 3 to 5 years. Regulations on adoption are there to protect the well-being of the child, so you may need a letter from your doctor confirming that you are healthy enough to raise a child. You also need to be a United States citizen or legal permanent resident of the United States. If you are not, it will be very difficult for you to adopt in the United States.
 
  • Adoptions can be domestic (the child is born in the United States) or international (the child is born and lives outside of the United States).Private domestic adoptions provide the best chance of adopting a newborn or a child of the same race and ethnicity as you.
  • Adoptions are arranged in a variety of ways, including through:
    • Lawyers: Adoption laws vary widely by state, so it is important to work with a lawyer who specializes in adoption and is licensed in the state in which you want to adopt. 
    • Private agencies: These agencies may handle domestic adoptions, international adoptions, or both. Each agency has its own standards about who they will accept as adoptive parents. Some states, including New York, do not allow agencies to discriminate against prospective parents based on a history of cancer. Children adopted through private agencies are usually younger than children adopted through public agencies. With a private agency, you can adopt a newborn child.
    • Public agencies: These are part of the State Department of Social Services. They usually work with children who have been taken away from their birth parents due to alleged abuse or neglect.

Can I have a biologic child if I have retrograde (dry) ejaculation?

Some cancer treatments cause injury to or removal of the nerves and muscles that control ejaculation. With retrograde ejaculation, the semen passes into the bladder instead of coming out through the penis. If you have retrograde ejaculation, but are still producing sperm, there are techniques that may help obtain sperm to attempt pregnancy, including:
 
  • Taking medication to tighten the muscles at the opening of the bladder. This allows the semen to pass forward out through the penis instead of into the bladder. 
  • Collecting a sample of urine after you stimulate yourself to ejaculate. This would be done at a sperm bank, where they can remove the sperm from the urine. 
If you are interested in either of these options, ask your doctor for a referral to a reproductive urologist.
 

Can I have a biologic child if I have erectile dysfunction?

Some cancer treatments cause injury to or removal of the nerves and blood vessels that control erection. If you are still producing sperm, but your penis is not able to become firm enough to enter a vagina, the sperm cannot fertilize the woman’s eggs. Several treatments can help, including medications and injections. If you are interested in trying these, ask your doctor for a referral to a urologist who specializes in erectile dysfunction.
 

MSK Resources

Fertility website
 
Fertility Options for Men Before and After Cancer Treatment (videos)
 
Sperm Banking 
 

Additional Resources

Cancer and fertility

American Cancer Society
Fertility and Men With Cancer: 
 
American Society of Clinical Oncology (Cancer.Net)
 
MyOncofertility
 
SaveMyFertility
 
Having Children After Cancer: How to Make Informed Choices Before and After Treatment and Build the Family of Your Dreams. Gina M. Shaw; Celestial Arts, 2011.
 

For teens and parents of children

Children’s Oncology Group
 
Teens Health
 

Infertility

American Fertility Association 
 
American Society of Reproductive Medicine
 
RESOLVE: The National Infertility Association 
 
Urology Care Foundation (American Urological Association)