You may be starting or have had cancer treatment that can affect fertility. This resource describes the options available to you to preserve fertility before treatment begins and to build a family after treatment is completed.
Natural Conception of a Child
Many structures of the body are involved in conceiving a child. Once puberty begins, hormones from the pituitary gland in the brain stimulate the testes (testicles) to make sperm. This takes about 74 days, after which the sperm pass into the epididymis where they mature and develop motility (ability to swim). When you are sexually excited, nerves from the spinal cord stimulate muscles in the vas deferens to propel the sperm through the vas. 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.
If this happens during sex with a female partner, a single sperm may fertilize her egg. If the fertilized egg begins to divide, an embryo is formed which can implant in the wall of the woman'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 men may have fertility problems unrelated to their cancer. In addition, some cancers affect the health of sperm even before treatment begins. The cancer can cause:
- A low sperm count
- Abnormally shaped sperm
- Sperm with reduced motility
Cancer treatment can cause problems in a number of different ways. It can:
- Impair the testes' ability to produce healthy sperm
- Harm the nerves that are needed to ejaculate
- Reduce the level of hormones that come from the brain to stimulate sperm production
Not all cancer treatments cause problems with fertility. It depends on:
- The number and quality of sperm you produce before treatment
- The type of surgery you have
- The type, dose, and duration of chemotherapy you receive
- The dose of radiation you receive and the area of the body that is irradiated
These fertility problems may be temporary or permanent. Some men regain the ability to produce healthy sperm within a few years after treatment, although rarely this can take many years. However, some men never regain their fertility. It is impossible to know exactly how you will be affected, although certain types of chemotherapy and radiation are known to be more associated with a permanent loss of fertility.
Fertility Preservation Before Treatment
Fertility preservation may enable you to have a biologic child in the future, even if you do not recover your ability to produce sperm. It involves collecting and freezing your sperm before cancer treatment. Boys do not produce sperm before puberty, so this is generally an option only for teens and adults. Options for pre-pubertal boys can be discussed with a reproductive urologist.
Some patients ask if they should try to get their partner pregnant before starting treatment. That can create unnecessary pressure if you are not yet ready to start building your family. Collecting and freezing sperm before treatment will enable you and your partner to attempt pregnancy when you are ready.
How is sperm collected?
Most men collect sperm at a sperm bank. The fact card Sperm Banking describes what is involved and has information to help you find a sperm bank. It also discusses the costs and describes how to get financial assistance through the LIVESTRONG Sharing Hope program.
You will need to make an appointment at the sperm bank ahead of time. When you first arrive, you will be given paperwork to complete. You may also have blood drawn. The staff at the sperm bank will give you a sterile cup and bring you to a private room for the collection.
Before collecting, wash and dry your hands. You will need to bring yourself to orgasm by masturbating. Do not use saliva (spit) or lubricants as these will harm the sperm. The liquid ejaculate that comes out of the tip of your penis contains the sperm. You will collect all the fluid in the cup. If you feel you cannot collect sperm this way, please tell your doctor or nurse. There may be other ways to collect.
Some sperm banks will allow you to collect at home. They will give you a plastic sterile cup for this. If you collect at home, you must bring the specimen to the sperm bank within 1 hour. During that time, keep the specimen at body temperature. 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.
How many collections do I need to make?
The answer to this question depends upon the number and motility of the sperm you have in your ejaculate. We suggest you make 3 collections if possible. For the first collection, it is best if you have no sex for 3 to 4 days before. This includes sex and masturbation. Then, if possible, skip about 2 days between the other collections. This will help you collect the highest possible number of sperm.
Your doctor may want you to start treatment before you can do 3 collections. If that is the case, there are new techniques that enable us to fertilize eggs even with very few sperm. Your doctor will advise you about how long you can safely wait before you start your treatment.
What does the sperm bank do with my sperm?
The sperm bank will analyze your semen, counting the number of sperm. This number varies from person to person but is generally above 20 million per milliliter. They also study the morphology (shape) of your sperm and their motility (ability to swim).
If you have enough healthy sperm to freeze, the sperm bank will divide the specimen into small vials and freeze and store them. Some sperm die during the freezing and thawing process. However, those sperm that survive suffer no damage while they are frozen. Sperm can be stored for as long as you want. Women have become pregnant with sperm stored for more than 20 years.
Are there other ways to collect sperm?
Collecting sperm by masturbating is not possible for everyone. For example, if you feel too sick, have too much pain, are too embarrassed or distressed, or are not able to masturbate because of religious or cultural beliefs or practices. For these patients, electroejaculation (EEJ) is another option. This is an outpatient procedure done under anesthesia, with you asleep. A probe that is about 1 inch wide is placed in your rectum where it emits a mild electrical current. This stimulates an ejaculation so your semen can be collected while you are asleep. More than 90% of men will ejaculate with this procedure.
If you do not have enough healthy sperm in your semen to freeze, or if you are not a candidate for EEJ, testicular sperm extraction (TESE) is another option. This is an outpatient surgical procedure done under anesthesia, with you asleep. A very small incision is made in your scrotum. The doctor examines the tissue inside your testis using a tiny surgical microscope to find the area(s) most likely to contain sperm. Small pieces of tissue are then removed.
With these procedures, the semen or tissue is transferred to a sperm bank where it is analyzed. If there are live sperm they are frozen and stored. If you would like to learn more about these options, ask your doctor or nurse to refer you to a reproductive urologist.
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 patients 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:
- You have recovered from treatment and are in good health.
- Any sperm that have been damaged by your treatment are removed from the body.
- Your testes have recovered as much as possible from the effects of treatment. This makes it more likely you will be able to make enough healthy sperm to conceive a child naturally.
Will a child conceived after I have received cancer treatment be healthy?
It is important to use birth control during and for a period of time after your treatment to ensure you do not conceive with sperm that may have been damaged from the treatment. This could possibly affect the health of a child conceived with this sperm. However, there is no evidence that children conceived naturally at least 12 months after completion of chemotherapy are at increased risk for any congenital abnormalities or other health problems. Because of this we assume that any sperm that have been damaged have been destroyed or repaired.
For Men Who Banked Sperm Before Treatment
How long should I continue to store my sperm?
You will have to pay a yearly storage fee as long as you want the sperm bank to hold your sperm. We do not recommend discarding the sperm until you are sure your fertility has recovered and that you need no further treatment. Some people decide to keep the sperm until they have completed building their families. If you are considering discarding your sperm, first speak with your doctor.
Once you have decided you will not be using your sperm, contact the sperm bank. They will have you sign papers so they can stop storing the sperm and discard it.
Should I use my stored sperm or first try to have a child naturally?
After waiting the length of time that your doctor suggests, make an appointment at the sperm bank to have a fresh sample of semen analyzed. The results will help predict the chances you will be able to father a child naturally. If there are enough healthy sperm, try for 3 to 6 months to get your partner pregnant. The amount of time to try depends to some extent on how old your partner is. Some men will be successful and never have to use their frozen sperm. However, if your partner does not get pregnant after 3 to 6 months, you may want to schedule an appointment for her to see a reproductive endocrinologist (a gynecologist who specializes in fertility). She can be evaluated and you can discuss your options, including using your frozen sperm.
How is my sperm used to conceive a child when I am ready?
The sperm bank will send your sperm to the reproductive endocrinologist working with you and your partner. Your doctor will suggest the best technique to fertilize her eggs. This is based on the number of healthy sperm you have, your partner's age, and her fertility status.
- Intra-uterine insemination (IUI or artificial insemination): Your doctor inserts your sperm through a very thin soft catheter into the woman's uterus. This is done around the time she ovulates (releases a mature egg). Most patients will not have enough healthy sperm for this technique. However, this may be an option for you if:
- You were able to collect multiple vials of sperm.
- Your sperm count was high and most of the sperm are healthy with good motility.
- Your partner is young with no fertility problems.
- In vitro fertilization (IVF): This technique is used for most patients who have banked their sperm. Your partner will take hormone injections for about 2 weeks to stimulate her ovaries. When her eggs have matured, they are removed. This is done using anesthesia, so she will be asleep. A very thin needle is passed through the wall of the vagina to the ovaries. All the mature eggs are removed and brought to the laboratory where they are fertilized with your sperm. There are 2 main methods:
- The eggs are mixed with millions of sperm that enter the eggs on their own.
- A single sperm is injected into the egg (intracytoplasmic sperm injection, or ICSI).
The fertilized eggs are kept in the laboratory for 3 to 5 days to be sure they start to divide and form healthy embryos. One or two of these are placed in your partner's uterus.
The effectiveness of these techniques depends on a number of factors:
- The number and quality of your sperm
- The age of your partner
- The technique used
- The experience of the fertility team
Will a child born using frozen sperm be healthy?
Being a cancer survivor and using frozen sperm does not increase the risk of your child having birth defects. It also does not mean that your child will develop cancer. 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 to test the embryos for some specific genetic disorders. You may want to request this if you or your partner have a hereditary cancer or some other genetic disorder.
For Men Who Did Not Bank Sperm Before Treatment
If my sperm count is low, can I still have a biologic child?
Even with no sperm in a semen sample, some patients still make sperm. You may be able to get someone pregnant. If you are not ready to father a child, always use birth control when having sex.
If you want to have a child but do not have enough sperm to conceive, testicular sperm extraction (TESE) is a possible option. This is an outpatient surgical procedure done under anesthesia, while you are asleep. A very small incision is made in your scrotum. The doctor examines your testis using a tiny surgical microscope to find where there may be sperm. Small pieces of tissue in these areas are then removed and examined. If healthy sperm are found they can be used 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
If I have retrograde (dry) ejaculation, can I still have a biologic child?
Some men do not see any fluid come from their penis after ejaculation with sexual stimulation. This can occur if the nerves and muscles that control ejaculation are damaged or removed. The semen passes into the bladder instead of out through the urethra. This is called retrograde ejaculation.
With retrograde ejaculation, you may still be able to collect sperm by:
- Taking medicine that tightens the muscles at the opening of the bladder. This allows the semen to pass forward out of the urethra instead of into the bladder. You only need to take this medicine for the period of time that you want to collect your sperm. This medicine can increase your blood pressure, so ask your doctor if it is safe for you. If you are interested in trying this, your doctor can refer you to a reproductive urologist.
- Collecting a sample of urine after you stimulate yourself. The sperm bank can remove the sperm from the urine. However, the urine is very acidic and can damage the sperm. To prevent this, you need to take a medicine to neutralize the acid in the urine. The sperm bank or your doctor will give you instructions on how to take this medicine.
If I have erectile dysfunction, can I still have a biologic child?
Erectile dysfunction is difficulty getting or maintaining an erection. This can develop for many reasons. Examples include:
- Increasing age
- Side effects of certain medicines
- Surgery or radiation therapy for treatment of some types of cancer
For men with this problem, the penis may not become firm enough to enter the vagina. As a result, the sperm cannot reach and fertilize the woman's eggs. Several treatments can help. These include medications and injections. If you are interested in trying these, your doctor can refer you to a urologist who specializes in erectile dysfunction.
If I am not able to have a biologic child, can I use donor sperm to build a family?
Some men do not have the opportunity to sperm bank before treatment or are unable to conceive using their frozen sperm. Using donor sperm is an option in this situation.
You can get donor sperm from a sperm bank. This is collected from men who are first screened to ensure they are healthy. Most donors are anonymous, but some may be willing to have the child contact them when they reach adulthood.
Your partner will first need to see a reproductive endocrinologist, a doctor specializing in fertility treatment. The doctor may have experience working with particular sperm banks. Consider selecting one they recommend. The frozen sperm you select will be sent to the doctor's office.
Intra-uterine insemination (IUI or artificial insemination) is the most commonly used method of using donor sperm to achieve a pregnancy. It is planned for around the time your partner ovulates (releases a mature egg). One or two vials of sperm are thawed and drawn up into a thin catheter. This is placed in your partner's uterus, and the sperm are released.
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, psychological and medical screenings are important. It is also important to talk with a lawyer.
Another option for building a family is adoption. Our web site has resources on adoption that may be helpful to you.
You can search for specific topics of interest within these sites, for example “donor sperm”
Cancer and Fertility