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Male Reproductive Structures
Many structures of the body are involved in conceiving a child. Hormones from the brain stimulate the testes (testicles) to make sperm. This begins at puberty. The sperm then pass into the epididymis. This is where the sperm mature and develop motility (ability to swim). Sperm are stored in the epididymis and in part of the vas deferens. When you are sexually excited, nerves from the spinal cord stimulate muscles in the lower pelvis. These propel the sperm through the vas deferens. The sperm mix with fluids from the seminal vesicles and prostate gland. The fluid and sperm together are called semen. Then, the muscles at the opening of the bladder close. This causes the semen to be propelled out of the penis through the urethra. This is called ejaculation.
If ejaculation occurs during sex with a female partner, sperm are propelled into the vagina. An individual sperm may enter the egg of a woman. This fertilizes the egg, creating an embryo. The embryo implants in the wall of the woman's uterus (womb). The cells continue to divide, becoming a fetus. It grows and develops during the nine months of pregnancy.
Some cancers affect the health of sperm even before treatment begins. Men with cancer may have:
- A low sperm count
- Abnormally shaped sperm
- Sperm with reduced motility
Effects of Cancer Treatment on Fertility
Videos
Urologist John Mulhull, director of the Male Sexual and Reproductive Medicine Program at Memorial Sloan-Kettering Cancer Center, discusses fertility-preserving options for men of childbearing age who have cancer.
Cancer treatment can cause problems in a number of different ways. It can:
- Impair the testes' ability to produce healthy sperm
- Harm the structures 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 following factors:
- Your diagnosis
- The number and quality of sperm you produce before treatment
- The type of surgery you have (Surgery that affects the reproductive structures may affect fertility)
- The type and dose of chemotherapy you receive (Some drugs are more likely to affect fertility than others)
- The dose of radiation you receive and the area of the body that is irradiated (Radiation treatment fields that include reproductive structures may affect fertility)
These fertility problems may be temporary or permanent. You may regain the ability to produce healthy sperm after treatment. This may take months or even years. It is impossible to be sure how you will be affected.
Fertile Hope is a national, nonprofit organization dedicated to providing reproductive information, support, and hope to cancer patients and survivors whose medical treatments present the risk of infertility. Learn more about your risk for infertility by using Fertile Hope's Risk Calculator.
Fertility Preservation
Although we can not always prevent problems with fertility, there are a number of options available for men who want to father a child using their own sperm in the future. This is called fertility preservation. It involves collecting sperm and freezing it before you begin treatment. When you are ready to father a child, the sperm are thawed and used to fertilize the egg of your partner or of a donor. Sperm are usually collected at a sperm bank (also called a semen bank). We hope that the questions and answers below will help you decide if sperm banking is the right choice for you.
Frequently Asked Questions
- How do I find a sperm bank?
- How is sperm collected?
- How many collections do I need to make? Will collecting sperm delay my treatment?
- Are there other ways to collect sperm?
- What does the sperm bank do with my sperm?
- How much will it cost to bank my sperm?
- How is my sperm used to conceive a child when I am ready?
1. How do I find a sperm bank?
Sperm banks are regulated by the US Food and Drug Administration. In addition, the New York State Department of Health grants laboratory licenses for semen analysis and tissue bank licenses for the collection, processing, and storage of semen. These licenses are given only if the sperm bank meets strict criteria to ensure your safety.
Find New York State-licensed sperm banks near Memorial Sloan-Kettering Manhattan and regional sites. (Selecting a Sperm Bank )
Find sperm banks through Fertile Hope. Under GEOGRAPHY select state, and under SERVICE select Sperm Banking.
If there is no sperm bank near you, a specimen can be mailed in. Cryogenics Laboratory can send you a kit with everything you need. However, we recommend you collect at a sperm bank if at all possible. You will have a better chance of having the highest number of healthy sperm in your specimen if you do not have to delay freezing due to travel time. Mail in a specimen only if the nearest sperm bank is very far away.
2. How is sperm collected?
The simplest way of collecting sperm is to do it yourself. This involves getting sexually excited and ejaculating. You can stimulate yourself or your partner can stimulate you. Your hands should be clean and dry. Do not use saliva or lubricants when stimulating yourself. These will destroy the sperm. Collect the entire specimen of semen in a sterile cup.
Most men collect their sperm at a local sperm bank. You will need to make an appointment ahead of time. The staff at the sperm bank will give you everything you need and bring you to a private room for the collection. Some sperm banks will allow you to collect at home. If you collect at home, you must bring the specimen to the sperm bank within one 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.
3. How many collections do I need to make? Will collecting sperm delay my treatment?
The number of specimens you need depends on the number and quality of your sperm. If possible, we suggest that you make three collections. This ensures you have enough healthy sperm to store. Do not have any sexual activity three to four days before the first collection. This will help you get the highest possible number of sperm in the specimen. In addition, you should not ejaculate for at least two days, and ideally four days, between collections.
In the event that your doctor wants you to start treatment before you can do three collections, there are new techniques that enable eggs to be fertilized with very few sperm. If your first collection has enough healthy sperm, you may not need to collect any more. Your doctor will advise you as to how long you can safely wait before you start your treatment.
4. Are there other ways to collect sperm?
Collecting sperm by getting sexually excited to ejaculate may not be the best way for you to collect sperm. For example:
- It may be too embarrassing or distressing.
- It may not be allowed because of your religious or cultural beliefs or practices.
- It may not be possible because of pain from treatments you have received.
Other methods of collecting sperm exist. There are also some experimental procedures that can be used to collect sperm. These involve removing pieces of the testicle. The tissue itself may be frozen, or immature sperm may be removed and frozen. These are all done as outpatient procedures under anesthesia. If you would like to learn about other methods of sperm collection, ask your doctor or nurse to refer you to a reproductive urologist.
5. What does the sperm bank do with my sperm?
The first thing the sperm bank does is analyze your sperm. They count the number of sperm in a defined volume (one milliliter) of semen. This number varies from person to person. A normal count is generally above 20 million per milliliter. They also study the shape of your sperm and their motility (ability to swim).
If the sperm look healthy, the bank will freeze and store the sperm until you are ready to use it. Some sperm are damaged during the freezing and thawing process. However, no damage occurs while they are frozen. Sperm can be stored for as long as you want. Women have become pregnant with sperm that have been stored for more than 20 years.
6. How much will it cost to bank my sperm?
The charges for sperm banking include several fees. These may include:
- An initial consultation
- Collection
- Analysis
- Freezing
- Storage of the specimens
The sperm bank may also require you to have blood tests for certain infectious diseases. There could be additional charges for these tests. Each bank charges different amounts for their services, so the total cost of sperm banking depends on the bank. The cost in the New York area is generally about $1,000 to $2,500. This fee includes storage for between one to five years. Many insurance companies do not cover sperm banking. Call your insurance company to find out if you have coverage. Explain that your doctor has suggested sperm banking because of a diagnosis of cancer. Having what's called a letter of medical necessity from your doctor can also help. Give this letter to your insurance company with the invoice from the sperm bank. Ask your doctor to provide this letter.
If you cannot afford these costs, you may be able to get financial assistance. Fertile Hope's Sharing Hope Program works with companies and clinics to arrange services at a reduced rate for eligible cancer patients. Their Web site explains who is eligible and describes what services are covered. You can also download the application from the site.
7. How is my sperm used to conceive a child when I am ready?
In general, we suggest waiting at least 12 months after treatment before trying to have a child. However, with some chemotherapy agents you may not need to wait this long. Please check with your doctor to see how long you should wait. You may want to first try to have a child naturally. You can have a fresh sample of sperm analyzed to see if you have enough healthy sperm to try this. Many men will be successful and never have to use their frozen sperm.
However, if after three to six months you have not been able to get your partner pregnant, you should schedule an appointment with her to see a reproductive endocrinologist. This doctor will tell you the best way to fertilize your partner's eggs using your frozen sperm. This is based on the number of healthy sperm you have, your partner's age, and her fertility status. When you decide to proceed with this, the frozen sperm will be sent from your sperm bank to the reproductive endocrinologist. The sperm will be thawed and used in one of the following ways:
- Intra-uterine insemination (IUI, or artificial insemination): Your doctor inserts your sperm through a very thin, soft catheter into your partner or donor'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
- Most of the sperm are healthy with good motility
- Your partner or donor is young with no fertility problems
- In vitro fertilization (IVF): This is the most commonly used technique for patients who have banked their sperm. Your partner or donor will need to take hormone injections for a number of weeks in order to stimulate the ovaries to mature extra eggs. When the eggs have matured they are removed. This is done using a very thin needle passed through the vagina. During the procedure your partner will be under anesthesia. The eggs are then fertilized with your sperm in a laboratory. There are two main methods:
- The eggs are mixed with thousands of sperm, which enter the eggs on their own.
- A single sperm is injected into the egg (Known as, intracytoplasmic sperm injection, or ICSI).
The fertilized eggs are kept in the laboratory for three to five days. If they start to divide and form healthy embryos, one or two of these are placed in your partner's uterus.
