Fertility Concerns and Preservation for Men

Approved by the Cancer.Net Editorial Board, 09/2019

Many cancer treatments affect fertility temporarily or permanently. Fertility is the ability to father a child. Infertility is the inability to father a child.

Before treatment begins, talk with your health care team. Ask how treatment could affect your fertility and about the options for preserving fertility.

How cancer treatments affect fertility

Fertility problems in men from cancer or its treatment occur in 2 main ways:

  • Through damage to endocrine glands or endocrine-related organs. These include the testicles, thyroid gland, and adrenal glands.

  • Through changes in the part of the brain that controls the endocrine system

Fertility problems may result from the following:

  • Damage to the sperm or lower sperm production

  • Lower semen production or an inability to make semen. Semen is made up of sperm from the testicles and fluid from the prostate and seminal vesicles. Damage to any of these structures, the nerves that allow them to function, or the route that gets them to the urethra can cause infertility.

Cancer treatments that affect fertility

These cancer treatments have known or possible fertility-related side effects:

Chemotherapy. Some drugs—specifically alkylating agents—are linked to fertility issues:

  • Busulfan (Busulfex, Myleran)

  • Carmustine (BiCNU)

  • Chlorambucil (Leukeran)

  • Cisplatin (Platinol)

  • Cyclophosphamide (Neosar)

  • Lomustine (CeeNU)

  • Mechlorethamine (Mustargen)

  • Melphalan (Alkeran)

  • Procarbazine (Matulane)

Other drugs used in cancer treatment may also have fertility risks. Ask your doctor about the specific drug(s) recommended in your treatment plan.

Radiation therapy. Radiation may kill sperm cells and stem cells that make sperm.

These types of radiation therapy can affect fertility:

  • Radiation therapy to the entire body for a bone marrow transplant

  • Radiation therapy directed at the midsection. Such targets include the abdomen, pelvis, lower spine, and testicles.

  • Radiation therapy to the pituitary gland in the brain

Surgery. Surgical removal of these organs may affect fertility:

  • Prostate

  • Bladder

  • One or both testicles

Additionally, surgery to remove pelvic lymph nodes may affect fertility.

Sperm production may return after treatment, although it may not be the same as before treatment. Treatment can stops or slows sperm production for years. For some men, cancer treatment leads to permanent infertility.

Factors related to increased risk of fertility issues:

  • Having higher doses of radiation therapy or chemotherapy

  • Having existing fertility issues

  • Having increased age, older than 40 (though infertility from cancer treatment can happen at any age)

Younger boys who receive treatment before puberty may have less sperm damage. But stronger treatments may still cause permanent future infertility. Such treatments include chemotherapy for a bone marrow transplant.

Cancer treatments may make fathering a child less likely. But pregnancy can still occur. Many doctors recommend waiting 6 months before attempting to father a child. This may allow sperm enough time to repair or to be cleared from the body. Ask your doctor about the best timeframe for you.

How to find help with fertility issues

Consider meeting with a male infertility specialist or a reproductive endocrinologist. These are doctors who specializes in conditions affecting fertility.

Recommendations for preserving fertility

The American Society of Clinical Oncology (ASCO) recommends that all men with cancer discuss the risk of infertility and fertility preservation options with their doctors as soon as possible before cancer treatment begins. If you are interested in preserving fertility, you should ask for a referral to a reproductive specialist, even if you are unsure if you want to have children in the future.

The options depend on several factors:

  • Your age

  • Your physical and sexual maturity

  • Your relationship status, such as having a female partner to provide eggs

  • Your feelings about specific procedures

ASCO’s recommendations for preserving fertility include:

Sperm banking. This procedure involves the freezing and storing semen. This is best done before treatment begins, as there is a higher risk of genetic damage in the sperm collected once treatment has started. Men may use the semen later. Options include intrauterine insemination and in vitro fertilization (IVF).

With IVF, a health professional collects a woman’s eggs. The stored sperm fertilizes the eggs in a laboratory. Then, the embryo is placed in the woman’s body to develop.

Sperm banking is an option for most post-pubescent men. A man may father a child even with few sperm. This is possible through a procedure called intracytoplasmic sperm injection (ICSI). During ICSI, a sperm is injected directly into an egg obtained during IVF.

Testicular-tissue freezing. Researchers are still studying this procedure, which happens before cancer treatment. It is for boys who have not been through puberty. The procedure involves removing, freezing, and storing testicular tissue. This tissue has stem cells that may later become sperm. Researchers are studying how to restore sperm-producing capabilities with thawed testicular tissue.

Hormonal therapy. Hormonal therapy is not effective for preserving fertility in men.

Read more about ASCO’s recommendations for preserving fertility, found on a separate website.

Protecting fertility during radiation therapy

Most fertility preservation methods must be done before treatment begins. But if you are receiving radiation therapy, your health care team may be able to shield the testicles, also called the testes, from radiation. The goal is to prevent sperm damage. It may be possible if the cancer is in another part of the pelvis.

Evaluating fertility preservation options

These options for protecting fertility are not appropriate for everyone. Consider these factors:

  • Health insurance may not cover the cost of fertility-preserving procedures

  • Their effectiveness varies

  • The added stress of fertility preservation in an already stressful time

You may benefit from counseling for fertility-related decisions. People considering fertility preservation should make the decision that feels right to them based on these and other factors.

Questions to ask your health care team

Consider asking the following questions before treatment begins:

  • What is my risk of infertility from each treatment option?

  • Are there other effective treatments with a lower risk?

  • What options do I have to preserve my fertility?

  • Will any of these options delay treatment? If so, how could this affect my chance of recovery?

  • Will any fertility preservation methods make my cancer treatment(s) less effective?

  • Do any fertility preservation options increase the risk that the cancer may come back?

  • Should I talk with a doctor who specializes in fertility before starting treatment?

  • What clinical trials are available to me?

  • Where can I find support for coping with fertility issues?

  • Where can I find help for conversations with my partner about fertility?

  • How will I know if I am fertile after cancer treatment?

Related Resources

Preserving Fertility in Children With Cancer

Moving Forward Video: Fertility for Young Adults with Cancer

Having a Baby After Cancer: Fertility Assistance and Other Options

More Information

LIVESTRONG: Fertility for Men

SaveMyFertility.org

The Samfund: Family Building Support

ASCO answers; Your Fertility and Cancer Treatment

Download ASCO's free 1-page fact sheet on Your Fertility and Cancer Treatment. This printable guide helps start the discussion about fertility preservation, introduces the risks of infertility from cancer and its treatment, and provides questions to ask the health care team. Order printed copies of this fact sheet from the ASCO Store.