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This information is about fertility (the ability to have children) and how it can sometimes be affected by cancer treatment. It is written for men with cancer, and their partners. We have a separate section on fertility for women with cancer.
Being told that you have cancer and that treatment may make you infertile is very difficult to come to terms with. The prospect of losing your fertility can be overwhelming no matter whether or not you already have children, or have considered having them before. Many men find that their feelings about becoming a father change over the years.
Before your treatment starts it is important to know if your fertility is likely to be affected. You can then make an informed decision about options that you may have, such as storing your sperm for future use (sperm banking).
Your doctor will discuss the risk of infertility with you before your treatment starts. If you have a partner it might be helpful for both of you to be present during these discussions. Don't be afraid to ask your doctor or specialist nurse any questions that you have.
While you are being treated with chemotherapy or radiotherapy, it is important to avoid getting your partner pregnant. This is because the treatment can damage your sperm, and could possibly harm a baby conceived at this time.
There is no evidence that cancer treatments can harm children fathered after treatment is over, but doctors usually advise that you should avoid fathering a child for about a year after your treatment. This is to give your sperm a chance to recover from any damage that chemotherapy or radiotherapy may have caused.
If your partner becomes pregnant during your treatment, she should let her own doctor know straightaway, as there may be some risk of damage to the baby.
For men, fertility is the ability to get a woman pregnant (father a child). For this to happen, a sperm from the man needs to fertilise an egg from a woman.
From puberty (which starts around the age of 12–13) onwards, the testicles begin to produce sperm, millions at a time. These are stored in the testicles until needed. Sperm production is controlled by various hormones (the body's chemical messengers). Hormones also control sex drive and the ability to get an erection.
Usually, sexual intercourse has to take place for the egg to be fertilised by a sperm. This involves the man getting an erection and ejaculating sperm into a woman's vagina.
Treatments for cancer can affect your fertility in different ways. Some cancer treatment can:
Treatments which only affect sperm production will not prevent you from getting an erection or enjoying sex.
Some treatments may affect your ability to get an erection, making sexual intercourse impossible. However, any of these treatment effects may make it impossible for fertilisation to take place through sex.
If you have sperm stored (banked) before treatment starts, this can be used in the future to fertilise a partner's eggs. Testosterone can be replaced by testosterone replacement therapy. There are also drugs and different techniques that can be used to help you get and maintain an erection. You can read more about this in our section on sexuality and cancer.
There are four main treatments for cancer and they can all affect fertility in some way:
Chemotherapy can cause infertility by stopping sperm production. This is usually temporary, but will be permanent in some cases. The effect that chemotherapy has on fertility and whether it is temporary or permanent will depend on:
In some circumstances it might be possible to have a chemotherapy treatment that is less likely to affect your fertility. Your doctor will explain how different chemotherapy treatments are likely to affect your fertility.
It may take two years or more for your fertility to come back. You can have regular tests to check the number and quality of your sperm when treatment is over.
Some types of radiotherapy for cancer may cause permanent or temporary infertility by affecting sperm production.
Radiotherapy to the pelvic area (usually given for prostate, rectal or bladder cancer) can lead to infertility, which may be temporary or permanent. Radiotherapy given directly to the testicles (this is rare) will cause permanent infertility.
Radiotherapy to anywhere near the testicles can reduce the amount of testosterone that is produced. A lack of testosterone can reduce sex drive and the ability to get an erection.
The risk of infertility is generally related to the dose of radiotherapy given. It may take up to five years for your fertility to return. If you are not producing sperm after this length of time it is unlikely that your fertility will come back.
TBI is given to some men with cancers like leukaemia or lymphoma, and usually causes permanent infertility. Only a small number of people who have this treatment will be able to have children afterwards, unless they have banked sperm beforehand.
Radiotherapy to the brain that includes the pituitary gland (which is at the base of the brain) can sometimes affect fertility. The pituitary gland controls the hormones that stimulate the testicles to produce testosterone.
Hormonal therapy is usually used to treat prostate cancer. Most hormonal therapies often cause the inability to have an erection (sexual impotence) and loss of sex drive (libido). This will continue for as long as you are having the treatment and may improve when it finishes.
If you have problems getting or keeping an erection, there are different options that may help. You can read more about this in our section on sexuality and cancer.
Most operations for cancer do not affect your ability to get your partner pregnant. However, some operations will make you unable to father a child.
Some types of surgery to the pelvic area (having your prostate gland or your bladder removed) or to the spine may make you unable to father children. This is because the surgery can damage the nerves and blood vessels in the pelvic area, making it impossible to get an erection. Again, you can read more about the options which can help you get or keep an erection in our section on sexuality and cancer.
Some types of surgery (for example when lymph glands near the testicles are removed) can cause a problem called retrograde ejaculation. Instead of sperm and semen coming out of your penis it goes backwards into your bladder. This affects your fertility but it doesn't have any effect on your ability to have an erection or an orgasm.
Having one testicle removed (for testicular cancer) should not affect your ability to have children, as the remaining testicle will usually work normally.
Having both testicles removed (a bilateral orchidectomy) will mean that you will not be able to father children. This treatment is also occasionally used to treat men with prostate cancer which has spread.
It can be difficult to predict whether your fertility will be affected by cancer treatment or if it will return to normal when treatment is over. You may be advised to store sperm before starting treatment, even if your chances of becoming infertile are low.
You will have counselling (at the fertility clinic) before you have sperm banking. You will also have to sign a consent form that states how your sperm is to be used. Blood tests will be taken to check that you don't have any diseases or infections that could be transferred through your semen (fluid that carries the sperm).
Sperm banking is a safe technique that's been successfully carried out for many years. Samples of your sperm are frozen and if you and your partner want to have a child later in your lives, these can be thawed and used with fertility treatments. Sperm samples can be kept frozen up until you are 55.
It is best to store sperm before treatment starts. This is because treatment (chemotherapy and radiotherapy) could damage your sperm and make it unsuitable for use in the future. Sometimes treatment needs to start immediately or you may not be well enough to produce a sample. In these situations sperm banking may not be possible or there may only be time to collect a single sample. There are now newer techniques (explained later) which can help men in this position.
The NHS often pays for sperm banking for men with cancer, but in some hospitals you may have to pay for it yourself.
There are no guarantees that stored sperm will be able to fertilise an egg and achieve a pregnancy, but many people have had healthy babies as a result of fertility treatments. The specialist staff at the clinic will talk all this over with you before you have sperm banking.
You will probably be asked to provide two or three samples of sperm (through masturbation into a container). This takes place in a private room (your partner can go with you) in the fertility clinic and two or three samples are collected over a week. The staff at the clinic will make things as easy as possible for you and ensure that you are not interrupted. You are usually advised not to have sex for a couple of days before collecting each sample. This helps to make sure that each sample contains enough healthy sperm to fertilise an egg.
Sometimes it might be possible to bring a sample in from home. This is usually if you can deliver it within 30–45 minutes.
Even if you aren't producing many sperm, or your treatment started quickly and you couldn't provide all the samples, your sperm can still be stored. A fertility treatment called ICSI (intra-cytoplasmic sperm injection), which only needs a single sperm to fertilise an egg, is now often used.
It is also now possible to look for and collect sperm by extracting a piece of testicular tissue or fluid. This can be done using a local or general anaesthetic. Small amounts of testicular fluid or tissue are removed by inserting a fine needle into the testicle or by making a small cut in the scrotum (the pouch of skin which contains the testicles).
The fluid or tissue is examined for sperm in the laboratory. The sperm is then removed and stored for future use. These are new techniques and the long-term effects on any children conceived in this way are not fully known. Your doctor or nurse at the fertility clinic can give you more information.
If you have had radiotherapy to the pituitary gland in your brain, or to your testicles, your testosterone levels may be low. This can happen many years after treatment. A lack of testosterone can affect your ability to get an erection and reduce your sex drive. It can also affect your health, and can cause problems such as thinning of the bones (osteoporosis).
Testosterone replacement therapy helps to reduce these problems and is given for life. It can be given as a patch that is stuck on the skin (transdermal), as an implant or as an injection into a muscle. Your doctor can give you more advice about testosterone replacement therapy.
If you sperm banked, you can be referred to a fertility clinic. Even if you haven't stored sperm, fertility treatments can still help men who have a low sperm count as a result of cancer or its treatments. The doctors at the clinic will advise you about the fertility treatments that are most likely to help you. This will depend on different factors such as the number and quality of your sperm and your partner's fertility.
If you don't have many sperm or could only give one sample a treatment called ICSI (intra-cytoplasmic sperm injection) can be used to fertilise your partner's egg. A single sperm is injected directly into an egg to fertilise it.
ICSI is always used with IVF (in vitro fertilisation) where fertilisation of the egg and the sperm takes place outside the body (in a test tube).
Because ICSI is a fairly new treatment, the possible long term effects on children conceived in this way are not fully known.
Talk to the staff at the fertility clinic about any concerns you have about possible risks.
If the cancer treatment has caused permanent infertility and you were unable to store sperm, you and your partner might consider using donated sperm.
Everyone who donates sperm is carefully selected. Usually a donor will be matched as closely as possible so that eye and hair colour, physical build and ethnic origin are the same as yours. The donor has to be fit and healthy with no medical problems and will be tested for different diseases and infections.
Choosing to use donated sperm is a difficult decision and often needs careful consideration. It isn't going to suit everyone. The staff at the fertility clinic, your doctors and specialist nurse can discuss this with you further.
There is a shortage of sperm donors in the UK so you may have to wait to find a suitable donor.
Some men may consider adoption. Other men choose not to have fertility treatment or to adopt and go on to enjoy life without children. Everyone is different.
Being told you have cancer and that treatment may affect your fertility can be very difficult. Your fertility may not be uppermost in your mind – getting rid of the cancer is often the priority. But some men may find the threat of losing their fertility as difficult to accept as the diagnosis of cancer. There is no right or wrong way to react or to feel.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk about their feelings with their partner, a close friend, or their family. Many people also find it helpful to talk about their feelings with a specialist counsellor.
Many hospitals have specialist nurses who may be able to help you. Some hospitals and fertility clinics also have counsellors that you could talk to. You could also contact one of the support organisations listed below.
This section has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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