Approved by the Cancer.Net Editorial Board, 04/2018
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 ask about your options for preserving fertility.
How cancer treatments affect fertility
Fertility problems from cancer or cancer treatment occur in 2 main ways:
- Through damage to endocrine glands or endocrine-related organs. These include the testes, thyroid, and adrenal glands. And they release hormones that stimulate puberty and control fertility.
- Through changes in the part of the brain that controls the endocrine system
Fertility problems may result from the following:
- Damage to the sperm
- Decreased sperm production
- Decreased semen production or an inability to produce semen. Semen is fluid made in the prostate. It carries sperm during sex
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)
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 bone marrow transplants
- 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 these organs may affect fertility:
- The prostate
- The bladder
- One testicle or both testicles
Additionally, surgery to remove pelvic lymph nodes may affect fertility.
Variation in cancer treatments’ effects on fertility
For some men, cancer treatment leads to permanent infertility. For others, it stops or slows sperm production for years. Then, that ability may returns, though it may not be the same as before treatment.
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 occur at any age)
Younger boys who receive treatment before puberty may have less sperm damage. However, 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. However, 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 reproductive endocrinologist. This is a doctor who specializes in conditions affecting fertility. And some reproductive endocrinologists specialize in cancer-related fertility issues.
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 whether 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 in 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 occurs before cancer treatment. It is for boys who have not been through puberty. The procedure involves removing, freezing, and storing testicular tissue. This tissue contains 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 ASCO’s website.
Protecting fertility during radiation therapy
Most fertility preservation methods must be done before treatment begins. However, if you are receiving radiation therapy, your health care team may be able to shield the testes from radiation. The goal is to prevent sperm damage. It’s possible if the cancer is in another part of the pelvis.
Evaluating fertility preservation options
These options for protecting fertility aren’t appropriate for everyone. Consider these factors:
- Health insurance may not cover the cost of fertility-preserving procedures
- Their effectiveness varies.
- They may be an added stress in an already stressful time.
You may benefit from counseling for fertility-related decisions.
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?
Several books cover this topic, as well. Check your library or bookseller.