Life After Cancer: Changes in a Man’s Fertility

Cancer can affect a man’s ability to make a woman pregnant (fertility).

This can happen if:

Your testicles don’t make sperm
Sperm can't get out of your body because the passage for sperm is damaged or blocked
The sperm are damaged

Doctors are still learning how cancer treatments affect a man's fertility. Infertility after treatment may be short term. Or it may be permanent. Fertility problems depend on:

The types of treatment you had
The type of cancer and where it was in your body
How long treatment lasted
Your age when you had treatment
How long it has been since treatment ended
Your overall health

Before treatment

Talk with your healthcare team before you start treatment. Your team can tell you about how treatments may change your ability to get a partner pregnant. They can tell you about options for storing sperm. Ask your team about seeing a fertility specialist before you start your treatment.

You may choose to have sperm frozen and stored for future use. This is called sperm banking. Or you may choose a type of treatment that may help protect your fertility. Talk with your team about your options. The American Society for Reproductive Medicine has more information on sperm banking.

If you have chemotherapy

Chemotherapy (chemo) can harm fertility in these ways:

Chemo can stop your body from making new sperm. Your testicles may not make sperm for a year or more after chemo. Or they may never make sperm again.
Your sperm may be damaged during chemo. And they may still be damaged for some time after treatment.

The effects depend on the medicines you get, the dose, and how long you were treated. Talk with your healthcare team about the medicines you took. Ask about the risks of each medicine on your fertility.

If you have targeted or immune (biologic) therapy

Researchers are still learning how these types of medicines affect a man’s fertility. They don’t work the same as chemo. Ask your healthcare team what effects your medicines may have on your fertility.

If you have radiation therapy

Radiation to the belly (abdomen) or testicles can harm sperm. High doses can also damage the cells that make sperm. The problems depend on the type of treatment, such as:

Radiation implants. This is called brachytherapy. These implants are less likely to harm fertility.
External beam radiation. This treatment to the groin or pelvis has a much higher risk of long-term infertility.
Radiation to the pituitary gland. This can affect hormone production important in how the testicles make sperm.

Your healthcare team can tell you what effects you may have from your treatment.

If you have surgery

Surgery can change your fertility in these ways:

If you’ve had both testicles removed (orchiectomy), this means you no longer make sperm. If you have 1 testicle left and it works normally, it may still make sperm.
Surgery to remove the prostate gland or seminal vesicles means that you will no longer make some of the fluid in semen. This fluid is needed to carry sperm outside the body.
Surgery may also damage nerves or blood vessels. This can cause problems with getting or keeping an erection. This is called erectile dysfunction (ED).
In some cases, the tube that carries semen out of the body may be cut. This will prevent ejaculation.
In some cases, surgery causes the semen to go into the bladder instead of out the penis. This is called retrograde ejaculation.

Your healthcare team can tell you what to expect after surgery.

After treatment

After treatment, your healthcare team can help you manage any effects to your fertility. If you plan to get your partner pregnant after your treatment is done, talk with your team first. Ask how long you should wait after treatment. Some kinds of treatment may change the genes in sperm. This can raise the risk for birth defects. You may need to wait at least a year or more. Your team can give you information to help you make decisions. They can help you find a specialist. And they can let you know when it’s OK to start trying for a pregnancy with your partner. They may also be able to help you find adoption or surrogate resources.

Ask your healthcare team:

How does my type of treatment affect fertility in men?
When is it safe to start trying to get my partner pregnant?
Do I need to see a fertility specialist? Can you refer me to one?

Seeing a fertility specialist

A fertility doctor can help in several ways. A fertility doctor can help you use sperm you froze before cancer treatment. Or he or she can help you use sperm from a donor. In some cases, sperm may be retrieved after treatment. Sperm may be collected from urine. Or surgery may be done to take sperm directly out of a testicle. Your doctor will help you understand your options and what may work best for you.

Working with a fertility specialist may not be covered by health insurance. It’s important to know this. Fertility treatments can cost thousands of dollars. In many cases, more than 1 treatment is needed. Talk with the fertility specialist and your health insurer to find out what your own costs will be.

Getting support

Fertility changes can be very stressful and upsetting. You and your partner may want to talk with a counselor. Ask your healthcare team for a referral to counseling. They can also help you find a nearby support group or other resources.