- How will prostate cancer treatment affect male fertility?
- What fertility preservation options are available for men preparing to undergo cancer treatment?
- How much time do you have to preserve your fertility before you need to start your cancer treatments?
- What is the likelihood of male infertility after cancer treatment?
- If you do not preserve your fertility, what are your parenthood options after treatment?
- Will a child conceived after your cancer treatment be healthy?
- After treatment, how will we know if your child’s fertility has been affected?
- What should I ask my doctor about cancer and fertility?
- After treatment, how will you know if your fertility was affected?
- How long must I wait after treatment to try to father a child?
- Coping with male infertility after cancer treatment
- Conclusion
Prostate Cancer is the most familiar type of cancer in males.
According to the American Cancer Society, around 174,650 people were diagnosed with prostate cancer in 2019, and almost 31,620 people died from this disease (1).
Around 1 in every 9 males are said to be diagnosed with prostate cancer during their lifetime.
However, the death ratio from this type of cancer is lower than others.
Many patients survive after prostate cancer, but can they have children?
The prostate is an essential organ for fertility, and prostate cancer treatment may affect the prostate and the surrounding organs.
That’s why we’re covering in this article the topic of male infertility after prostate cancer.
We’re answering the most common questions men have about fertility before initiating cancer treatment.
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How will prostate cancer treatment affect male fertility?
There are various methods to successfully treat prostate cancer, including (2):
Surgery
In prostate cancer surgery, the doctor eliminates the prostate gland in addition to a portion of the tissue surrounding it, including the seminal vesicles.
Radiation therapy
Radiation utilizes high-energy beams to kill malignant growth cells.
Hormone therapy
Hormone therapy is also known as androgen suppression therapy.
It counters the effect of testosterone, preventing this hormone from energizing prostate cancer cells.
Chemotherapy
Chemotherapy utilizes anti-cancer drugs in intravenous infusions or orally.
They reach the prostate cells and destroy prostate cancer.
There are other types of treatments, but all of the above may affect male fertility.
Radiation and chemotherapy may affect a male’s reproductive organs.
Hormone therapy works against testosterone, which is fundamental for reproduction.
Surgery may lead to temporary erectile dysfunction and retrograde ejaculation.
Surgery may also lead to an incidental obstruction of the vas deferens.
This is part of the ejaculatory duct that connects the testicles to the outside and carries sperm cells.
Moreover, removing the prostate reduces sperm volume and takes out a critical fluid.
Prostatic fluid was essential to preserve sperm cells, and men without this extra fluid may have it difficult to have children.
You will still release sperm in ejaculations, but sperm quality will probably become affected after treatment (3).
What fertility preservation options are available for men preparing to undergo cancer treatment?
For all of the above, communication with your healthcare team is always essential.
If parenthood is important to you, be sure to discuss that with your doctor beforehand.
There are a few alternatives you can evaluate, though.
They may help you stay with a higher chance of fathering kids, even after treatment (4):
Sperm banking
Freezing (cryopreservation) of sperm is the best way for men to safeguard their fertility before prostate cancer treatment.
The most well-known approach to collect semen is through masturbation.
The sperm will remain frozen, or “banked,” until you need them.
It can be stored safely for many years without any harm.
They are primarily used for in vitro fertilization and similar techniques.
Testicular Sperm Extraction
Fertile men who can’t discharge sperm still have sperm cells in their gonads.
In testicular sperm extraction, a specialist extracts little sections of testicular tissue, similar to a biopsy.
Healthcare providers perform this under anesthesia or general sedation.
The sperms are then either frozen or used to fertilize a female egg cell.
This procedure might be an alternative before or after prostate cancer treatment.
Testicle shielding during radiation
In this preservation method, the testicles are secured during radiation treatment.
Reduced harm reaches your sperm cells and testicles.
Thus, the chance of conceiving naturally will be higher.
How much time do you have to preserve your fertility before you need to start your cancer treatments?
You can preserve your fertility by various methods above, and it does not take much time.
It’s done in a sperm bank and usually involves ejaculating by masturbation.
In some cases, when you are unable to ejaculate, electroejaculation is performed.
Sometimes, you may not have enough high-quality sperm cells in your semen.
In such cases, sperm extraction and aspiration procedures are an alternative.
They may take certain hours, but they are usually not days or weeks.
In general, fertility preservation methods won’t delay cancer treatment.
You can adopt any of them at any given moment before starting with your treatment.
If you’re in the middle of the protocol, talk to your doctor to evaluate your options (4,5).
What is the likelihood of male infertility after cancer treatment?
Problems of fertility after cancer treatment are widespread.
They might be impermanent or long-lasting.
Few men recover the capacity to release healthy sperm cells after treatment.
Radiotherapy is one of the most damaging therapies, and almost all patients reduce their chance of conception.
Their testosterone levels and the ability to create sperm cells reduce by around 30%.
The rate of male infertility depends on the radiotherapy dose.
Leydig cells are mostly affected after a dose of 14-20 Gy.
Higher doses lead to irreversible testicle damage.
Likewise, chemotherapy leads to 15-30% of permanent infertility, which remains valid for all types of tumors, including prostate cancer (5).
Spontaneous fatherhood after hormone therapy is possible, but it usually takes many years.
It is uncertain, and most patients have azoospermia (no sperm cells in their ejaculate) after treatment.
In this case, it is nonobstructive azoospermia because the cause is related to hormone imbalances.
The effects remain for many years, and most patients still have castrated testosterone levels four years after treatment (6).
Fertility after radical prostatectomy depends on many variables.
It is mainly affected in patients with bilateral obstruction of the vas deferens.
These patients have obstructive azoospermia.
The only option to conceive in these cases is through assisted reproductive techniques (5).
Less harmful treatments for fertility, such as brachytherapy, results in fertile ejaculate.
Still, sperm quality will be affected by hypospermia (reduced sperm volume) or asthenospermia (reduced sperm motility).
The latter usually involves alterations in sperm morphology and sperm function.
Some cases use a combination of treatments to treat prostate cancer.
Thus, the risk is higher than using only one option, and the chance remains uncertain.
That’s why fertility preservation through any of the above methods is a preferred option.
If you do not preserve your fertility, what are your parenthood options after treatment?
If you do not preserve your fertility, there are still some male infertility treatment options.
They include (5):
Natural conception
Some men with healthy sperm conceive naturally after waiting a period of time.
It is usually years and depends on the type of cancer treatment.
Intracytoplasmic sperm injection (ICSI)
This is the technique in which a single sperm is inserted into an egg.
This sperm cell is usually collected through masturbation.
Intrauterine insemination (IUI)
This is a type of artificial insemination that is also helpful to those who have low sperm count after treatment.
Donor sperm
Using a donor’s sperm cells is another option to conceive a child.
Will a child conceived after your cancer treatment be healthy?
If you use fertility preservation techniques before cancer treatment, the chance of conceiving a healthy child is very high.
Prostate cancer itself wouldn’t harm your children if you collected sperm samples before treatment.
But what if you had your partner pregnant after cancer treatment?
It is possible, and the risk of hereditary disease is not high.
A study reported a risk of less than 0.1% after a very high dose of radiotherapy.
Still, the chance of achieving natural conception is uncertain and depends on many different factors (5).
After treatment, how will we know if your child’s fertility has been affected?
If you conceive a male child after cancer treatment, his fertility won’t be affected by your treatment.
It’s an entirely different organism, and his gonads won’t be subject to cancer treatment.
There’s a modest risk of genetic disorders, though.
One of them may affect your child’s fertility.
Talk to your doctor to know your chances and what to expect from your children’s health, depending on the type of treatment you had.
What should I ask my doctor about cancer and fertility?
Most patients hesitate to ask important questions about fertility problems. It’s crucial for you to discuss all your concerns with your doctor clearly.
You may ask the following questions:
- What type of treatment will I receive? How will this type of treatment affect my fertility?
- What methods are available to save my fertility before I start my treatment?
- What is the chance of succeeding with fertility preservation and fathering a child after cancer treatment?
After treatment, how will you know if your fertility was affected?
Fertility specialists have various methods to find out your chance to conceive naturally after cancer treatment.
The most common is a sperm count, but you may also need to measure your testosterone levels and other blood markers.
Semen examination at a sperm bank checks whether you are making sperm or not.
They also investigate your sperm count and motility.
Your testes need time to recover after your treatment, so you need to wait for at least one year before having a semen analysis.
It may require a few or many years for certain men to begin sperm production once again.
Consult a reproductive urologist if you need a more detailed evaluation.
How long must I wait after treatment to try to father a child?
The time periods you need to wait relies upon your analysis and the treatment you got.
In most cases, there are no firm standards for how long men should wait after treatment.
Still, most studies suggest around 2 to 5 years after chemotherapy, radiation therapy, or hormone therapy (6).
A few men will not have to wait this long, while others may have to wait longer.
Some will have permanent damage and won’t recover their ability to father a child.
So, you should discuss this matter with your healthcare provider to know how long to wait and what to expect.
Coping with male infertility after cancer treatment
Dealing with male infertility after cancer treatment feels different for everyone.
Men who are not planning for kids may not be worried about fertility.
But if this is important for you, talking it out before therapy is fundamental.
Still, if you had your treatment done before any fertility preservation technique, there are options available.
Keep in mind that fertility treatments can be expensive, and infertile men might need to have a child through a sperm donor or adoption.
Conclusion
Although this disease is often treatable, prostate cancer treatment side effects include a high rate of male infertility cases.
We expect similar results in severe instances of benign prostate hyperplasia.
Regularly visit your doctor and discuss your risks.
Perform regular screening and follow instructions.
Overall, remember that you should do fertility preservation before cancer therapy.
You can still have a child after cancer treatment, but the chance is lower, and it usually requires waiting a long time to recover.
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