Male Infertility After Prostate Cancer Treatment

Prostate cancer is one of the most commonly diagnosed cancers in males.

In 2019, the American Cancer Society reported that approximately 174,650 individuals were diagnosed with prostate cancer, resulting in almost 31,620 deaths from the disease(1).

According to the 2019 report by the American Cancer Society, approximately 1 in 9 males may be diagnosed with prostate cancer during their lifetime.

Despite its prevalence, the mortality rate for prostate cancer is comparatively lower than that of some other cancers.

While many patients survive prostate cancer, concerns arise about the potential impact on fertility. Can individuals who have undergone prostate cancer treatment still have children?

The prostate plays a crucial role in fertility, and certain treatments for prostate cancer may potentially impact not only the prostate itself but also the surrounding organs. The extent of impact on fertility can vary depending on the specific treatment plan.

In this article, we explore the impact of prostate cancer and its treatments on male fertility.

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 inhibits the effects of testosterone on prostate cancer cells, impeding their growth.

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 impact a male’s reproductive organs differently, potentially affecting fertility

Hormone therapy works against testosterone, which is fundamental for reproduction. 

Surgery may lead to temporary erectile dysfunction and, in some cases, 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, prostate removal can reduce sperm volume and alter the composition of seminal fluid, which plays a role in fertility.

While prostatic fluid contributes to sperm preservation, male fertility is influenced by multiple factors, and the absence of this fluid may impact fertility outcomes.

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

Cryopreserving sperm, commonly known as freezing, emerges as a paramount method for men to preserve their fertility prior to undergoing prostate cancer treatment. The primary means of collecting semen for this purpose is through masturbation, ensuring a reliable and efficient process. These preserved sperm are securely banked, awaiting use when needed. Notably, they can be stored for numerous years without any compromise to their viability.

This long-term storage makes them an invaluable resource, particularly in procedures like in vitro fertilization and related techniques.

Testicular Sperm Extraction

Men with fertility potential who are unable to ejaculate may still have viable sperm cells in their testicles. The procedure of testicular sperm extraction involves specialists obtaining small sections of testicular tissue, resembling a biopsy. This medical intervention is performed under anesthesia or general sedation to ensure the patient’s comfort and well-being. This procedure might be an alternative before or after prostate cancer treatment.

Testicle shielding during radiation

In this preservation method, the testicles are shielded during radiation treatment, minimizing potential harm to both sperm cells and testicular tissues. Consequently, this proactive approach enhances the likelihood of conceiving naturally, offering a protective measure against adverse effects on fertility.

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 cases where natural ejaculation is not possible, healthcare providers may perform electroejaculation.

Occasionally, individuals may not have a sufficient quantity of high-quality sperm cells in their semen.

In such cases, sperm extraction and aspiration procedures are an alternative. 

These procedures may take a few hours, but they typically do not require days or weeks.

In general, fertility preservation methods won’t delay cancer treatment. 

You can consider any of these methods at any point before initiating your cancer 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. 

Some men may regain the ability to release healthy sperm cells after treatment, but it is not common.

Radiotherapy is considered one of the more damaging therapies, and the majority of patients experience a reduced 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. 

Similarly, chemotherapy results in 15-30% permanent infertility, a risk that applies to 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, as the cause is related to hormone imbalances.

The effects persist for many years, with most patients still experiencing castrated testosterone levels four years after treatment (6).

Fertility after radical prostatectomy is influenced by various factors.

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 fertility treatments, such as brachytherapy, can result in a fertile ejaculate.

Still, sperm quality will be affected by hypospermia (reduced sperm volume) or asthenospermia (reduced sperm motility). 

The latter typically involves alterations in sperm morphology and function.

In some cases, a combination of treatments is used to address prostate cancer.

Thus, the risk is higher when using a combination of options, 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 may conceive naturally after a waiting period.

The waiting period is typically several 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)

Intrauterine insemination (IUI) is a type of artificial insemination that can be beneficial for individuals with a low sperm count after treatment.

Donor sperm

Using a donor’s sperm is another option for conceiving 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 is unlikely to harm your children if you collected sperm samples before treatment.

However, what if you impregnate your partner after cancer treatment? It is possible, and the risk of hereditary disease is not high.

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 is unlikely to be affected by your treatment.

It’s an entirely different organism, and his gonads won’t be subject to cancer treatment. 

There is a modest risk of genetic disorders, however.

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?

Many patients may hesitate to ask important questions about fertility problems. It’s crucial for you to discuss all your concerns clearly with your doctor.

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 likelihood of success with fertility preservation and the possibility of 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 treatment, so it is recommended to wait for at least one year before undergoing a semen analysis.

For some men, it may take a few or several years to resume sperm production.

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 duration of the waiting period depends on your diagnosis and the type of treatment you received.

In most cases, there are no firm standards for how long men should wait after treatment. 

However, most studies suggest a waiting period of around 2 to 5 years after chemotherapy, radiation therapy, or hormone therapy (6).

Some men may not have to wait this long, while others may need a longer waiting period.

Some will have permanent damage and won’t recover their ability to father a child. 

Therefore, it is advisable to discuss this matter with your healthcare provider to determine 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 fertility is important to you, discussing it before therapy is crucial.

However, if you underwent treatment before considering any fertility preservation technique, there are still options available.

It’s important to note that fertility treatments can be expensive, and men facing infertility might consider options such as using 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. 

Similar results are expected in severe cases of benign prostate hyperplasia.

Regularly visit your doctor and discuss your risks. 

Perform regular screening and follow instructions.

In summary, it is advisable to consider fertility preservation before undergoing 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.

Next Up

Find out 10 Tips For Living with Prostate Cancer.