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MAKING THE DECISION

For men, what is the likelihood of infertility from cancer treatments?

Fertility after cancer treatments depends on multiple factors, including age at diagnosis or treatment, type and dose of chemotherapy, location and dose of radiation, type of surgery affecting the reproductive system, and pre-treatment fertility status. Many men have low sperm counts or motility at the time of cancer diagnosis. For some doses of radiation therapy to the testicles or some types of chemotherapy, recovery of sperm production is 80-90%, while for others it is 0-30%. Even with those statistics for groups of men, we cannot predict recovery of sperm for one individual man. We can only give him a probability of sperm production resuming. It is crucial that you ask your medical team about fertility after the type of treatment you will be receiving, and to use that information in making a decision on whether to bank sperm before you begin treatment.


How will I know if I am fertile or infertile after cancer treatment?

The only way to know if you are producing sperm is to have a semen analysis. Semen is examined under a microscope to estimate the number of sperm, their motility (ability to swim forward to meet an egg), and shape. If you have some sperm, but not a totally normal semen analysis, it still is possible to conceive naturally, especially if your female partner's fertility is good. If you do not want to become a parent, it is important to use contraception.


I was just diagnosed with cancer - does this news mean that I don't have to bank my sperm?

Sperm banking is recommended for any man whose cancer treatment could permanently damage his fertility. Since we cannot accurately tell which men will recover sperm production, banking sperm is the most effective way to insure you will have the option of having a biological child in the future.


When should therapeutic sperm banking be started?

The option to bank sperm should be discussed as early as possible after the diagnosis of cancer, because it is best to collect semen before treatment begins. Usually, it is considered safe to collect sperm samples during the first week of chemotherapy or radiation treatments. Although chemotherapy or radiation can damage the genetic material in developing sperm, the mature sperm found in a man's semen are resistant to damage.


Will banking sperm delay my medical treatment?

Fortunately, storing semen samples does not have to delay the start of medical treatment. It is best to collect a specimen after 48 hours of abstinence from sexual activity. Although sperm constantly are being produced in the testes, it takes some time to replenish sperm levels after each ejaculation. To allow recovery of maximum semen volume, the second sample should be collected after another 48 hours of abstinence. If scheduling of a medical treatment does not allow that much time, waiting 24 hours between collections is usually enough. Men usually are advised to store several samples, but preserving even one may be worthwhile.


What influences semen quality?

Sperm Cryopreservation

Semen quality is measured in several ways: by the sperm count (the number of sperm cells present in one milliliter of seminal fluid), the sperm motility (the activity of the sperm cells), and the morphology (the percentage of the sperm cells that have a normal shape). Semen quality can be damaged temporarily or permanently. Men who have recently been diagnosed with cancer often have poorer semen quality than usual. Some of the problem may be related to the illness itself and some to recent medical procedures, such as biopsies or surgeries that involve general anesthesia. A high fever or recent exposure to toxic chemicals may affect semen quality, as can chemotherapy for cancer or radiation therapy aimed near the testes. A man's age has only minor influence on semen quality, but being a heavy smoker or abusing alcohol sometimes can interfere.
 
Semen quality also varies with each ejaculated specimen. If you have poor semen quality, the laboratory director will discuss the issue with you before your specimens are stored permanently.


How long does it take for sperm production to return post cancer treatments?

For less toxic treatments recovery often takes 1-3 years while for very toxic treatments (for example, preparation for a bone marrow or stem cell transplant) it may take as long as 5 to 10 years, if normal sperm production returns at all. Recovery of sperm production after this time is rare, but it can happen. Our advisors caution that you should not count on recovery, but be aware that it is a possibility and always use contraception if you do not want to conceive. Even when there are no sperm present in the semen, a man still may be making sperm in some small areas of his testicles. Some men have biopsies of a testicle to try to recover sperm that could be used with IVF to create a child. This procedure is called testicular sperm extraction.


Is it worth banking semen if the quality is not optimal?

With modern infertility treatments, it makes sense to bank sperm even if you have a low sperm count or motility. New techniques of in vitro fertilization can often achieve a pregnancy by injecting just one live sperm cell into an egg. The embryos that develop can be replaced into the woman's uterus. Men with better semen quality may be able to use their samples to create a pregnancy by simple insemination of their partner, a much less expensive and involved procedure than going through in vitro fertilization.


How many samples should be preserved?

If semen quality is high enough to permit artificial insemination as your eventual choice of fertility treatment, the chance of a successful pregnancy will increase with the number of samples you bank. More samples allow more tries at insemination. If the treatment will be in vitro fertilization, one sample may be enough, but it is still a good idea to store several samples. For each pregnancy that you desire, you should bank between three and six specimens, depending on their semen quality.


How long can sperm be safely stored?

Samples of semen do not deteriorate even over many years of deep freezing. Banking sperm before cancer treatment may allow a teenager or young adult to become a father years later, when he is ready to start a family. For a man who is about to have a vasectomy, therapeutic sperm banking provides an option to father a child if his life circumstances change.


Does using cryopreserved sperm increase the risk of birth defects?

NO. Among thousands of children who have been conceived with frozen sperm, the incidence of birth defects has been no different than that among children conceived through sexual intercourse.

Cancer and its treatments can damage the DNA inside each sperm. After cancer treatment, some men recover sperm production but still have damaged DNA. Luckily, it seems that damaged sperm rarely create a successful pregnancy. So far, no unusual rates of birth defects or childhood cancers have been seen in the children of men who conceived them after cancer treatment, although the number of babies available to study is limited.


Will my children be healthy?

Men diagnosed with cancer may have special concerns about the health of their children. Most types of cancer are not inherited from father to child. Studies of the children conceived after a parent's cancer treatment do not find any unusual rates of birth defects or cancer. There are a few types of cancer that can run in families, however. Your doctors can tell you whether your cancer falls in this group. If so, you may want to talk to a genetic counselor (a professional with special training in educating people about inherited health problems) and discuss possible health risks for your future children.


If I am sexually active, should I use birth control during cancer treatment?

Yes. After the first few days of cancer treatment, doctors often suggest that you use some type of birth control to prevent starting a pregnancy with damaged sperm. In general, you should continue to use some type of contraceptive method to prevent pregnancy during your cancer treatment and at least for six months afterwards. You cannot assume you are infertile.


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Last Update : February 03, 2009
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Center for Reproductive Medicine
The Cleveland Clinic
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