Male Fertility and Cancer Treatment

Male infertility is an inability to produce healthy sperm or to ejaculate sperm. Cancer treatment can affect a man’s ability to have children by causing genetic damage to sperm cells. The endocrine glands and endocrine-related organs, such as the testes, thyroid, and adrenal gland, release hormones that stimulate puberty and control fertility. Fertility problems occur when cancer or cancer treatments damage one of these glands or organs, or alters the part of the brain that controls the endocrine system. Men who receive higher doses of radiation therapy or chemotherapy need to wait longer for sperm production to begin again and have a higher likelihood of being permanently infertile. In some cases sperm production can recover after cancer treatment, however before commencing treatment there are steps a man can take to preserve his fertility.

Cancer and infertility
Some types of cancer temporarily lower a man’s fertility. Infertility is most likely to happen before cancer treatment and just after treatment is finished. For those who will recover sperm production, semen analysis will usually improve within one to three years after finishing cancer treatment. However, some men improve many years later.

Testicular cancer: Fertility may be poor during the two years before testicular cancer is discovered. Although only one to three percent of men with testicular cancer get cancer in both testicles, the cancer-free testicle may not function normally. On the other hand, men treated for testicular cancer often end up with improved semen quality within several years.

Newly-diagnosed Hodgkin’s disease, lymphoma or leukemia: Recent surgery, fever or physical stress experienced by survivors may affect the quality of semen.

Cancer treatment and infertility
Cancer treatment, not cancer itself, is often what damages fertility. Here are some common treatments and their possible effects on fertility.

  • Radiation therapy can slow down or stop sperm cell production if the testicle is in or near the target area for the radiation. A lead shield can help protect the testicles, but radiation “scatters” within the body, so it’s impossible to shield the testicles completely.
  • Total body irradiation used before some bone marrow transplants often causes permanent infertility. If the testicles get a mild dose of radiation, a man’s fertility may drop but can then recover over the next one to four years. If the radiation dose to the testicles is high, sperm production may stop forever.
  • Chemotherapy does the most damage to fertility. High doses of chemotherapy can damage sperm cell production and the testicles’ ability to make testosterone. This hormone is crucial in a man’s fertility.
  • Surgery to treat prostate or bladder cancer removes the prostate and seminal vesicles. These glands make the liquid part of a man’s semen. They also cut the pathway for sperm cells to be included in the semen. Men with testicular cancer or colon cancer sometimes have surgery that can damage nerves involved in orgasm. The result may be a “dry orgasm” or the sensation of pleasure, but without ejaculating any semen.

Fertility Testing
A semen analysis tests a man’s fertility. The analysis usually includes at least three scores that define semen quality:

  • The sperm count is the number of sperm present. A normal count is at least 20 million sperm per of semen.
  • The motility is the percentage of sperm that are actively swimming around. At least 50 percent of the sperm should be motile.
  • The morphology is the shape of the sperm. It is considered normal if at least 30 percent of the sperm have an ideal shape.

Fertility Preservation Options

  • Sperm Banking: Before beginning chemotherapy or radiation, a man produces a semen sample at a sperm bank. Masturbation is the preferred method since even using a condom during intercourse could leave the semen contaminated with bacteria. A semen analysis is done, and as long as the sample contains some live sperm cells, it can be frozen and stored for future use in infertility treatment. Once frozen, samples can be kept for at least 20 to 30 years (possibly longer) without further damage. Males who have reached puberty (even as young as age 12 or 13) can bank sperm for as long as the semen contains enough live and healthy sperm.
  • Testicular sperm extraction and epididymal sperm aspiration: For men who do not have mature sperm in their semen, this procedure involves removing a small amount of tissue from the testicle. This tissue is examined under the microscope for mature sperm, which can be frozen or used immediately for IVF.
  • Testicular-tissue freezing. This investigational option for boys who have not experienced puberty involves removing, freezing, and storing testicular tissue, which contains stem cells that may eventually become sperm before treatment begins. Researchers are studying how to thaw the tissue and surgically put it back into the body to restore sperm-producing capabilities.
  • In Vitro Fertilisation – Intracytoplasmic Sperm Injection (IVF-ICSI): When less than two million sperm cells are available for infertility treatment, the usual choice is to use them in In Vitro Fertilisation with Intracytoplasmic Sperm Injection (IVF-ICSI). The woman who will carry the child must undergo hormone shots for several weeks to stimulate her ovaries to ripen more than one or two eggs. The woman’s eggs are harvested and fertilised with the man’s sperm to create embryos that can be frozen for later implantation.  Since only a few sperm are needed, IVF-ICSI is a good option for men who have poor semen quality or have sperm with poor motility.
  • Intrauterine Insemination (IUI): This option is for men with semen quality that is closer to normal. A man’s semen sample is purified and concentrated to contain as much active sperm as possible. The sample is put in a thin catheter (tube) and slipped directly through the woman’s cervix into her uterus to give the sperm a head start on fertilising the egg. The procedure is done at a woman’s midcycle, her fertile time of the month. Sometimes the woman is given extra hormones to ripen more than one egg, but not in the high doses used in IVF.

Family Building Options

  • Donor Insemination: An unknown or known man donates his sperm to the sperm bank. This sperm is normally used in IVF to create embryos using the partner’s eggs.

Male and Female Fertility Preservation – What you can do
Before treatment begins, talk with your oncologist about the possible fertility-related side effects and options you may have to preserve your fertility.

Medfem Fertility Clinic is keeping hope alive by offering the opportunity to freeze eggs and sperm before treatment. If you are facing a medical treatment such as chemotherapy, radiation or surgery that may affect your fertility, we may be able to help you. In these circumstances, we often need to take action prior to the medical treatment. Therefore, we try to see all urgent cases within 24 hours of having received a referral from your physician.
If you or someone you know has been recently diagnosed with cancer that can impact their future fertility, call our offices immediately at +27 (11) 463 2244 to schedule a consultation.

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