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Protecting Fertility in Male Childhood Cancer Patients

Certain childhood cancer treatments can affect a male patient’s ability to father children in the future.

After receiving a diagnosis of cancer, having children is likely not the top matter on the mind of patients or parents. But families should discuss the impact of treatment with the patient’s oncologist before therapy starts.

Male Reproductive System

Fertility refers to a person’s ability to reproduce: a man’s ability to father a child and a woman’s ability to get pregnant.

In men, testes produce sperm and the male hormone testosterone.

When sperm fertilizes an egg, a pregnancy occurs. 

The pituitary gland releases hormones that stimulate testosterone production. Testosterone regulates many processes that assist in the transition of a boy into manhood. These processes include the maturation of sperm and the development of male sex organs.

Cancer Treatments That Affect Fertility

Treatment that affects a patient’s pelvic area, reproductive organs, and pituitary gland function may affect a patient’s fertility.

  1. Drugs known as alkylating agents and certain other anti-cancer medications can cause problems with fertility.

    Alkylating Drugs
    Heavy  Metal Drugs
    Non-classical alkylators
  2. Radiation or surgery to the pelvic area or to the region of the brain that contains the pituitary gland can have an impact on fertility.

Take Action Before Treatment Starts

Before treatment begins, parents and the patient, if old enough, should talk with the medical team about the effect cancer treatment could have on the patient’s ability to have children.

  • If the treatment could affect fertility, ask the medical team what actions can be taken to protect fertility.
  • Find out the cost of treatments and if it is covered by insurance. Find resources for support.

Procedures That Can Preserve Fertility

  1. Testicular tissue freezing

    In testicular freezing, surgeons remove small pieces of testicular tissue and freeze it to use later. The tissue contains cells that could start sperm production in the future. Doctors can implant the thawed tissue when the man is ready to father children. This procedure is still considered experimental, but many studies are underway. Also, this tissue could contain cancer cells, so there is a risk that any cancer cells could spread when the tissue is implanted.

  2. Sperm banking

    Sperm banking is an option after puberty. For this procedure, males give samples of semen. The laboratory staff checks the sample in the laboratory. The sperm are frozen and stored (banked) for the future. Sperm can be frozen for an indefinite amount of time.

    Sperm extraction

    Sperm extraction is an option for males who cannot give a semen sample. It involves a needle biopsy to gather sperm from the testicular tissue. Sperm cells are frozen for future use.

  3. Testicular shielding

    When patients have radiation treatment or imaging tests that involve radiation, the medical team can place a protective cover over the outside of the body to protect the testicles from damage. This shield protects the testicles from scatter radiation when other parts of the body receive radiation.

Questions to Ask Before Treatment Begins

When your son is so young, it may seem strange to discuss fertility options. But many health care providers believe that having the discussion before treatment begins is the best time.

Consider asking questions such as:

  • Could treatment increase the risk of, or cause, infertility?
  • Are there other recommended cancer treatments that might not cause fertility problems?
  • Which fertility preservation options would you advise for me?
  • What fertility preservation options are available at this hospital? At a fertility clinic?
  • Would you recommend a fertility specialist (such as a reproductive endocrinologist) that I could talk with to learn more?
  • Is condom use advised, based on the treatment I’m receiving?
  • What are the chances that my fertility will return after treatment?
  • How much do these fertility options cost? Are they covered by insurance? Are there financial resources available?

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Reviewed: June 2018