Infertility in Male Cancer and Stem Cell Transplant Patients

Infertility is the inability to get a partner pregnant after a year or more of regular sexual intercourse without using any birth control methods. 

Infertility can be a side effect of certain chemotherapy medicines, radiation treatments, surgical procedures, and drugs used to prepare patients for a stem cell transplant (bone marrow transplant.)

Before therapy starts, families should discuss the impact of treatment on the patient’s fertility. Families may also speak a fertility specialist who can discuss options to preserve fertility.

How the male reproductive system works

To understand fertility, it’s helpful to understand how the male reproductive system works.

The testes (testicles) are inside a loosely hanging pouch of skin known as the scrotum. In men, testes produce sperm and the male hormone testosterone. When sperm fertilizes an egg, a pregnancy occurs.

When boys enter puberty, the pituitary gland releases hormones that stimulate testosterone production. Testosterone controls many processes that cause puberty. These processes include the maturing of sperm and the development of male sex organs.

Testosterone also regulates functions such as: 

• Deepening of the voice

• Enlarging of the penis and testicles

• Increasing the growth of facial and body hair

• Enhancing muscular development 

How treatment affects fertility in males

Treatment that affects a patient’s reproductive organs and pituitary gland may have an impact on their fertility.

Chemotherapy

Some chemotherapy  can cause problems with fertility.

Radiation and Surgery

Radiation or surgery to the pelvic area or the region of the brain that contains the pituitary gland can affect fertility.

Take action before treatment starts

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

• If the treatment could affect fertility, ask the medical team what can be done to protect fertility.

• Find out the cost of treatments and if they are covered by insurance.

Procedures that can preserve fertility

Before puberty

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 tissue when the man is ready to have children.

This procedure is still considered experimental, but many studies are ongoing. Also, this tissue could contain cancer cells. That means there is a risk that any cancer cells could spread when the tissue is implanted.

After puberty

Sperm banking

Sperm banking is an option after puberty. For this procedure, males give samples of semen. The staff checks the sample in the laboratory. The sperm are frozen and stored 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.

Before or after puberty

Testicular shielding

When patients have treatment or imaging tests that involve radiation, the medical team can place a cover over the outside of the body. This shield protects the testicles from radiation.

Checking sperm after treatment

Sperm is checked 1 year after treatment ends. This finds out if the sperm are healthy. Patients give sperm samples that are sent to a lab for testing. 

Healthy men make sperm their entire lives. If you have sperm after treatment, it is likely that you will keep making it. However, if your sample does not contain sperm after treatment, your body may not be able to make sperm.

Other ways to have children after treatment

There are many ways to become a father after cancer treatment. There is a chance that cancer treatment will not affect the ability to have children. 

Other fertility options include:

• In vitro fertilization. This is when a health care provider uses your sperm to fertilize an egg in a laboratory. Then, the fertilized egg is placed inside the partner’s uterus where it grows.

• Sperm from a donor 

• Adoption

Questions to ask before treatment begins

When your son is 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?

• What fertility preservation options are available at this hospital? At a fertility clinic?

• Would you recommend a fertility specialist (such as a reproductive endocrinologist?

• Do you advise using condoms, 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?