Infertility in Male Childhood Cancer Patients

Infertility can be a side effect of certain childhood cancer treatments. Infertility is the inability to get a partner pregnant after a year or more of regular sexual intercourse without using any birth control methods.

Before therapy starts, families are encouraged to discuss the impact of treatment on the patient’s fertility. The pediatric cancer center may also have a fertility specialist who can discuss options to preserve fertility.

The testes (testicles) in men produce testosterone and sperm. Puberty begins in boys when the brain instructs their bodies to start producing testosterone. When sperm from a man fertilizes an egg in a woman, she becomes pregnant.

The testes (testicles) in men produce testosterone and sperm. Puberty begins in boys when the brain instructs their bodies to start producing testosterone. When sperm from a man fertilizes an egg in a woman, she becomes pregnant.

How the Male Reproductive System Works

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

The testes (testicles) are located in 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 regulates many processes that assist in the transition of a boy into manhood. These processes include the maturing of sperm and the development of male sex organs.

Testosterone also regulates male 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 Cancer Treatment Affects Fertility in Males

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

  1. Alkylating agents and similar chemotherapy drugs 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 care 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.

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 treatment or imaging tests that involve radiation, the medical team can place a cover over the outside of the body to protect the testicles. 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?
  • What fertility preservation options are available at this hospital? At a fertility clinic?
  • Would you recommend a fertility specialist (such as a reproductive endocrinologist)?
  • 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?

Reviewed: July 2020