In males, fertility refers to the ability to make healthy sperm that can fertilize an egg to cause pregnancy. Infertility happens when there is a problem with how sperm are made, stored, or released.
Infertility and other fertility problems can be side effects of certain chemotherapy medicines, radiation therapy, or surgery. This does not mean that everyone who has these treatments will have fertility problems. Each person’s risk is different. Many people who have treatment-related fertility problems are still able to have children later in life, either naturally or with medical help.
Fertility preservation options are ways to help protect fertility to give a better chance of fathering a child in the future.
Before treatment starts, talk with your care team about possible effects on fertility and options to protect fertility.
How the male reproductive system works
Parts of the male reproductive system
Puberty is the stage in life when a boy’s body goes through physical and hormonal changes that prepare him for adulthood. This usually occurs between ages 9 and 16. During puberty, the brain signals the testicles to make testosterone, a hormone that causes changes such as facial and body hair growth, a deeper voice, and the start of sperm production.
Sperm are made in the testicles and then move to the epididymis, a coiled tube where they are stored and continue to mature. During sexual activity, sperm travel through the vas deferens, a tube that carries them to the urethra, which runs through the penis. Along the way, sperm mix with seminal fluid to create semen. During orgasm, semen is released through the urethra and out of the penis. This is called ejaculation.
Chemotherapy, radiation, surgery, or illness can affect the reproductive organs or brain. This can lead to:
Changes in hormones that control sperm production
Fewer sperm (low sperm count), lack of sperm, or poorer sperm quality
Damage to reproductive organs that affects how sperm are stored or released
Some changes to the body may be temporary. Other changes could be long-term or permanent.
Risk factors for fertility problems in males
Risk factors for fertility problems include:
Medical conditions that affect the brain, pituitary gland, or testicles
Surgery to the brain, pelvic area, or reproductive organs
A health care provider can diagnose fertility problems after puberty. Screening may start with a physical exam and medical history. Tests may be used to measure sperm or hormones.
Semen analysis
Semen is the bodily fluid that contains sperm. A semen analysis, also called a sperm count, measures the quantity and quality of sperm. Results of the analysis include:
Volume: Amount (number) of sperm
Sperm count: Number of sperm per milliliter
Sperm movement: How active the sperm are
Sperm shape: The shape of the sperm. Abnormal sperm shape can affect fertility.
White blood cells: Number of white blood cells. A high white blood cell count may be a sign of an infection.
Healthy males make sperm their entire lives. If sperm are present after chemotherapy or radiation is complete, the body is likely to continue to make sperm. If no sperm are found, it may mean that your body cannot make sperm.
Hormone tests
Blood tests are used to measure the level of certain hormones, such as:
Testosterone: Low testosterone can lead to low sperm counts or unhealthy sperm.
Follicle-stimulating hormone (FSH): High or low levels of FSH may mean there are problems with sperm production or other hormones.
Luteinizing hormone (LH): High or low levels of LH can affect testosterone and sperm production.
Prolactin: If prolactin is too high, it can affect testosterone levels.
Estradiol (estrogen): Estrogen is normally low in males. High levels can affect testosterone and fertility.
Your care team can explain test results and let you know if you need other tests.
Fertility treatments and preservation for males
Fertility treatments and male fertility preservation options depend on many factors, including age and past and future treatments. Not all options are safe and effective for all patients.
Some fertility preservation procedures may not be covered by health insurance. They may be an out-of-pocket expense. Ask your care team about financial assistance programs or grants for fertility preservation.
Fertility treatment options depend on whether puberty has started. Talk to your care team to understand the options, costs, and risks.
Before puberty
Testicular tissue freezing (testicular tissue cryopreservation): A small piece of testicular tissue is removed and frozen for future use. The tissue contains immature cells, which may be used later to try to make mature sperm. Testicular tissue freezing is mainly used for males who have not gone through puberty or who can’t freeze sperm. It is still being studied as a fertility treatment.
After puberty
Sperm banking (sperm freezing or cryopreservation): You provide a semen sample, which is frozen and stored for the future.
Sperm aspiration or extraction: Sperm are removed from testicular tissue using a needle or incision. Sperm are frozen and stored for future use.
Embryo freezing (embryo cryopreservation): Sperm are collected and then used to fertilize an egg in a lab (in vitro fertilization or IVF). The fertilized egg (embryo) is frozen and stored. When you are ready for children, the embryo is thawed and placed in your partner’s uterus to begin the pregnancy.
Before or after puberty
Testicular shielding: A protective shield is placed over the pelvic area during radiation therapy to reduce exposure. Shielding helps to prevent radiation from damaging the testicles. This may help you make healthy sperm in the future.
Keep in mind that there are many ways to become a father when you are ready. 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 your partner’s uterus where it grows.
Sperm from a donor
Adoption
Continue to use birth control
Some people think they cannot have children and may skip birth control. But pregnancy can happen, even with low sperm counts. If you are sexually active and not planning a family, use birth control. Use condoms to help prevent sexually transmitted infections (STIs).
Questions to ask your care team
Talk to your care team about the risk of fertility problems before starting treatment, even if your care team does not bring it up. These questions can help you to plan ahead and find support:
How likely is it that chemotherapy, radiation, or illness will affect my fertility in the short term or long term?
Are fertility changes likely to be temporary or permanent?
Are there other recommended treatments that will not cause fertility problems?
What fertility preservation options are available?
Should I see a fertility specialist or reproductive health doctor?
Are there resources to help with emotional support or financial concerns related to fertility?
Key points about fertility problems in males
Infertility happens when the reproductive system is damaged or does not work properly.
Chemotherapy, radiation, surgery, and other treatments can sometimes affect fertility in males.
Not everyone who has these treatments will have fertility problems. Certain treatments carry a higher risk.
Fertility testing may include blood tests and a semen analysis.
Talk to your care team about fertility preservation options before starting treatment. Some preservation options must be done before treatment begins.
Fertility preservation options depend on the patient’s age, puberty status, diagnosis, and timing of treatment.
A fertility specialist and social worker can help you understand options, risks, timing, and costs.
Fertility problems (infertility) can be a side effect of illness or treatments. Learn about male fertility preservation options and how to talk to your doctor.
Fertility problems (infertility) can be a side effect of illness or treatments. Learn about female fertility preservation options and how to talk to your doctor.
Some treatments for childhood cancer may affect the ability of survivors to have children. Read about treatments that may affect fertility and family planning options.
