Hormone levels and your capacity to father children following therapy are both impacted by testicular cancer and its treatment. Before beginning treatment, it’s crucial to go over any potential side effects with your doctor so you are informed of the risks and can consider your alternatives.
Most boys and men only have one testicle affected by cancer. Typically, the remaining testicle can produce enough testosterone, the primary male hormone, to maintain your health. You will require testosterone in some form for the rest of your life if the second testicle needs to be removed because the cancer has spread to both testicles or if a new cancer appears in the other testicle. Most frequently, this takes the form of a skin-applied gel or patch or a monthly injection (shot) administered at your doctor’s office. If you require testosterone supplements, discuss the appropriate form with your doctor.
Infertility may result from testicular cancer or its treatment (unable to father a child). Men who might desire to father children may think about preserving sperm in a sperm bank in advance of starting treatment. However, low sperm counts brought on by testicular cancer could make it challenging to get a good sample.
For guys who have had testicular cancer, infertility can also be a problem later in life. Sperm banking is frequently a wise choice for boys who have already completed puberty because the frozen samples are rarely harmed by prolonged storage. Researchers are also investigating methods that could one day enable younger boys to father children.
After the testicular cancer has been treated, fertility can sometimes recover if one testicle is still there. For instance, fertility usually comes back around two years after treatment ends.
Men have a variety of possibilities for fathering children, even with extremely low sperm counts in semen. Before starting therapy, be careful to bring up any fertility issues with your doctor.
In This Article...
How likely is it to become infertile after testicular cancer?
You could require this procedure to have the lymph nodes in the back of your abdomen removed (abdomen). Retroperitoneal lymph node dissection is the medical term for this procedure (RPLND). The operation is sizable.
The procedure may harm the nerves that regulate sperm release (ejaculation). Your future ability to have children as well as your sexual life may be impacted by this.
You might urinate in reverse after this procedure. Retrograde ejaculation is the term for this. Instead of exiting your penis, your semen and sperm return to your bladder.
Retrograde ejaculation prevents you from getting pregnant through regular sexual activity. However, after having intercourse, it might be able to extract sperm directly from your testicles or from your urine. The sperm can be used for in vitro fertilization or direct fertilization of your spouse (IVF).
Chemotherapy and fertility
Most men with testicular cancer who get chemotherapy experience temporary infertility.
After the treatment is over, fertility typically returns to normal after a few months. However, it doesn’t improve for some males. If you have received very large doses of chemotherapy, this is most certainly the case.
Radiotherapy and fertility
If your cancer has gone to the lymph nodes in the back of your stomach, you may need radiotherapy (abdomen).
The middle of the stomach or belly, and occasionally the groin, are the areas the radiographer targets with radiation beams. The chance of radiation exposure to the surviving testicle is minuscule.
Sperm are produced in the testicles. The testicle is shielded from the radiotherapy rays by your radiographer, although there is a slight possibility of harm.
Any effects from the radiotherapy should typically only remain for a few months after treatment is finished because sperm are constantly being produced in a healthy testicle.
Your medical professionals will advise you against trying to become a father while receiving radiation treatment and for up to a year after.
Can someone with testicular cancer still generate sperm?
Typically, testicular cancer only affects one testicle, leaving the other testicle free to continue producing testosterone and sperm. Rarely will you require the removal of both testicles and lose the ability to generate sperm.
You should still be able to become pregnant naturally even if one of your testicles needs to be surgically removed. To get an erection and ejaculate, one testicle can supply enough testosterone. Additionally, it ought to deliver enough sperm for a healthy pregnancy.
The doctors might need to perform a procedure called retroperitoneal lymph node dissection if your cancer has spread (RPLND). Through this procedure, cancerous lymph nodes from the abdomen’s rear are removed. There is a higher chance of developing a disorder known as retrograde ejaculation since this technique has the potential to harm the nerves that control ejaculation. When you have orgasm, semen enters the bladder instead of exiting through the penis; this can make it difficult for you to conceive naturally.
Before having surgery for testicular cancer, you might want to consider storing your sperm in a sperm bank if the procedure requires the removal of one or both testicles.
Chemotherapy is the process of eradicating cancer cells using certain drugs. It typically functions by reducing the rate of growth of cancer cells until it eventually stops.
In order to stop the growth of tumors and eradicate cancer cells, radiation treatment uses very energetic particles or waves (often x-rays).
Due to the temporary decrease in sperm production and sperm health damage caused by both therapies, chemotherapy and radiation therapy may have similar effects on your fertility. The amount and quality of your sperm can take more than two years to recover to normal, and infertility can sometimes be irreversible.
Testicular cancer may lower your testosterone levels, and radiation and chemotherapy treatments may further limit the synthesis of testosterone in the testicles. Should this problem arise, your doctor will be able to prescribe testosterone gels, patches, or supplements.
The illness and its treatment won’t always have an impact on your sexual performance, but the fear that comes with the disease may have an impact on your sex drive, body image, and mental health. This is typical and entirely acceptable. It’s crucial to discuss the potential side effects of treatment with your doctor if you’re considering different testicular cancer therapies and you plan to establish or expand your family. This way, you’ll know what to anticipate following treatment.
It’s also crucial to understand that testicular cancer only increases your chances of experiencing infertility, particularly in more severe types of the disease. Treatment may prevent you from becoming a parent for a few years.
Depending on your situation, having a child may be the last thing from your mind when you receive a diagnosis, but you should think about freezing your sperm so that you can still have children after therapy.
It can be very frightening to receive a testicular cancer diagnosis and to discuss a treatment plan with your doctor. The best action you can take at this time is to take care of yourself in the here and now while simultaneously considering your alternatives for the future.
There are additional medical professionals, including as psychologists, fertility experts, and genetic counselors, who can provide advice and support if you’re currently feeling lost or bewildered. Additional resources for ongoing assistance include your spouse, friends, and family. Learn more about the potential impact of cancer on fertility here.
Does the removal of a testis influence fertility?
The majority of guys who have had one testicle removed go on to naturally bear children. Infertility results from men losing the ability to create sperm after having both testicles removed (rarely necessary). Infertility also affects men who have retrograde ejaculation following RPLND.
How long must I wait after treatment to try to father a child?
Your diagnosis and the treatment you received will determine how long you must wait. We often advise waiting at least a year after treatment is complete before trying for a child if you have undergone chemotherapy or radiation. This gives your body time to eliminate any sperm that may have been harmed by medication. Some individuals, however, might not have to wait this long, while others would have to wait longer. To learn how long they advise you to hold off, speak with your healthcare practitioner.
How will I know if I’m fertile after treatment?
To determine whether you are producing sperm and to examine your sperm count and motility, you might have a semen study performed at a sperm bank (ability for your sperm to swim). To give your testes time to heal, you should wait at least a year after finishing treatment before having a semen analysis. Keep in mind that it may take some men years to begin generating sperm again if they are unable to discover any in the test. Six to twelve months later, you can redo the semen analysis. Ask your doctor to recommend a reproductive urologist if you want a more thorough evaluation.
Will a child conceived after my cancer treatment be healthy?
There is no proof that having a child after undergoing cancer treatment puts them at a higher risk for birth abnormalities or other health issues. To prevent getting pregnant with sperm that might have been harmed by chemotherapy or radiation exposure, it’s crucial to take birth control while you’re receiving treatment. The child’s health could be impacted by this injury. In order to be sure all damaged sperm have been eliminated from your body after chemotherapy and radiation treatment, we also advise using birth control for a year.
Some malignancies are inherited from parents and passed on to their offspring. If you have a hereditary cancer, ask your doctor or nurse. If so, you can consult a genetics counselor to find out how this might impact a child’s health.
You might want to think about preimplantation genetic testing if you have a particular genetic mutation that can be passed on to a kid (PGT). PGT is a technique for examining in vitro fertilized embryos for the mutation you possess. When you’re ready to try getting pregnant, you can decide to only select those embryos that don’t contain the genetic abnormality.
What if I have a low sperm count?
After undergoing cancer treatment, some men resume producing sperm, but because of their low sperm count, they may not be able to conceive naturally. In vitro fertilization, however, might still be able to help you conceive a biological kid (IVF). IVF involves a number of steps, including:
- A group of eggs in your female partner’s ovaries are stimulated to mature by taking hormone injections (shots) for roughly ten days.
- Egg retrieval: A very fine needle is inserted through the vaginal wall of your spouse to remove the mature eggs from her ovaries while she is under anesthesia (medicine to make her unconscious). This process requires ten to twenty minutes.
- Fertilization: In a lab, your sperm is used to fertilize the eggs. They will inject one sperm into each egg if your sperm count is low (intracytoplasmic sperm injection, or ICSI). To ensure that the fertilized eggs begin to divide and develop into healthy embryos, they are kept in the lab for 3 to 5 days.
- Embryo transfer: To try to become pregnant, one or two embryos are put into your partner’s uterus. For potential future use, the others are frozen and kept in storage.
What if I am no longer fertile, but banked sperm before treatment?
You and your spouse will need to consult a reproductive endocrinologist in order to use the sperm you frozen prior to treatment (doctor who specializes in infertility). The quality of the specimens you were able to freeze before to treatment will determine how your female partner’s eggs will be fertilized.
- A thin, soft catheter is used to pull up one or two vials of your thawed sperm for intra-uterine insemination (IUI, also known as artificial insemination). The sperm are discharged once this is inserted into the uterus of your female spouse. When she ovulates is when this is done (releases a mature egg).
- The majority of patients have sperm banked will not have enough sperm to employ this treatment because it often takes women 3 to 6 IUI attempts before they are successful. However, if your partner is young and free of reproductive issues and you have numerous vials of sperm with high sperm counts and decent motility, it can be a suitable alternative for you.
- The majority of persons who use their own sperm undergo in vitro fertilization (IVF). There are numerous procedures to follow:
- A group of eggs in your female partner’s ovaries are stimulated to mature by hormone injections over the course of roughly 10 days.
- Fertilization: In a lab, your sperm is used to fertilize the eggs. They will inject a sperm into each egg if your sperm count is low. To ensure that the fertilized eggs begin to divide and develop into healthy embryos, they are kept in the lab for 3 to 5 days.
- Embryo transfer: To try to become pregnant, one or two embryos are put into your partner’s uterus. The remainder is frozen and kept for later use.
What if I am no longer fertile and didn’t sperm bank before treatment?
Some patients produce small numbers of sperm following cancer therapy, even when no sperm were discovered in a sample of semen. You would need to visit a reproductive urologist and undergo testicular sperm extraction in order to attempt to obtain sperm (TESE). This is an outpatient surgery carried out while you’re unconscious and under anesthetic. Your scrotum receives a minor incision (surgical cut). Your doctor takes tissue samples from your testicles. To look for sperm, these are inspected. If sperm are discovered, they can be utilized to try fertilizing the eggs of your female spouse. Read the page Sperm Collection by Testicular Sperm Extraction for additional details on this process (TESE).
Ask your doctor or nurse to recommend a reproductive urologist if you want to learn more about this surgery. If you don’t want to think about this, read on to find out about other family-building possibilities.
What if I have retrograde (dry) ejaculation?
Some cancer therapies harm or remove the muscles and nerves that regulate ejaculation. Instead of exiting through the penis during retrograde ejaculation, the semen enters the bladder. There are ways to obtain sperm to try becoming pregnant if you have retrograde ejaculation but are still making it, including:
- taking medicine to make the muscles around the bladder opening tighter. As a result, the semen might exit the body through the penis rather than the bladder.
- obtaining a urine sample following ejaculatory stimulation. The sperm can be extracted from urine in a sperm bank where this procedure is carried out.
Ask your physician to recommend a reproductive urologist if you are considering either of these alternatives.
What if I have erectile dysfunction?
Some cancer therapies damage or remove the blood vessels and neurons that regulate erection. The sperm cannot fertilize your female partner’s eggs if you are still making sperm but your penis cannot harden sufficiently to fit into her vagina. Erection problems can be treated with a variety of methods, such as drugs and injections. Ask your doctor to recommend a urologist who specializes in erectile dysfunction if you’re interested in trying these.
What are my other options to build a family?
Before receiving therapy, some men are unable to bank their sperm or are unsuccessful in conceiving using their frozen sperm. Adoption and the use of donor sperm are other options for starting a family.
Donor sperm
Using donor sperm entails fertilizing your female spouse with sperm that belongs to another man. A sperm bank receives the sperm of young, healthy men for donation. The majority of donors prefer anonymity, although some are open to having the child get in touch with them when they’re adults. Based on a variety of qualities and attributes listed on the sperm bank website, you can choose a donor.
Another option is to ask a friend or relative to give sperm on your behalf. Even if you have the greatest of intentions, this might not be the ideal solution for you if expectations aren’t made clear. Sometimes a friend or relative would offer their assistance without fully comprehending what is entailed. Your donor should undergo psychological and medical testing, regardless of how well you know them. Additionally, both of you should consult with attorneys that focus on reproductive law.
- You and your female companion should visit a reproductive endocrinologist as a first step. If you need sperm, they can suggest sperm banks. The frozen sperm will be delivered to your reproductive endocrinologist after you select a donor.
- The most popular way to use donor sperm to conceive is through intra-uterine insemination, often known as IUI or artificial insemination. It is scheduled for right around your female partner’s ovulation period. A slender, delicate catheter is used to pull up one or two vials of thawed sperm (flexible tube). The sperm are discharged once this is inserted into your partner’s uterus. Most women need between three and six IUI attempts before becoming pregnant.
Adoption
Another option for starting a family after cancer treatment is adoption. Both domestic and foreign adoptions are possible (if the child is born in the United States) (the child is born and lives outside of the United States). In the US, adopting a newborn kid can cost over $40,000 and take anywhere between one and four years. Adoptions abroad are heavily regulated, and national laws frequently change. Some nations forbid those who have undergone cancer treatment from adopting.
When considering adoption, there are several factors to take into account. Before you start the procedure, it’s critical to be aware of your comfort level. Consider the following when making your choice:
- Are you more comfortable adopting an older child or a newborn child?
- Do you prefer to adopt children that have your racial and ethnic background, or are you okay with doing so as well?
- Would you be open to adopting a child with unique medical requirements?
Nowadays, the majority of adoptions are open or semi-open, enabling some communication between the adoptive parents, the birth parents, and the adopted child. The type and quantity of interaction are agreed upon by all parties.
Arranging an adoption
Adoption organizations or attorneys can organize adoptions. Both public and private agencies exist. Matching the birth parents and adoptive parents frequently involves a caseworker from the agency. The birth parents’ preferences for adoptive parents and the traits of the kid the adoptive parents hope to adopt are used to determine whether the two sets of parents are a good match.
- The state Department of Social Services includes public organizations. They typically assist with kids who have been removed from their biological parents because of allegations of abuse or Private adoption agency may handle both domestic and international adoptions. Each adoption agency has specific requirements for prospective adoptive parents. The average age of children adopted through private agencies is lower than that of children adopted through public ones. If you wish to adopt a newborn kid, a private domestic adoption might be your best bet.
- Private adoptions can be organized by adoption attorneys. Working with an attorney that specializes in adoption and is licensed in the state where you want to adopt is essential because adoption regulations differ from state to state.
Visit the National Foster Care and Adoption Directory online at www.childwelfare.gov/nfcad to locate an adoption agency. Choose your state and the kind of agency you’re interested in (such as public, private domestic, or private intercountry).
Search the Intercountry Adoption website at travel.state.gov/content/travel/en/Intercountry-Adoption.html to identify organizations that specialize in international adoption.
Home study
A social worker will do a home study before you may adopt to determine your capacity to care for a kid. The ideal time to schedule the home study will be advised by your agency or attorney. You will be asked questions by the social worker that may seem quite intimate. This is to ensure that you are aware of the requirements and prepared to move forward with an adoption. As this is necessary to adopt in this nation, the social worker will need to verify that you are a citizen or legal permanent resident of the United States. The social worker will perform a medical evaluation as well. Your ability to adopt a child is unaffected by your history of cancer, but you might require a note from your doctor outlining your diagnosis and treatment. Additionally, you will require a note from your physician confirming that you are in good health, capable of being a parent, and anticipated to live long enough to raise a child (up until they turn 16 years old). The social worker will stay in touch with you after the kid is placed in your custody to assist with any problems that may develop.