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Male Fertility

male-infertilityMale Infertility

Some male cancer survivors find that they are not able to have children due to the effects of cancer treatment. By identifying your risk for infertility, you can take steps before treatment to preserve your fertility. For survivors who have already completed treatment, there are other options for having children.

Male Infertility: Detailed Information
This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources sections for questions to ask and for more resources.

Cancer and treatment may put survivors at risk for infertility. Male infertility generally means an inability to produce healthy sperm or to ejaculate sperm. There are many different causes of infertility in cancer survivors including physical and emotional. Certain treatments can cause or contribute to this condition.

It is best to discuss the risks of infertility with your doctor before cancer treatment begins. However, there are options for survivors who experience infertility as a result of cancer or treatment. Set up an appointment with a member of your health care team to discuss any concerns or questions you may have. Keep in mind that you can ask for a referral to a fertility clinic or specialist for help with this important issue.

Learning that you are no longer fertility or that infertility could occur can affect you emotionally. If you want to have children, it is understandable that this could be upsetting. This document outlines the physical causes of infertility and options for survivors who experience difficulty having children. It does not discuss the emotional effects. Talk with your doctor if you think that infertility may be having an impact on your emotional well-being.

What causes infertility in men?
Fertility in men can be affected by a number of factors including:
Genetic: Male infertility can be inherited, especially when Y-chromosomes are missing a tiny piece of genetic code. Men who have genetic causes of infertility may pass the problem to their sons if they are able to father a child through infertility treatments.
Hormonal: Men whose hormones are out of balance can become infertile. This can sometimes be related to cancer or treatment.
Physical: There may be physical reasons such as problems with the tubes that form the pathway for sperm to travel to the areas near the prostate. These tubes can be blocked by scar tissue after injury or infection. Lower sperm counts can also be caused by varicoceles or clusters of enlarged veins in the testicles.
Disease-related: Some diseases or illnesses can cause lower sperm counts such as cancer, diabetes, mumps orchitis or tuberculosis.
Environmental: Exposure to environmental factors can affect fertility such as high heat, radiation or pesticides.
Lifestyle factors: Obesity, tobacco use, heavy drinking or using anabolic steroids for body-building can affect fertility.
Age: Semen quality may decrease with age.
Cancer and treatment for cancer: Some types of cancer treatment may interfere with a man’s fertility, either temporarily or permanently

Which cancers are most likely to cause male infertility?
Some cancers are more likely to cause male infertility such as:
Testicular cancer: Fertility may be poor during the two years before testicular cancer is discovered. Although only 1 to 3 percent of men with testicular cancer get cancer in both testicles, the cancer-free testicle may not be totally normal.
Newly-diagnosed Hodgkin’s disease, lymphoma or leukemia: Recent surgery, fever or physical stress experienced by survivors may affect the quality of semen.

Which cancer treatments are most likely to cause male infertility?
Cancer treatment, not cancer itself, is often the factor that damages a man’s fertility. For example, radiation and chemotherapy treatments kill cells that are in the middle of dividing and growing at a time when they may be more easily damaged. Cancer cells divide much more often than most normal body tissues, so they are killed off while normal cells survive. However, hair and sperm cells are more sensitive to chemotherapy and radiation because they grow constantly.

Some of the concerns for specific types of treatment follow:

Radiation Therapy
Radiation therapy can slow down or stop sperm cell production if the testicle is in or near the target area for the radiation. A lead shield can help protect the testicles during radiation aimed at a nearby organ such as the prostate.
Total body irradiation used before some bone marrow transplants often causes permanent infertility.
If the testicles get a mild dose of radiation, a man’s fertility may drop but can then recover over the next one to four years.
If the radiation dose to the testicles is high, sperm production may stop forever. This happens because the spermatogonia are destroyed. These are the stem cells in the testicles that divide and grow to produce mature sperm.
Radiation damage to the part of the brain that controls hormone production can sometimes prevent the hormone messages from getting to the testicles.

In high doses, cisplatinum chemotherapy (Platinol) or bleomycin (Blenoxane, Bleomycin), that is often used to treat testicular cancer, can also damage fertility.
The alkylating chemotherapy group does the most damage to fertility. These drugs include cyclophosphamide (Cytoxan), chlorambucil (Leukeran), busulfan (Myleran), procarbazine (Natulan, Matulane), nitrosoureas (Carmustine, Lomustine), nitrogen mustard (Mustargen), and L-phenylalanine mustard (Alkeran).
A man is at higher risk for infertility if he gets two or more alkylating medicines, has higher doses of chemotherapy, or has a combination of chemotherapy and pelvic radiation.

Radical surgery to treat prostate or bladder cancer removes the prostate and seminal vesicles. These glands make the liquid part of a man’s semen. They also cut the pathway for sperm cells to be included in the semen.
Men with testicular cancer or colon cancer sometimes have surgery that can damage nerves involved in orgasm. The result may be a “dry orgasm” or the sensation of pleasure, but without ejaculating any semen.

What are symptoms of male infertility?
Men usually do not have any symptoms of infertility unless they have dry orgasms. They generally do not realize that they are infertile until they have a semen analysis and discover that the semen quality is low. If you are curious about your own fertility, talk to your doctor about being tested.

How can a man’s fertility be tested?
A semen analysis tests a man’s fertility. A sample is collected very soon after ejaculation and examined under a microscope. The analysis usually includes at least three scores that define semen quality:
The sperm count is the number of sperm present. A normal count is at least 20 million sperm per milliliter of semen.
The motility is the percentage of sperm that are actively swimming around. At least 50 percent of the sperm should be motile.
The morphology is the shape of the sperm. It is considered normal if at least 30 percent of the sperm have an ideal shape. Some labs use a different (Kruger) scoring system which is stricter—only 14 percent of sperm cells need to have an ideal shape with this system.

When does cancer-related infertility start and how long does it last?
Infertility is most likely to happen before cancer treatment and just after treatment is finished. It is possible that an analysis may say you are infertile, yet the results may change over the next month or even years.

If a man is going to recover sperm production, his semen analysis will usually improve within one to three years after he finishes cancer treatment. However, some men have had improvements many years later. It is important that men be aware that an abnormal sperm analysis should not be counted on as an effective means of birth control.

What are some options for a man whose fertility was or will be affected by cancer or treatment?
Options for men who have concerns about the effect of cancer or treatment on fertility include:
Sperm banking
Testicular tissue freezing
Donor sperm

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