Fertility issues for men and people assigned male at birth

Radiotherapy to the pelvic area can damage sperm or reduce their number. Sometimes these effects are short term and sperm production can recover. In other cases, the effects may be permanent. If you have a low sperm count before treatment, it may be harder to have a child after treatment. Your doctor may advise you to get your sperm count checked before treatment.

For some, radiotherapy to the brain can have an impact on the hypothalamus and pituitary gland. These glands produce important hormones involved in sperm production. When cancer treatments impact this, sperm production may decrease, leading to infertility.

Hormone therapy, chemotherapy and other cancer drugs may damage sperm or reduce sperm counts. Ask your consultant if your drug treatment is likely to affect your fertility.

Some types of surgery can affect your fertility. For example, after surgery to remove your prostate gland or nearby lymph glands (RPLND) or surgery to remove your bladder, you may have a ‘dry’ orgasm. This means no semen comes out when you climax. If you have a dry ejaculation you are less likely to be able to father a child naturally.

Some surgeries can also affect your ability to get an erection or to orgasm.

Orchidectomy (removal of a testicle) should not affect your fertility if you have a normal testicle on the other side. If your other testicle is small or your sperm count is low, this may impact your fertility. It is important to discuss fertility with your consultant.

Talk to your specialist nurse or consultant about how treatment might affect your fertility.

Not thinking about having children?

If you’re young, single, in a same-sex relationship or you feel you don’t want children, talking about fertility might not feel like a priority. But it’s best to discuss your options and ask your doctor about sperm banking, in case you want to have children in the future.

Avoiding pregnancy

Your cancer treatment can damage the sperm that you are currently producing and cause birth defects. It is important to use a barrier method of contraception, like condoms, throughout your treatment and for some time afterwards. Get advice from your doctor about how long you need to use condoms for.

After treatment

In general, doctors recommend that you have a sperm test at least 6 months after treatment to check your fertility. But your cancer doctor will give you advice based on your individual circumstances.

Support
You may need counselling if infertility is a problem for you, especially if you have never had a child. The reality may only sink in when treatment is over.

When you are ready, you may find it helpful to talk openly to your partner, your family or a friend about these feelings. If they understand how you feel, it is often easier for them to offer help and support. It is important too to talk to your doctor or nurse. They may arrange for you to speak to a trained counsellor or a specialist, if you are finding it hard to deal with any strong emotions that you may have.

Storing sperm (sperm banking)

Storing sperm, also known as sperm banking, is the preservation of sperm by freezing. SIMS IVF provides a service where these samples can be frozen and stored. Other private fertility clinics also exist.

The frozen sperm can be used at a later date for artificial insemination or other assisted reproduction techniques, such as in vitro fertilisation (IVF).

This is when an egg is surgically removed from a woman’s ovaries and fertilised with sperm in a laboratory. The fertilised egg, which is called an embryo, is then returned to the woman’s uterus to grow and develop.

Who’s suitable?
You will first need to be referred to SIMS IVF by your cancer specialist (oncologist). Also, you must be 18 or over and be able to give informed consent. Whether you are suitable or not for sperm storing may depend on the type of cancer you have or your medical history. You will need a blood test to check for viruses like hepatitis B, hepatitis C, HIV and cytomegalovirus (CMV).

What’s involved?
You will be asked for a number of sperm samples, usually at the clinic. You can freeze between 1 and 3 samples, depending on the time available and the quality of the sample. Not all sperm are suitable for freezing. If they are suitable, the sperm will be frozen and stored for up to 10 years. This period may be extended in some cases.

You may worry that organising the sperm banking may cause a delay in starting chemotherapy. This is seldom the case as it can be done while you are having tests and waiting for results. However, your own health will take priority over sperm banking. If you need chemotherapy or radiotherapy urgently, your cancer specialist will explain this to you.

What is the cost of sperm banking?
The service at SIMS IVF is currently free for all cancer patients living in Ireland. It is funded by the clinic and the HSE, but check that this is still the case before your appointment. You can also use other fertility clinics, but there will be fees involved.

Trying to conceive?
When the time comes that you feel ready to have a child, talk to your cancer specialist. They can tell you if your body has recovered from the effects of treatment.

You will need to have your fertility checked. If treatment has affected your fertility, your frozen sperm can be used.

More than likely, you and your partner will be advised to have assisted reproduction techniques. These can involve IVF and ICSI, which means your sperm will fertilise your partner’s eggs in the laboratory. But if you have many sperm samples, artificial insemination may be done instead.

Where can I be treated?
You can decide to have this treatment at SIMS IVF. If you decide to be treated elsewhere, it is possible for the frozen sperm to be transferred to a clinic of your choice. However, your clinic must agree to it beforehand and the transfer is done at your own risk.

What happens if sperm banking isn’t possible?
If you can’t store sperm, it can sometimes be extracted from the testicles using testicular sperm extraction (TESE). This is a surgical technique which involves removing small pieces of testicular tissue under a general anaesthetic and checking for the presence of sperm. If sperm is present and is retrieved, it can be used to fertilise an egg outside of the uterus (IVF).

Where can I get more information?
If you would like to find out more about sperm banking, talk to your doctor or nurse. You can also call our Support Line on 1800 200 700 or visit a Daffodil Centre for advice in confidence from our cancer nurses.