Fertility Preservation for Men

At the Center for Reproductive Medicine, we know a cancer diagnosis can be life-changing. On top of concerns over your health and the treatment protocols available to you, you must suddenly navigate fertility considerations, as many cancer therapies can compromise your reproductive health

If you’re facing cancer treatment via chemotherapy or radiation, we urge you to proactively investigate our fertility preservation services for men. Our highly trained team of reproductive endocrinologists is committed to working with you before and after your cancer treatment. We provide expedited consultations for patients like you prior to and following cancer therapy, education and awareness about the effects of therapy, and support as you begin the process of fertility preservation.

How do cancer therapies affect a man’s fertility?

In general, the gonads of boys are relatively resistant to the effects of chemotherapy before the onset of puberty. Boys may go through a normal puberty and have normal reproductive function despite undergoing cancer treatment in childhood or early adolescence. However, in some cases, radiation therapy to the pelvis or abdomen in prepubescent boys may cause enough damage to the gonads so that puberty does not occur normally.

After puberty, age does not seem to affect the quality of the sperm produced until a man reaches 50 years. However, sperm production is very sensitive to chemotherapy and radiation. Radiation to the pelvis or directly to the testicles will stop sperm production. Radiation to the upper leg or upper abdomen may cause some damage to the testicles, but sperm production may recover in these cases. Radiation therapy related to bone marrow transplantation usually causes infertility, but this has been reversible in a few cases with recovery of sperm production up to seven years later. As with women, these risks also depend on the age of the male, the type and dose of the chemotherapeutic agent used, and the field and dose of radiation used.

Fertility preservation options prior to cancer therapy

There are several options for male patients to preserve their fertility prior to beginning cancer treatment.

Semen cryopreservation

The best way for men to preserve their reproductive potential before cancer treatment is to cryopreserve (freeze) and store their semen. In the past, this was not always a viable option, as many men with cancer have sperm counts that are lower than normal. However, with advances in in vitro fertilization and intracytoplasmic sperm injection (a procedure where an individual sperm is injected directly into the egg), even very small numbers of sperm can be used to establish a pregnancy.

If possible, several semen specimens should be cryopreserved at intervals of one to three days. Most men can delay cancer treatment for several days or a week for this purpose.

Testicular aspiration

If a patient cannot produce semen secondary to surgery or another medical condition, a testicular biopsy can be performed. Under anesthesia, a small section of testicular tissue is obtained and then cryopreserved. (Testicular sperm cannot naturally fertilize an egg, so intracytoplasmic sperm injection must be utilized in conjunction with in vitro fertilization to establish a pregnancy.)

In addition, sperm can also be obtained from the vas deferens or the epididymis as needed and then cryopreserved. These extractions are performed as outpatient surgical procedures.

Shielding the testicles from radiation

In the cases of some cancers, if radiation to the pelvis is part of the patient’s treatment plan, he can discuss with his oncologist the possibility of shielding the testicles from the radiation.

Fertility preservation options following cancer therapy

After the completion of cancer treatment, an assessment should be conducted to determine whether the patient is producing any viable sperm. It is encouraging if a semen analysis shows any sperm at all, since sperm production will generally improve over time after treatment has stopped. If the semen analysis shows no sperm at all, the procedure should be repeated in a lab that has experience looking for very small numbers of sperm. Occasionally sperm production will return to normal over time.

Assisted reproductive technologies

In some cases, centrifuging the semen can detect viable sperm. Even very small numbers of sperm can be used for in vitro fertilization combined with intracytoplasmic sperm injection. If a sperm count above five million is present, intrauterine insemination can also be performed.

Sperm extraction

Even if a man has no sperm in his ejaculate following cancer treatment, there are still fertility options available. Microdissection testicular sperm extraction is a surgical procedure to retrieve sperm directly from the testis for use with in vitro fertilization and intracytoplasmic sperm injection. This procedure is performed by select urologists who specialize in male infertility and is carefully coordinated with the female partner's egg retrieval.

Donor sperm

Men whose sperm production seems to be permanently damaged may want to consider artificial insemination of their female partner using donor sperm. There are several large sperm banks across the country, and each carefully screens donors with respect to their personal health and family histories. The semen is tested for sexually transmitted diseases and then quarantined for six months. The donor is then rechecked for HIV, hepatitis and other sexually transmitted conditions, and the semen is released only if all the results are negative. Using these large sperm banks, it is usually possible to match the physical characteristics (and often even the hobbies or interests) of the male partner.

Helpful resources

We urge our patients who are considering fertility preservation services to learn more about the resources available to them, including:

• American Society For Reproductive Medicine (ASRM)
• American Cancer Society
• Lance Armstrong Foundation
• Fertile Hope