Fertility, Sex & Testosterone
Why bank sperm?
If you are about to start treatment for testicular cancer, we encourage you to look into sperm banking before undergoing radiation or chemotherapy, as both these treatments have a high likelihood of destroying your fertility. The best way to maximize your chances of conceiving genetic children in the future is to bank sperm prior to treatment.
When sperm is frozen or "cryopreserved," the sperm cells enter a state of suspended animation and all sperm activity is essentially halted until thawing. After thawing, a percentage of the sperm revive and return to the prefreeze state. While the freezing process will kill a significant percentage of sperm, the surviving sperm can be thawed and used for insemination purposes as many as fifty years later. Cryopreservation has been used for many years and is a safe and effective way to preserve sperm. According to the American Association of Tissue Banks, cryopreservation does not appear to alter or damage the genetic material in sperm.
Sperm banking is a simple, accessible and affordable way for testicular cancer patients of all ages to preserve their reproductive abilities. Not all oncologists offer counseling and education about fertility issues prior to cancer treatment.
For the vast majority of men the orchiectomy will not adversely affect fertility. In many cases the testicle is removed so quickly that there is not a chance to think about fertility. This is ok for most men, but if you had a cryptorchid (undescended) testicle or if one of them it atrophic (due to disease or has always been much smaller) you might want to bank sperm before the orchiectomy.
After the RPLND surgery many men experience Retrograde Ejaculation. This is when nerves are damaged during surgery and your ejaculate will no longer propel forward out of the penis. It instead goes backward into the bladder. This does not make you infertile. There are methods of retrieving the sperm for in-vitro fertilization (IVF) in these cases.
Common questions regarding sex after testicular cancer treatment:
Will the orchiectomy affect my sex life?
After having one testicle removed, there is often no reason why your ability to father children, sexual performance or sexual appetite should be affected.
Why don't I feel like having sex?
This is perfectly normal, for a while. The treatment side effects such as tiredness and feeling sick are bound to take a toll on your libido. The emotions involved with a cancer diagnosis (fear, anxiety, anger, etc) will have an effect on your sex drive as well. After your treatment is through and you come to terms with being diagnosed with cancer, your libido will come back.
Will my ejaculate return after surgery?
The ability to have antegrade (forward) ejaculation depends on the presence of sympathetic nerves traveling in and around the retroperitoneal lymph nodes. If the nerves can be spared safely, then your ability to have antegrade ejaculation should be excellent. However, as with any nerve, transient injury due to traction or manipulation during surgery may delay or stop antegrade ejaculation completely. This is called Retrograde Ejaculation. When surgery is preformed after chemotherapy, the chance for damage to these nerves is much greater.
Will my erections be affected by the RPLND surgery?
No. The ability to have erections is governed by a separate set of nerves that arise from lower in your spinal cord and travel into your pelvis. These nerves will not be disturbed during RPLND surgery.
Many hospitals have a sex therapist they can refer you to if you aren't comfortable talking to your doctor or your partner about these issues.
Many TC survivors suffer from low testosterone. It is best to have your testosterone levels tested before your orchiectomy and again a few weeks after. If your testosterone levels drop, testosterone replacement therapy may be needed to give you a normal sex drive and so you can get an erection. Click the link below for a short questionnaire on low testosterone.
Testosterone replacement can be taken the following ways: by mouth, bi-weekly injection or by rubbing gel (ANDROGEL) on the skin. There is also a testosterone replacement patch that delivers a steady amount of testosterone all the time, keeping your moods stable and your sex drive normal.
To see the ADAM questionnaire about symptoms of low testosterone, click here.