Infertility, especially in men who wish to conceive after treatment, is a great concern to newly diagnosed patients. Unfortunately, this often gets mentioned in a passive way by doctors, and many men are not fully educated on the potential risks. Different treatment types may affect fertility differently. It is important to understand the risks to fertility before starting treatment, and assess your options if you wish to father children in the future.
It is important to note that not every patient will become infertile after treatment. This varies largely from person to person, and from different treatment types. Today, we want to break it down a little bit, discuss how the different treatments may affect fertility, and how to discuss these concerns with your oncologist.
The orchiectomy (removal of the testicle) usually does not have an effect on fertility. The remaining testicle will produce more sperm to make up for the one that is missing. Sexual activity too soon after the surgery can have some unpleasant affects with pain and discomfort, but from the standpoint of fathering children, it's usually not an issue. If you have both testicles removed then fertility is most definitely lost.
The affects that chemotherapy have on fertility can vary from person to person, and can be affected by which drugs are used, and how high of a dose you receive. In many patients, infertility after only receiving chemotherapy is temporary, and may return after some time. In others receiving high dose chemotherapy, or chemo in conjuction with other types of treatment, infertility may be permanent. The normal time frame for a return to normal fertility is between 12-18 months after treatment has ended. In some cases, it has been found that men with testicular cancer had low sperm counts before treatment, and that successful treatment with chemotherapy improves sperm count in the long term.
Usually, radiotherapy does not have a significant impact on fertility. Though, studies have shown that radiation scatter from the lymph nodes to the testicles may decrease sperm count temporarily. The effects are largely based on where you receive the radiation, and how much is able to scatter to the remaining testicle. There is better shielding available today to help prevent scatter, but it isn't always 100% effective. In most cases of lowered sperm count after radiation, the counts return to normal, on average, after 1-2 years.
Retroperitoneal Lymph Node Dissection
While the RPLND surgery does not affect the sperm count or directly involve the testicles, it still presents a risk to fertility. The risks to fertility with this surgery lie in possible damage to nerves that control ejaculation, causing what is known as retrograde ejaculation. This means that during orgasm, the semen backs up into the bladder and is passed through urine. While better surgical procedures are coming out, there is always a risk for this and should be discussed prior to surgery.
What to Discuss with Your Oncologist
No matter what kind of treatment options you are facing after your orchiectomy, it's important to discuss the risks to your fertility. Unfortunately, there is no way to know before treatment how severe the effects may be. There are many things to be considered when starting treatment, and fertility is often pushed to the side. You may want to see a specialist to track sperm count before and after treatment. If it's financially possible, you may also consider sperm banking in the event that infertility becomes an issue.
Sperm banking is something you may want to discuss with your oncologist to get feedback from a medical standpoint. It's important to talk to your partner about it as well. In a few cases, sperm may not be viable for preservation. It is also a significant financial obligation. It should be discussed thoroughly before a decision is made. For many men, especially those receiving high dose chemotherapy, undergoing RPLND, or a combination of different treatments, it is the best way to ensure the ability to father children after treatment.
**As always, it is recommended you discuss these possible issues with your oncologist. Each person is different, and every case may have varying side-effects. Talk to your doctor for more information on what may be best for your case and for your future.**