About cancer & fertility
How common is cancer in adolescents and young adults?
About 980 Australian males aged 15 to 29 are diagnosed with cancer each year. The most common cancers in adolescent and young adult males are melanoma (skin cancer), Hodgkin’s disease and cancer of the testis.
How does cancer affect fertility in young males?
For some adolescent and young adult survivors of cancer the chance of having children in later life can be affected by cancer or cancer treatment. At the time of diagnosis parenthood is often not a priority concern, but steps can be taken to protect fertility for the future.
Some cancers can directly affect the production of healthy sperm. Males with testicular cancer often have lower fertility before treatment starts. Hodgkin’s lymphoma can also be linked to a low sperm count or poor sperm quality. Treatment can reduce fertility further.
However, many men will still be able to father children naturally even if they have a lowered sperm count.
How do cancer treatments affect fertility?
Cancer treatments include surgery, radiation and chemotherapy.
Cancer treatments can cause temporary (up to five years following treatment) or long-term (permanent) fertility problems.
The level of fertility after treatment depends on the number of rounds of treatment, the dose, the area being treated, and whether several types of treatment are used together.
For young males who are sexually active, it is important that conception does not happen during cancer treatment. Contraception can be discussed with the doctor and used if needed.
How does chemotherapy affect fertility?
Chemotherapy or ‘chemo’ is a very common form of cancer treatment. Chemotherapy medicines act to stop or slow the growth of cancer cells.
Chemotherapy also attacks normal cells, such as the cells in the lining of the sperm-producing tubes in the testis. Chemotherapy can temporarily or permanently destroy developing sperm cells.
How does radiotherapy affect fertility?
Radiation treatment or ‘radiotherapy’ uses high energy X-rays to kill cancer cells in a specific area while limiting damage to normal cells.
Radiotherapy for testicular or other cancers near the testes can damage the testis leaving permanent problems with sperm production.
Radiotherapy to the whole body (used before a bone marrow transplant) and radiation to the brain can also lower male fertility by affecting the glands that produce hormones that act on the reproductive system.
As radiation to the testes can cause genetic damage in the early development stages of sperm (germ cells), it is best to avoid attempting a pregnancy for six to 12 months (depending on type of treatment) after radiotherapy.
How does surgery affect fertility?
Fertility can be affected when a young male has a testis surgically removed (orchidectomy) to treat testicular cancer.
Cancer in a single testis may not affect fertility if the remaining testis continues to make testosterone (male sex hormone) and to produce sperm.
Surgery within the pelvic region (such as for bladder or colon cancer) can sometimes damage nerves in the region leading to erection and/or ejaculation problems.
What is fertility preservation for young males with cancer?
If you are diagnosed with cancer as an adolescent or young adult, it is important to consider fertility as you may wish to have children in the future.
Your fertility can be preserved before treatment for cancer begins, so it is important to know about the risks and options soon after cancer is diagnosed.
Many health professionals are able to help and support you when making decisions about preserving fertility.
As a young male, your main option for preserving fertility is semen or sperm storage (sperm banking) before cancer treatment starts.
Why is sperm storage important?
All adolescent and young males who are going to have chemotherapy or radiotherapy should speak to their doctors about their fertility before treatment begins.
It is highly recommended that young males produce semen samples (through masturbation) for sperm storage. Semen quality may be poor so some males may need to provide several samples.
Modern IVF (in vitro fertilisation) treatments can be successful with just a few moving sperm.
When should sperm be stored?
It is recommended that sperm are collected before treatment begins but if that is not possible, in some cases sperm can be collected within certain periods during treatment. You should talk about this with your doctor.
Where can sperm be stored?
Sperm are frozen and kept in liquid nitrogen (-196˚C) for long-term storage. Specialist centres providing IVF and other assisted reproductive technologies often have sperm storage facilities.
What other options may be available to store sperm?
Some males are not able to produce a semen sample by masturbation, for reasons like feeling unwell or anxious. Tissue samples containing sperm can sometimes be taken from a small piece of testicular tissue (biopsy). If sperm are found, the sample is frozen and stored for later use.
A testicular biopsy is safe. There is a very small risk of infection or bleeding and it generally clears up in a few days.
Are there problems with children born to males after cancer?
There are no known risks to children born using frozen sperm collected from males before cancer treatment.
If your sperm are collected during treatment, it is important to speak to a genetic counsellor about any possible risks to children conceived from those sperm.
How are the frozen sperm used later for fertility?
Freezing and thawing sperm can damage how well sperm can move. If you want children at a later stage, frozen-thawed sperm can be used in assisted reproductive technologies such as artificial insemination of your partner or IVF.
When is the best time to talk to your doctor?
The best time to talk about fertility is as soon as possible after your cancer diagnosis. This will allow time to get all the information you need to make a decision about fertility preservation.
Who can you talk to about cancer and fertility?
At the time of a cancer diagnosis you may have many feelings and thoughts about what cancer means now and in the future.
Health professionals involved in cancer treatment can talk to you about possible risks to your fertility. You may be referred to a fertility specialist and social workers, psychologists or genetic counsellors may be available.
Parents, partners or family members can be helpful at this time.
What factors might influence your decision?
The decision to store sperm is a very personal one. The cultural or religious beliefs of a young male and his family, or his sexual orientation, may be important factors in his decision.
Guidance from family and health professionals may be important for you when making a decision about cancer treatments and fertility.
Sperm storage for adolescents with cancer needs careful management. It can be extremely difficult for males to come to terms with the diagnosis of cancer at a young age and fatherhood is not usually the main concern.
Producing a semen sample by masturbation can be stressful for young males. Family support and encouragement without pressure can be extremely valuable.
Management & support
How is fertility followed up after cancer treatments have finished?
Follow-up after cancer treatment depends on the type of cancer and the treatment.
If cancer and/or treatment have put your fertility at risk, regular semen testing will check if fertility has been reduced and if it improves over time.
A referral to a fertility specialist may be needed when thinking about having children. The fertility specialist will talk to you about the options if fertility has not returned to normal, including the use of stored sperm.
Where can more information and support be found?