Understanding the challenge of reproductive damage from cancer treatment.

Fertility can be compromised by both cancer pathophysiology and treatment options. While infertility may be reversible for some treatment regimens, persistent infertility may occur in 50–95% of malignancies; therefore, a discussion surrounding potential fertility preservation options is paramount.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963336/

Certain types of cancer, as well as cancer treatments, can affect fertility temporarily or permanently. Cancer treatments such as chemotherapy, radiation, and surgery may cause fertility problems affecting your ability to father a biological child by either causing an inability to produce sperm, by causing damage to nerves and blood vessels needed for erection and ejaculation, or by causing a loss of ability to produce hormones that stimulate sperm production. Cancers such as testicular cancer, leukemia, lymphoma, aggressive bladder cancer, and prostate cancer can affect fertility. Patients with primary brain tumors are at risk for infertility because of the potential damaging effects on the hypothalamus and pituitary gland, brain surgery, and radiotherapy.

The good news is, fertility problems from cancer treatment may be temporary and not always permanent.

A good percentage of men regain the ability to produce sperm after cancer treatment. This generally takes 1 to 3 years, but can sometimes take longer. However, some men have only partial recovery, with low sperm counts, and some men never recover sperm production. There are ways to be prepared and protect your fertility that are discussed in this blog.

There are many factors that can influence sperm count or the ability to ejaculate.

Whether or not your fertility is affected depends on factors such as:

• Your baseline fertility before treatment
• Your age at the time of treatment
• Type of cancer and treatment(s)
• Type of surgery you’ve had
• Amount (chemotherapy or radiation) of treatment
• Length (duration) of treatment
• The amount of time that has passed since treatment
• Other health conditions

The sperm count immediately declines after chemotherapy or radiation. In the case of radiation, it can take up to two years for patients to recover and go back to their normal sperm count. If the patient received a higher dose of radiation, it might take even longer to recover to the baseline sperm count. The recovery from chemotherapy also depends on the doses and duration of treatment and the chemotherapy agent that is used.

There is a potentially higher risk of genetic damage in sperm collected after the initiation of chemotherapy, although the good news is that no research studies indicate a higher incidence of birth defects for babies whose fathers underwent cancer treatment in the past.

It is strongly recommended that sperm be collected before the initiation of treatment because the quality of the sample and sperm DNA integrity may be compromised after a single treatment. Although sperm counts and quality may be decreased even before the initiation of therapy, and even if there is an urgent need to initiate chemotherapy and there is limited time to obtain adequate ejaculate specimens, these concerns should not prevent patients from banking sperm.

Among the several options available to help preserve fertility are:

• Sperm banking, which is the most common and easy option for young men of reproductive age who would like to have children one day. Samples of semen are collected and checked under a microscope in the laboratory. The sperm are then frozen and banked for the future. Sperm can be frozen for an indefinite amount of time if stored properly.
• Testicular or gonadal shielding involves a protective cover placed on the outside of the body to shield the testicles from scatter radiation to the pelvis when other parts of the body are being treated with radiation.
• Testicular sperm extraction is a procedure for men who are not able to produce a semen sample. Sperm is collected through a medical procedure and frozen for future use.
• Testicular tissue freezing or cryopreservation may be an option in certain cases, although this is not a standard procedure offered everywhere.

Because of the many factors that affect fertility, it’s hard to predict how any one person will be affected by treatment. To preserve the full range of possibilities, fertility preservation options should be discussed as early as possible, before treatment starts. The discussion can ultimately reduce emotional distress and improve the quality of life. Ask your cancer care team how treatment could affect your fertility and about the options for preserving fertility. The Male Fertility checklist has a list of questions that can help you prepare for your treatment and assess your fertility status before and after treatment.