Late Effects Assessment Programme: Male fertility

Late Effects Assessment Programme: Male fertility

Some cancers and cancer treatments can cause infertility. Infertility happens when you stop producing sperm or when your sperm is too damaged. Not all cancers and cancer treatments cause infertility.

Key points to remember

This page is written for young people who have had cancer treatment.

  • not all cancers and cancer treatments cause infertility
  • some do so it is important to understand your individual risks
  • the risk of any problems with fertility is different for everyone

Will I be infertile from cancer or treatment I had?

Not all cancers and cancer treatments cause infertility but some do so it is important to understand your individual risks. Infertility happens when you stop producing sperm or when your sperm is too damaged. Azoospermia is the medical name for having no sperm in semen.

2 main causes of infertility

There are 2 main causes of infertility for males who have survived childhood cancer:

  1. A direct effect on the sperm-producing cells in the testes.
  2. A direct effect on the hormone-producing areas of the brain.

1. A direct effect on the sperm-producing cells in the testes

This can happen in one of the following ways.

Chemotherapy

Chemotherapy with certain drugs - specifically alkylating agents. The most common ones used in treating childhood cancer are Ifosphamide, Cyclophosphamide, Procarbazine, Melphalan, Thiotepa, CCNU, and BCNU. The greatest risk is from high total doses of these drugs and/or radiation to the brain, pelvis or lower spine.

Radiation

Radiation to the pelvis, testicles and total body irradiation (TBI).

Surgery

Surgery to the testicles or near the prostate (not common).

2. A direct effect on the hormone-producing areas of the brain

A direct effect on the hormone-producing areas of the brain such as the pituitary gland in the brain that controls the production of hormones. These hormones are the follicle stimulating hormone (FSH) and luteinising hormone (LH).

This can happen from radiation or surgery to the brain.

Other factors that can affect your risk of infertility

  • age at diagnosis or treatment
  • pre-treatment fertility status

How do I know if this is a problem for me?

These are important issues for young people. Hormones produced in the brain also regulate growth, as well as when and how you go through puberty. It is often at this time that problems (if any) may appear. You can have blood tests to check the hormone levels once you reach puberty. You can have a semen (sperm) analysis at any time to check if you are producing sperm. Sperm have been known to recover up to several years after treatment with some chemotherapy drugs. This depends on the dose and whether chemotherapy is combined with other alkylating agents or treatments. Your oncologist will be able to discuss this with you more fully.

What options are there if my fertility has been affected?

There are a number of options available to help you father a child.

There are a number of options available to help you father a child. If necessary, your healthcare team can make a referral to a specialist fertility clinic where you can discuss treatments and available options. If the type of treatment you had is very likely to have affected your fertility, you will get more specific information when you go to clinic.

Remember that 1 in 10 couples are infertile in the general population.

What about my sex life?

Fertility and sexual function are different. Even if you are told you are infertile you can still have a normal sex life.

Should I use contraceptives?

Use contraceptives. Do not assume you will be infertile from your treatment. Also, protect yourself from STDs.

Yes! Do not assume that because you have had some of these treatments you will be infertile. It is important that you take precautions until you are ready to have a family. It is also important to protect yourself from sexually transmitted diseases.

Will my baby have cancer?

Some young cancer survivors worry that the treatment they had may affect their baby. There is no evidence of increased health problems or abnormalities in children of people who have had treatment for cancer. Except for some rare inherited cancers, there is also no evidence that children of cancer survivors have an increased risk of developing cancer compared to other people.

Sperm bank

If you had sperm banked before treatment, it is important to tell the bank if your contact details change. They will contact you periodically. If they have lost contact with you for 10 or more years, they may destroy your banked sperm.

You can discuss all these issues at your clinic

You can discuss any of these issues in more detail when you go to clinic. The risk of any problems with fertility is different for everyone.

All the pages in the childhood cancer section of this website have been written by health professionals who work in the field of paediatric oncology. They have been reviewed by the members of the National Child Cancer Network (NZ). Medical information is authorised by the clinical leader of the National Child Cancer Network.

This page last reviewed 27 February 2013.
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