Testicular Cancer and Fertility

Testicular Cancer and Fertility

There are several connections between testicular cancer and fertility. They include the fact that testicular cancer usually affects young men who are either still building their family or considering starting one. Many men who have testicular cancer discover at the time they find they have cancer that they have few or no sperm at all and, all of the active treatments for testicular cancer can either directly or indirectly affect male fertility.

Effects of Treatment on Male Fertility

In this article we will address the way the various treatments for testicular cancer affect male fertility. Many men who have testicular cancer already have fertility issues so they can often be helped with inguinal orchiectomy. This procedure removes the testicle through an incision in the groin, either to the right or left of the pubic bone and just below the belt line. Cancerous testicles are always removed through an inguinal incision and never through the scrotum. For most men, this does not pose a problem nor does it introduce any type of infertility problems. The word of wisdom here is that if either testicle was ever undescended or if one was smaller than the other or atrophied, then it is a good idea to bank some sperm before the surgery.

RPLND, Retrograde Ejaculation and Nerve Sparing Surgery

In order to remove lymph nodes in the retroperitoneum, an RPLND is performed. Retroperitoneal lymph node dissection (RPLND) is an operation where the lymph nodes around the aorta at the back of the abdomen are removed to either determine whether cancer has spread outside of the testicle or to remove the cancerous site. It is a major operation that involves an incision from the sternum to the pubic bone. If a full bilateral lymphadenectomy is performed, it means that all of the lymphatic tissue is removed while a modified version of the procedure removes the lymph nodes on either the right or left side. The possible effect on fertility of this procedure is retrograde ejaculation where the sperm travels into the bladder instead of out into the opening of the penis during ejaculation. If the procedure is modified, then a nerve sparing technique may be used to avoid the issue. If a man has chemotherapy before an RPLND, then the odds of sparing the nerves to preserve normal ejaculation are lessened. Scarring caused by the chemotherapy makes it harder to find the nerves.

Although a man may experience retrograde ejaculation after an RPLND that does not mean that he is sterile. The sperm is still there, however, it must be retrieved another way. There are certain drugs that can help by temporarily preventing retrograde ejaculation so there is a chance to bank some sperm. Otherwise, it is possible to recover sperm through a variety of methods used in assisted reproduction techniques, artificial insemination, IVF or ICSI.

Chemotherapy Can Kill Everything

Chemotherapy is used to destroy germ cells and it does a great job of it when it comes to killing testicular cancer cells. Since sperm are generated by germ cells, chemotherapy usually wipes them out as well. In some cases the sperm never return, but in most other cases within two to three years after the treatments have ended about 50% of men will eventually return to normal. Some men have low sperm count even after five years post-treatment. This may be due to the level of chemotherapy used, the state of the sperm before the disease and treatment, and the amount of chemo used. The more chemotherapy used the less likely for fertility to be reestablished. It is recommended that due to the high likelihood of extended periods of infertility following chemotherapy, a man should bank sperm before the process begins.

You can learn more about sperm banking through fertility centers and check out our section on male fertility to learn more about keeping your sperm healthy in order to have it banked.