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Testicular cancer surgery

If you have , you will most likely need at least one of your testicles removed. This is called an orchiectomy.

Often, only one testicle needs to be removed. If your other testicle is healthy, you can probably still make sperm and father a child after surgery. But some men with testicular cancer have poor fertility because the testicle that is left doesn’t work well.

For this reason, sperm banking before a testicle is removed is now recommended for men and boys who want to preserve their fertility. This is called fertility preservation. You can learn more about this in .

Prostate cancer surgery

Men who have certain kinds of may develop fertility issues.

Radical prostatectomy

Radical prostatectomy removes the prostate gland and seminal vesicles, which make semen. It is an option if the cancer hasn’t spread beyond the prostate gland.

If you have this surgery, your body will no longer be able to make semen or release sperm during sex. You can still have an orgasm, but no fluid will come out of your penis.

Surgery to remove your prostate can also damage the nerves that allow you to get an erection, causing erectile dysfunction (ED). If this happens, you might not be able to get enough of an erection for sexual intercourse.

If you can get an erection and have orgasms, you still won’t be able to father a child through sex because no semen will come out. When your prostate gland is removed, your testicles still make sperm, but the tubes (vas deferens) that deliver sperm to your urethra are cut and tied off. This prevents the flow of sperm out of your testicles.

Even after this surgery, there still are . This sperm can be used to fertilize a woman’s eggs and father a child. 

Bilateral orchiectomy

Bilateral orchiectomy removes both testicles. Removing both testicles stops your body from making testosterone. This acts as a type of which can slow the growth of prostate cancer cells. This surgery is most often done when the cancer has spread outside the prostate and surgery can’t get rid of all the cancer.

If you have this surgery, you won’t be able to make sperm cells, so you won’t be able to father children. before surgery may be an option if you want to father children in the future.

Bladder cancer surgery (radical cystectomy)

For this surgery your bladder, prostate, and seminal vesicles are all removed. Without your prostate gland and seminal vesicles, you can’t make semen or release sperm during sex. You can still have an orgasm (climax), but no fluid will come out of your penis.

Surgery to remove your bladder can also damage the nerves that allow you to get an erection, causing erectile dysfunction (ED). If this happens, you might not be able to get enough of an erection for sexual intercourse.

If you can get an erection and have an orgasm, you still won’t be able to father a child through sex because no semen will come out. When your prostate is removed, your testicles still make sperm, but the tubes (vas deferens) that deliver sperm to your urethra are cut and tied off. This prevents the flow of sperm out of your testicles.

Even after this surgery, there are still which can be used to fertilize a woman’s eggs and father a child.  

Surgery to remove lymph nodes

Surgery for testicular cancer and some  may including removing (part of your body’s immune system) from your lower belly (abdomen) or pelvis. Surgery to remove these lymph nodes can damage nerves that are needed to ejaculate during sex.

When these nerves are affected, your body still makes semen, but it doesn’t come out of your penis during orgasm. Instead, it either flows backward into your bladder (called retrograde ejaculation) or it stays in your urethra. Medicines can sometimes make it possible for you to ejaculate semen out of your penis again.

Radiation therapy

Radiation aimed at the testicles, or nearby pelvic areas, can kill the stem cells that make sperm. This can affect your fertility.

Testicular cancer

Radiation is sometimes used in the treatment of early-stage seminoma (a type of ).  It is used to treat nearby lymph nodes where the cancer might have spread.

During this treatment, the remaining testicle is usually shielded to protect it from direct radiation exposure. However, radiation can scatter once it enters the body, so it may still impact the testicles. This can lead to fertility problems, either temporary or permanent.

Some men stay fertile while getting radiation treatments, but their sperm might be damaged. Damaged sperm can cause pregnancy problems and birth defects. It’s important to wait at least 6 months (and sometimes up to 2 years) before having unprotected sex or trying for a pregnancy.

Your doctor will be able to consider your situation and give you specific information about how long you should wait.

Prostate cancer

There are two types of radiation that might be used to treat prostate cancer.

Internal radiation (brachytherapy)

Internal radiation () is given by placing radioactive seeds into the prostate. These seeds give off a lower dose of radiation over a longer period of time. With this method, the testicles are exposed to a much lower dose of radiation with less damage done to sperm cells.

Many men remain fertile or start making sperm again after treatment is done. However, the radioactive seeds stay in place for a period of time. So be sure you understand any restrictions you need to follow during and after brachytherapy.

Ask your cancer care team if you should:

• Avoid sexual intercourse, and for how long
• Use birth control, and for how long
• Limit close contact with pregnant woman and children, and for how long

External beam radiation therapy

External beam radiation therapy is also used for some people with prostate cancer. Beams of radiation are focused on the prostate gland from a machine outside the body. It can be used to try to cure earlier-stage cancers, to treat cancers that have grown outside the prostate, or to help relieve symptoms.

This type of radiation treatment is more likely to cause permanent infertility, even if your testicles are shielded.

Childhood leukemia

Radiation therapy is sometimes used to treat certain childhood leukemias. Radiation to the testicles may be done if tests show the leukemia has spread there. Children who receive radiation to the testicles are likely to become infertile, so fertility preservation options should be discussed.

Learn more: Preserving Fertility in Children and Teens with Cancer

Some children with leukemia may also need radiation to the brain. This can affect the hypothalamus and pituitary gland. These glands work together to release hormones needed to make testosterone and produce sperm.  Not having enough of these hormones can lead to infertility.

Chemotherapy

(chemo) works by killing cells in your body that divide quickly. This includes cancer cells, but also the cells that make sperm. With some chemo, your sperm production might slow down or stop.

Temporary infertility happens when sperm production returns after treatment ends. This can take time, even years. And your sperm production may never return to pretreatment levels. This may or may not affect your fertility.

 Permanent infertility can happen if the cells in your testicles that divide to make new sperm (spermatogonial stem cells) are damaged to the point that they can no longer produce maturing sperm cells.

Chemo medicines that are most likely to cause infertility in men are:

• Busulfan
• Carmustine
• Chlorambucil
• Cisplatin
• Cyclophosphamide
• Ifosfamide
• Lomustine
• Melphalan
• Procarbazine

Other chemo medicines can also affect fertility, but less often.

Higher doses of these chemo medicines are more likely to cause permanent fertility changes. Getting more than one of these medicines can have greater effects. The risks of permanent infertility are even higher when men are treated with both chemo and radiation therapy to the abdomen (belly) or pelvis.

Talk to your doctor about the chemo medicines you will get and the fertility risks that come with them.

Avoiding partner pregnancy during and after chemo

It’s important to not get your partner pregnant while you’re getting chemo. Even if you remain fertile, your sperm may be damaged during treatment. This can lead to birth defects and other pregnancy complications for your partner.   

After treatment, many doctors suggest waiting 6 months before trying to father a child. This is to allow damaged sperm enough time to repair or to be cleared from the body. Ask your doctor about the best timeframe for you.

Hormone therapy

used to treat prostate cancer or other cancers can decrease levels of the male hormones needed to make sperm and get an erection. This can affect your ability to have a child.

These medicines can also cause sexual side effects, like a lower sex drive and problems with erections. The decrease in sperm production and the sexual side effects tend to improve once these medicines are stopped.

Targeted therapy and immunotherapy

Some targeted therapy and immunotherapy medicines might affect your fertility. Research is still being done to find out which of these medicines affect male fertility. Ask your cancer care team if the medicines you will be getting are likely to cause fertility problems.

Thalidomide, lenalidomide, and pomalidomide (immunomodulatory drugs – ImiDs) are known to cause birth defects in an unborn child (fetus). A woman can be exposed to these medicines during sexual intercourse with a man who is currently taking them or has taken them in the last 4 weeks.