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TESTICULAR CANCER AND YOUR FERTILITY

Treatment options: what are they and how will they affect my fertility?
 

There are three types of treatment available to you: surgery, radiotherapy and chemotherapy.

Surgery

Removing the affected testicle and tumour by surgery (orchidectomy) is the standard treatment for testicular cancer where the cancer has remained within the testicle. This is usually done within a two week period. It will not adversely affect your sexual performance. Another option is surgery involving a lumpectomy where just the tumour is removed, although this is only possible under specific conditions and is not considered standard treatment in many settings.

Having one testicle will not normally affect your fertility because the remaining testicle usually produces more sperm to compensate for the one that has been removed. However, you may still wish to consider and discuss with your specialist healthcare team storing your sperm before any form of treatment begins - if cancer is diagnosed in both testicles or if it returns in the healthy testicle which is then removed, you will no longer be able to produce testosterone or sperm. You will require testosterone replacement therapy which can be given as patches or injections, or less commonly by tablets. If you have this therapy you will be able to maintain an erection and your sex drive. However you will not be able to father a child.

If the cancer has spread to your lymph nodes it is likely these will be removed by surgery. This can sometimes damage the nerves that control ejaculation and may leave you infertile. In these cases you should consider storing your sperm before surgery.

Radiotherapy

After surgery it is not necessary to give any further treatment, providing the cancer has not spread beyond the testicle. This form of treatment is known as surveillance. Unfortunately the cancer returns or relapses (usually at the site of the lymph nodes in the abdomen) in about 30% of patients. Almost all of these patients are cured with chemotherapy; however, chemotherapy does have side effects. Therefore some doctors offer either radiotherapy or mild chemotherapy to prevent the cancer coming back.

Radiotherapy uses high energy beams of radiation to help destroy the cancer cells. This milder treatment has a much less profound effect on your immune system and some patients opt for this extra treatment for preventative purposes. Radiotherapy will not normally affect your fertility but storing your sperm should be considered before treatment starts.

Chemotherapy

If it is apparent that the cancer has spread beyond the testicle you will almost certainly need chemotherapy.  Chemotherapy uses powerful medicines to kill the cancer cells or stop them multiplying. There are a number of possible side effects with this treatment, including lowering the number of sperm your body produces. This may cause temporary infertility during and after treatment (up to two years after in some cases) or in some cases this can be permanent. The effect of chemotherapy on sperm is uncertain and there is no evidence that chemotherapy can harm children. However most specialist healthcare teams would advise that you do not conceive for about a year after treatment. It is important to continue to use contraception during this period as it is still possible to conceive.

Low sperm count

Some men with testicular cancer have a low sperm count before they start treatment. In these men, successful treatment with chemotherapy can sometimes cause their sperm count to return to a more normal level.

After your treatment is completed

Once your treatment has stopped you will be monitored on a regular basis for at least five years by your specialist healthcare team.

Sex and your treatment

Whether you choose to remain sexually active during your cancer treatment or not is entirely a personal choice and the type of treatment you have will affect you in different ways. You should continue to protect yourself and your partner during this time.

What is sperm storage?

Storing your sperm, also known as sperm banking, is the preservation of your sperm by freezing. The sperm may be used in the future for artificial insemination or other assisted reproduction techniques.

Why consider sperm banking?

There are a number of reasons why you may wish to consider storing your sperm. Certain treatments may lower the number of sperm your body produces which in turn can lead to infertility. This may be temporary and will recover following treatment. Sometimes the treatment may lead to permanent infertility. In some cases the tumour bearing testicle may be able to produce sperm whilst the healthy one may be non-functioning. If there is any doubt sperm storage should be discussed before surgery begins. Sometimes the cancer may return to the healthy testicle and if removed you will not be able to father a child.

Even if you don’t plan to start a family, sperm banking is worth considering in case you change your mind in the future.

Where can you find a sperm bank or clinic?

Your specialist healthcare team will be able to advise you if the hospital where you are being treated has sperm banking facilities. They can also provide you with information on your local fertility centre where you may be offered the opportunity to bank your sperm.

Visiting the sperm bank or clinic

When you first visit the clinic, the consultant or specialist healthcare team will discuss the process and answer any questions and concerns you may have. You may wish to take someone with you at this stage or to keep notes of the meeting.

You will be asked to provide a sperm sample, through masturbation, to the clinic who will then freeze and store it. When you are ready to have a child the semen is thawed and then used to artificially inseminate your partner.

To provide a sample may require several visits to a clinic. Understandably, some men may find the situation stressful or embarrassing and may not be able to produce a sperm sample through masturbation. Some men may have a low sperm count and will need to visit the clinic at a later stage when the treatment has finished and the count is improved. If you have a low sperm count, a technique known as microinjection of sperm may be used. This involves identifying good quality sperm from your semen which is then stored for use at a later stage. The semen will be thawed and the surviving sperm used to fertilise your partner's egg. The fertilised egg is then implanted in the womb to grow naturally.

Not everyone is suitable for sperm banking and a low sperm count, poor sperm quality, and the freezing and thawing process can all affect your ability to father a child. If your cancer has spread and you need to begin your chemotherapy right away, your doctor may advise against sperm banking because it could delay the start of your cancer treatment. Don’t worry if you are unable to bank any sperm. There are many new techniques and procedures in development.

What tests and consents are involved?

There are a number of tests and consent forms that you will need to complete including:

If you are under 16 you will need your parent or guardian’s permission to have your sperm treated and stored.

Your blood will be screened for HIV, hepatitis B and hepatitis C. This is usually arranged by your specialist healthcare team.

You will need to confirm what you would like done with your sperm in the event of your death.

Q. Following my cancer treatment, what happens if tests show that I am fertile?

A. You will need to discuss the results with your specialist healthcare team. Yo