Can I Have Children After Being Treated for Testicular Cancer?

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The sperm is the male reproductive cell. It is produced in a series of winding ducts in the testicles known as the seminiferous tubules. They migrate to the epididymis, which is another coiled duct, where they receive nutrients and mature. It typically takes about 12 days to travel the length of the epididymis at which point they become capable of fertilizing the female egg (ovum). They are stored in the vas deferens which has smooth muscle capable of projecting the sperm through the urethra in the process of ejaculation.

The sperm contains a single copy of each of the 23 chromosomes, which combine with the 23 chromosomes of the egg creating a full 46 chromosome fertilized egg known as a zygote.

Who's at Risk for Infertility?

Those who have received chemotherapy or radiation therapy have the greatest risk of infertility. The more extensive the radiation or the higher the dose of chemotherapy, the greater the risk. Following radiation, about 65% of men are able to conceive. Those treated with high-dose cisplatin have about a 40% chance of conception. Certain surgical procedures, which will be explained in better detail below, can also result in infertility. Overall, around 50-80% of testicular cancer patients regain fertility within 5 years of completion of treatment for testicular cancer.

Even without treatment, testicular cancer itself becomes a risk factor for decreased fertility. This is because sometimes testicular cancer is associated with other conditions, which in themselves can cause decreased fertility, such as an undescended testicle (a condition known as cryptorchidism).

Several studies have also suggested the existence of lower sperm counts and decreased sperm motility in testicular cancer patients, even before treatment, compared to the general population.

How Can Chemotherapy and Radiation Therapy Cause Infertility?

Both chemotherapy and radiation can result in infertility through direct interference with the process of sperm formation, known as spermatogenesis.

As mentioned above, the sperm is created in the seminiferous tubules from cells known as spermatogonia. Spermatogonia are sensitive to both radiation and chemotherapy, especially at high doses. When spermatogonia are destroyed, or their cell replication halted, the process of spermatogenesis is stopped. This may occur for the short term or the long term based on the intensity of treatment as well as other pre-existing factors for infertility.

How Can Surgery Cause Infertility?

Surgery can result in infertility through a mechanism different than that of chemotherapy and radiation. The surgical procedure that most likely results in infertility is a procedure where the lymph nodes that drain the testes in the abdomen are removed in a surgery known as retroperitoneal lymph node dissection. Infertility occurs when the nerve that controls the sphincter muscle, which prevents semen from going backward up the urethra to the bladder upon ejaculation, is injured and rendered nonfunctional. As a result, the sperm goes the wrong direction in the urethra and end up in the bladder rather than being expelled outward from the penis.

 This condition is known as retrograde ejaculation and causes infertility even if the sperm is sufficiently numerous and functional. 

What Is Sperm Banking and How Is It Accomplished?

Sperm banking is the process of collecting and preserving sperm which can be used at a later date for insemination and pregnancy. Sperm is typically collected through masturbation, although surgical options also exist. Ejaculation should typically be avoided for about 48 hours prior to sample collection to maximize the actual sperm count. The sperm is typically frozen using liquid nitrogen and may be viable for use years down the road. Sperm samples have been successfully used for conception even 20 years after freezing the specimen. Sometimes a sample will be immediately thawed to determine odds of having a viable sample after freezing. For specific details, instructions and costs, please check with the banking institution itself. 

Are There Alternatives to Sperm Banking?

There have been attempts to halt spermatogenesis prior to chemotherapy and radiation therapy with medications in the hope of sparing the spermatogonia and preserving spermatogenesis. These attempts have not met with substantial success and are not currently recommended.

Are There Downsides to Sperm Banking? 

There are costs and fees for sperm collection and storage. Sperm banking is not able to guarantee conception and pregnancy in the future. It should also be known that only about 10% of men who banked sperm actually go on to use it in the future to father a child.

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