How will treatment for testicular cancer affect fertility?
Orchidectomy
Having one testicle removed will not affect sexual performance and will not normally affect fertility. You may be advised to perform sperm banking prior to an orchidectomy if it is likely that further treatment with chemotherapy may be needed or there is a possibility that your other testicle might be producing a low level of sperm.
Chemotherapy
Chemotherapy can lower the number of sperm that the body produces. This may cause temporary infertility, and in rare cases, permanently. Men who are having chemotherapy will therefore be advised to store sperm.
The effect of chemotherapy on sperm is uncertain and there is no evidence that chemotherapy can harm any children born subsequently. It is not known how much chemotherapy may be present in the semen during treatment and there is a risk that partners may be exposed to chemotherapy during sexual intercourse. A condom is therefore recommended while you have treatment and for a short time afterwards.
Radiotherapy
Radiotherapy is used to reduce the risk of seminoma returning in lymph nodes situated in the back. Radiotherapy can also be given following chemotherapy in men who have more advanced disease and who are unable to have further surgery such as RPLND (Retroperitoneal Lymph Node Dissection). Radiotherapy will not normally affect a man’s fertility but storing sperm may still be recommended.
Retroperitoneal Lymph Node Dissection
Retroperitoneal Lymph Node Dissection (RPLND) is an operation to remove cancer from lymph nodes in the abdomen. It can sometimes affect the nerves that control ejaculation. The sperm will not be released by the penis but will flow back into the bladder via the urethra, or water pipe (retrograde ejaculation) making you infertile. You should consider storing sperm before surgery if this has not already been done.
Sperm Storage
What is Sperm Storage?
Storing sperm, also known as sperm banking, is the preservation of sperm by freezing. The sperm may then be used later for artificial insemination.
Where can a sperm bank or clinic be found?
The specialist healthcare team will be able to provide you with information on your local fertility centre. Sperm can be stored for 10 years initially but this period can be extended if after this time.
Visiting the sperm bank or clinic
When you first visit the clinic, the specialist team will answer any questions and concerns. You will be asked to provide a sperm sample, through masturbation, which will be frozen and stored. When you are ready to father a child, the sperm can be thawed and then used to artificially inseminate your partner. Before sperm banking you will have some blood tests to check for viruses such as HIV, Hepatitis B and Hepatitis C.
To provide sample you may need to make several visits to a clinic. You should abstain from ejaculating three days before sperm storage to ensure the best amount and quality of sperm is obtained. Not everyone is suitable for sperm banking and a low sperm count, poor sperm quality, and the freezing and thawing process can all affect the quality of the sperm count.
In some circumstances it is possible to ejaculate into a condom at home, providing the sample can be taken to the sperm bank within an hour. The condom will be provided by the sperm-bank and will not contain lubrication or spermicide.
For men who are unable to store sperm it can, in sometimes be extracted from the testicles using a surgical technique which involves removing small pieces of testicular tissue under a general anaesthetic and checking for the presence of sperm. If sperm is present and can be retrieved, it can be used to fertilise an egg outside of the uterus (IVF). Only one healthy sperm is needed to father a child.
