Testicular cancer, the most common type of cancer in males between the ages of 20 and34, according to a February 2004 article in "Cancer," strikes males at a particularly sensitive time in respect to fertility . Many males in this age group are not thinking about parenthood yet, and the concern about having cancer often replaces concern about fatherhood, unless medical personnel bring it up. The good news is that nearly all males with testicular cancer can father children after treatment, especially if they plan ahead before treatment starts.
Testicular cancer occurs in the testes, the male reproductive organs responsible for the creation and storage of sperm. Two types of testicular cancer can develop: seminoma, a slow-growing cancer that more often affects men in their 30s and 40s; and the more common and faster growing nonseminoma. Treatments vary according to the type of cancer and how far cells have spread. The possibility of future fatherhood depends on the treatment.
Surgery and Fertility
Orchiectomy, or testicular removal, can be done to treat both seminomas and nonseminomas. If just one testicle is removed, the other will be able to produce adequate sperm for fathering a child. If both testicles are removed, sperm should be banked prior to orchiectomy, or there will be no possibility of getting a woman pregnant.
Surgery to remove lymph nodes in the abdomen can cause retrograde ejaculation. Nerve-sparing surgical techniques can prevent retrograde ejaculation, but not all surgeons perform this surgery. Sperm can be retrieved
from the testicle or bladder with fertility procedures if retrograde ejaculation occurs.
Radiation and Fertility
Radiation is typically used only to treat seminomas, because nonseminomas don’t respond as well to it. Radiation to the testes will cause a temporary drop in sperm counts, but many men will recover the ability to make sperm after one to two years. Freezing sperm before radiation eliminates the possibility of ending up with no sperm and being unable to achieve a pregnancy.
Chemotherapy and Fertility
Chemotherapy kills germ cells, which include sperm. While some men will never start producing sperm again after chemotherapy, 50 percent will have normal sperm counts after 24, according to the textbook, "Cancer of the Testes." Banking sperm will assure that the possibility to father a child won’t be destroyed along with the cancer cells during chemotherapy treatment. Both types of testicular cancer are treated with chemotherapy.
Post Treatment Considerations
Men who have one testicle that’s producing adequate sperm and whose sperm counts return to normal after chemotherapy can achieve pregnancy in the usual way after treatment. If sperm is frozen, intrauterine insemination or in vitro fertilization reproductive techniques are needed to achieve pregnancy. If the number of sperm frozen is very low, a procedure known as intracycloplasmic sperm injection, or ICSI, injects a single sperm into a single egg. Embryologists do the procedure after eggs are removed during egg retrieval.
If there is sperm in the testes but not in the ejaculate due to retrograde ejaculation, sperm can be removed directly from the testicle and injected into the retrieved eggs. The two procedures can be coordinated so that fresh rather
than frozen sperm is available.