Testicular Cancer and Fertility

Testicular cancer and fertility have a complex relationship. There are many things that can lead to infertility and therefore the association between testicular cancer and fertility can be confusing. However, this topic is obviously an important one given that testicular cancer is most common in relatively young men, most commonly from 15 to 35 years of age, which is still during the time that many men are planning to have a family or have not yet begun to have a family.

The reason this is a complex topic is that infertility can be associated with many things. For one, infertility can be associated with some of the same things that put some men at risk for testicular cancer in the first place. For example, a history of undescended testicles or other abnormalities of testicular development can all impact fertility, with or without cancer.

Second, testicular cancer itself appears to lower the sperm production in some men. In some cases this will improve with treatment, in others it will not.

Finally, fertility can be impacted by some of the treatments that are used to manage testicular cancer. Obviously, complete removal of both testes would result in infertility. While in some advanced cases or cases when both testes harbor cancer both testes need to be removed, in the large majority of cases only one testicle is removed for treatment of testicular cancer. Assuming the other testicle is normal, normal fertility can occur with only one testicle.

Other treatments may also impact fertility. For example, in some cases of malignant tumors, a lymph node dissection is included in the treatment surgery. This surgery can compromise the nerves to the male reproductive tract and lead to retrograde ejaculation which can prevent normal fertility. However, most modern techniques are very good at sparing these nerves and preventing these problems. Chemotherapy, if used as part of the treatment regimen, can also lead to problems with sperm production. In some cases this is temporary but in some cases will be permanent. Radiation treatment at high levels can also cause infertility but in most cases these high levels are not used in the treatment of testicular cancer.

What can be done? For cases where loss of fertility is likely or a major concern, sperm banking prior to treatment is an option for some men. In these cases, sperm is saved frozen and can be used at a later date if the patient desires to start a family after treatment. In this way, even if treatment of the cancer results in infertility there is healthy sperm available at a later date.

Every patient is different, both in terms of their existing fertility as well as their risk of losing fertility with treatment. If you have concerns about testicular cancer and fertility, speak to your own physicians about your fertility and the risks that treatment may have on it.