Fertility Issues in Boys and Men with Cancer

Cancer treatments can affect a boy’s or a man’s fertility. Most likely, your doctor will talk with you about whether or not cancer treatment may lower your fertility or cause infertility. Sometimes you, or parents of a child being treated for cancer, may need to initiate this conversation with the doctor.

Whether your fertility is affected depends on factors such as:

• your age at the time of treatment
• the type of cancer and treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• the amount of time that has passed since cancer treatment
• your baseline fertility status, such as any fertility problems in the past
• other personal health conditions and factors

Learn about fertility issues for females in Fertility Issues in Girls and Women with Cancer.

Ask your doctor how the recommended cancer treatment may affect your fertility before starting treatment. Consider asking questions such as:

• Could treatment increase the risk of, or cause, infertility?
• Are there other recommended cancer treatments that might not cause, or cause fewer, fertility problems?
• Which fertility preservation option(s) would you advise for me?
• What fertility preservation options are available at this hospital? At a fertility clinic?
• Would you recommend a fertility specialist, such as a urology fertility specialist, that I could talk with to learn more?
• Is condom use advised, based on the treatment I will be receiving?
• What are the chances that my fertility will return after the type of cancer treatment being advised?

Learn about side effects related to Sexual Health Issues in Men with Cancer.

Cancer treatments may affect a male's fertility

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility caused by cancer treatment may be temporary or permanent.

Talk with your health care team to learn what to expect based on your treatment(s):

• Chemotherapy (especially with drugs called alkylating agents) can damage sperm in men and sperm-forming cells (germ cells) in young boys.
• Hormone therapy (also called endocrine therapy) can decrease the production of sperm.
• Radiation therapy to the reproductive organs as well as radiation therapy near the abdomen, pelvis, or spine may lower sperm counts and testosterone levels, causing infertility. It may also destroy sperm cells and the stem cells that make sperm. Radiation therapy to the brain can harm the pituitary gland and decrease the production of testosterone and sperm. 
• Stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments can damage sperm and sperm-forming cells and cause infertility.
• Surgery for cancers of the reproductive organs and for cancers in the pelvic region can damage these organs, nearby nerves or lymph nodes in the pelvis, leading to infertility.
• Other treatments: Talk with your doctor to learn how specific types of immunotherapy or targeted cancer therapy, may affect your fertility.

Making fertility-related decisions

Making decisions about whether or not to preserve your fertility isn’t easy. You’ll need to learn about the risks of the proposed cancer treatment to your fertility as well as the best fertility preservation options for you. Infertility can be a difficult and upsetting side effect of some cancer treatments.

Although it might feel overwhelming to think about your fertility right now, most people benefit from having talked with their doctor (or their child’s doctor, when a child is being treated for cancer) about how treatment may affect their fertility and options to preserve fertility.

Although many people want to have children at some point in their life, families can come together in many ways. For support during this time, reach out to your health care team with questions or concerns, as well as to professionally led cancer support groups.

If you are a young person with cancer, or the parent of a young boy or teen with cancer, this video of fertility options for young male cancer patients from the Children's Hospital of Philadelphia may help you talk with the health care team.

Fertility preservation options for boys and men

Men and boys with cancer have options to preserve their fertility. These procedures may be available at the hospital where you are receiving cancer treatment or at a fertility preservation clinic. Talk with your doctor about the best fertility preservation option(s) for you based on your age, the type of cancer you have, and the specific treatment(s) you will be receiving.

The success rate, financial cost, and availability of these procedures vary. A growing number of states require insurance companies to cover fertility preservation methods. Learn if the state you live or work in requires insurance companies to cover fertility-related costs for people with cancer.

• Sperm banking (also called semen cryopreservation) is the most common and easy option for males who have gone through puberty, who would like to have biological children one day. Samples of semen are collected and checked under a microscope in the laboratory. The sperm are then frozen and stored (banked) for the future. Sperm can be frozen for an indefinite amount of time. Later, the sperm can be thawed and used during an IVF procedure so a woman may become pregnant.
• Testicular shielding (also called gonadal shielding) is a procedure in which a protective cover is placed on the outside of the body to shield the testicles from scatter radiation to the pelvis when other parts of the body are being treated with radiation.
• Testicular sperm extraction (TESE) is a procedure for males who are not able to produce a semen sample, or if the sperm count is low, for example. Sperm is collected through a medical procedure and frozen for future use.
• Testicular tissue freezing (also called testicular tissue banking and testicular tissue cryopreservation) is an option for boys who have not gone through puberty and are at high risk of infertility. It is still considered to be an experimental procedure for which clinical trials are ongoing.

If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation whenever possible. Your health care team will advise you on the timing of fertility procedures you may choose to have and whether a delay may affect your treatment plan and prognosis.

Getting personalized care

Regardless of your age, race, economic status, sexual orientation, or gender identity, it’s important to make decisions that reflect what is important to you. If having biological children is important, talk with your health care team about how the proposed cancer treatment may affect your ability to make a female pregnant. These conversations can help you get the information you need to make decisions that feel right to you. Talking about issues related to reproduction, sexual orientation, and gender identity can feel awkward, to you or your doctor, but that doesn’t mean you shouldn’t have these conversations. They are important and most people with cancer are glad they had these discussions with their doctor.

Finding more resources, financial support, and clinical trials

These organizations have information about fertility preservation options for people with cancer:

• Oncofertility Consortium
  Learn more about fertility preservation options, connect with a patient navigator, and find community resources.
• Alliance for Fertility Preservation
  Comprehensive information on fertility preservation, including laws and legislation in some states that require insurance companies to cover the cost of fertility preservation as well as answers to commonly asked questions.
• Livestrong Fertility
  Access financial support and find a fertility clinic in your area if cancer treatment presents a risk to your fertility. Learn about a discount program for qualifying patients. 

Learn about clinical trials by searching NCI-funded clinical trials and these NIH-funded clinical trials. You can also get answers to commonly asked questions about clinical trials, learn how clinical trials work, and why people participate in a clinical trial: Clinical Trials Information for Patients and Caregivers.

Listen to tips on how to manage changes in sexuality and fertility caused by cancer treatments such as radiation therapy.
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