Fertility (Localised Testicular Cancer)

Fertility is a consideration when starting treatment for localised testicular cancer. This is because some treatments can cause fertility problems.

This page explains how sperm banking works in the short and long term. It also discusses the possible effect of treatment on sperm.

What is Sperm Storage?

Storing sperm, also known as sperm banking, means keeping some of your sperm for future use by freezing it. The sperm can then be used later as your contribution to creating a baby with your partner.

Why Consider Sperm Banking?

Sometimes your treatment for localised testicular cancer can affect your fertility on a temporary or permanent basis. There are several steps along the testicular cancer journey that can cause this: unilateral orchidectomy (removal of one testicle) and chemotherapy. Infertility will certainly be the case in the very rare event of a bilateral orchidectomy (removal of both testicles).

Due to the above factors, it makes sense to discuss sperm storage before treatment. Even if you are not planning to either start a family or have any more children, it’s worth thinking about whether things could change.

How Do I Find a Sperm Bank?

Some hospitals where you may be having treatment offer sperm banks. If not, your specialist healthcare team will be able to direct your to a local fertility centre. Sperm can be stored for 10 years initially but this period can be extended if your fertility is still impaired.

Visiting the Sperm Bank or Clinic

On your first visit, the specialist healthcare team will discuss sperm banking and answer any questions or concerns.

You will be asked to have blood tests before making your sperm deposit. This is to check for HIV, Hepatitis B and Hepatitis C. If you have any of these viruses, you can still store your sperm but you will need to have further medical advice.

You will be asked to provide some sperm by masturbating. This will then be frozen and stored. When you are ready to have a child, your sperm can be thawed and used to artificially inseminate your partner.

To provide the right sample, you may need to make several visits to the clinic. You should not ejaculate for three days before sperm storage to ensure the best amount and quality of sperm in your sample.

Unfortunately not everyone is able to donate their sperm. If you have a low sperm count or poor sperm quality, you may not be able to do so. Also, the freezing and thawing process can all affect the quality of the sperm count. 

If you find it difficult to relax in the clinic or have mobility issues, in some circumstances, it is possible to ejaculate into a condom at home. This is only possible if the sample can be taken to the clinic within an hour. You will need a special condom provided by the clinic that does not contain lubricant or spermicide.

What is a Normal Sperm Count?

On average, men produce 1.5–5mls of ejaculate which may contain between 20–150 million sperm per millilitre. 60% of this sperm should appear normal.

Some men with testicular cancer have a low sperm count before they start treatment and sometimes in these men, successful treatment for testicular cancer can cause their sperm count to return to a more normal level.

However, men in this situation should still consider storing their sperm before treatment as their sperm count may get worse.

Don’t forget that only one healthy sperm is needed to father a child.

Testicular Sperm Extraction (TESE)

If you are unable to store sperm, in some instances it can be taken from the testicles using a procedure called Testicular Sperm Extraction (TESE).

This is surgery where small pieces of testicular tissue are removed under a general anaesthetic and the surgeon checks for the presence of sperm. If sperm is present, it will be taken out by the surgeon and stored for you.

In some instances, this surgery can be combined with the removal of the testicle as part of your orchidectomy procedure. However, this is an involved procedure and surgery would need to be planned carefully with your medical team.

What Tests and Consents are Involved in Banking Sperm?

Before storing sperm, you will need to have some blood tests and sign some papers. These include:

  • If you are under 16, your parent or guardian need to give permission for your sperm to be treated and stored.
  • Your blood will be screened for HIV, Hepatitis B and Hepatitis C.
  • You will need to confirm what you would like done with your sperm in the event of your death.

What if My Sperm is Healthy After Treatment?

You should discuss your results with your specialist healthcare team. If you want, you could have the stored sperm destroyed. However, if your sperm count is still low, your sperm can be stored for as long as needed.

What Are the Costs of Sperm Storage?

Currently, the NHS will pay for the costs of the initial consultations, blood tests and storage of sperm. Most centres will have cover to store sperm for up to three years.

Funding for further treatment or longer term storage is under review and you should discuss this with your specialist healthcare team if you need it.

What if I Move Somewhere Else?

If you move house, and especially if you move to a new cancer clinic or GP, you must ensure that your previous clinic and GP have your new address details. You do not need to move your stored sperm.

When you need to use your stored sperm, you should contact the clinic where the sperm is stored and make arrangements to access it. Sperm will be destroyed if it is no longer required after 10 years.

How Will Localised Testicular Cancer Treatment Affect My Fertility?

After Orchidectomy 

Removing the affected testicle or testicles and tumour with orchidectomy surgery is the standard treatment for testicular cancer. Having one testicle removed (unilateral orchidectomy) will not adversely affect sexual performance and will not normally affect your fertility.

Even though this is the case, you may be advised to bank your sperm before your orchidectomy. This is often because in your case:

  • If it is likely that further treatment with chemotherapy will be needed afterwards.
  • Your other testicle is producing a low level of sperm.

Sometimes patients are offered a rarer type of surgery called a partial orchidectomy. This is where only the tumour is removed and not the testicle. It is not considered standard treatment.

For localised testicular cancer, where the cancer has not spread beyond the testicle, you will be unlikely to need further treatment. Your next steps might be to choose surveillance.

One-Off Chemotherapy

Instead of surveillance, some men choose a one-off dose of chemotherapy. You can read more about this type of chemotherapy here. If this is your preferred route, you should ask your medical team about the potential effect on your fertility.

You might find it helpful to discuss your fertility questions with one of our Orchid nurses on our helpline. Call us.

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