Although a small percentage of men who develop testicular cancer may suffer from male infertility already, some treatments for testicular cancer can cuase fertility problems.
Storing sperm, also known as sperm banking, means keeping sperm for the future by freezing it. The sperm can be used at a later date following treatment if infertility develops.
Sometimes testicular cancer treatment can lead to temporary or permanent infertility. The situation can vary depending the type of treatment needed.
Men who are having an urgent unilateral orchidectomy (removal of one testicle) have traditionally not had sperm banked or analysed for abnormalities (semen analysis) beforehand. This is starting to change and may be performed prior to orchidectomy. Alternatively, men may have already banked sperm (for instance before chemotherapy) and may want more information about treatment effects.
After orchidectomy, a one-off dose of chemotherapy may be recommended or if cancer has spread outside the testicle a longer course of chemotherapy. Chemotherapy can cause infertility which is why sperm is traditionally banked before treatment starts.
Scientists do not yet know the full effect of chemotherapy on sperm. There is no evidence that chemotherapy can harm any children you have afterwards. However, most specialist healthcare teams advise men not to father a child for about a year after treatment.
Additionally scientists do not yet know how much of the chemotherapy drugs will end up in your semen. There is a risk that partners may be exposed to chemotherapy during sex,it is advisable towear a condom to protect them.
Radiotherapy will not normally affect a man’s fertility but storing sperm may still be recommended.
Retroperitoneal Lymph Node Dissection (RPLND) is an operation which may be performed after chemotherapy has finished. It is performed if there is any evidence of residual cancer in the lymph nodes in your abdomen (middle).
This procedure can sometimes damage the nerves that control ejaculation which may leave men unable to ejaculate normally. Sperm will not be released by the penis but will flow back into the bladder via the urethra (the urination tube). This is called ‘retrograde ejaculation’. Generally, this makes a man infertile, although in some instances, it is possible to retrieve sperm from a urine sample.
Some hospitals where you may be having treatment offer sperm banks. If not, the specialist healthcare team may have the details of a local fertility centre. Sperm can be stored for 10 years initially but this period can be extended if fertility is still impaired after this time.
Usually on the first visit, the specialist healthcare team will discuss sperm banking and answer any questions or concerns.
Men will be asked to have blood tests before making your sperm deposit. This is to check for HIV, Hepatitis B and Hepatitis C. If any of these viruses are present , men can still store sperm but may need to have further medical investigation.
Men will be asked to provide some sperm by masturbating. This will then be frozen and stored. When men are ready to have a child, the sperm can be thawed and used to artificially inseminate a partner.
To provide the right sample, men may need to make several visits to the clinic. They should not ejaculate for 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.
If it is difficult to relax in the clinic or men 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. Men will need a special condom provided by the clinic that does not contain lubricant or spermicide.
On average, men produce 1.5–5mls of ejaculate which may contain between 20–150 million sperm per millilitre and around 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.
Only one healthy sperm is needed to father a child.
In some instances sperm can be taken from remaining testicle 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.
Before storing sperm, men will need to have some blood tests and sign some papers. These include:
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 is under review and men should discuss this with their specialist healthcare team as it can be more expensive to store the sperm longer term.
Men who move house, especially if this involves a move to a new clinic or GP, must ensure that the previous clinic and GP have the new address details.
When the stored sperm is needed, men 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.
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