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The male reproductive system is made up of the scrotum, testicles, vas deferens, epididymis, seminal vesicles, prostate gland, penis, and urethra. The reproductive system is controlled by the pituitary gland in the brain. The testicles are located in the scrotum (the loose pouch of skin that hangs behind the penis). The testicles are made up of Leydig cells (cells that produce the male hormone - testosterone) and germ cells (cells that produce sperm).
The most common effect of cancer therapy on the male reproductive system is infertility (the inability to initiate a pregnancy). Infertility can occur as a result of certain types of chemotherapy, radiation to the brain or testicles, or surgery involving the male reproductive system.
Chemotherapy of the “alkylator” type (such as cyclophosphamide, nitrogen mustard and procarbazine) may cause infertility. The total dose of alkylators used during cancer therapy is important in determining the likelihood of damage to spermproducing cells. The higher the total dose, the more potential for developing infertility. If alkylating chemotherapy was used in combination with radiation, the risk of infertility may be increased.
Males who have had cancer treatments that place them at risk for reproductive problems should have a yearly check-up that includes careful evaluation of their hormone and puberty status. Blood may be tested for hormone levels (FSH, LH, and testosterone). If any problems are detected, a referral to an endocrinologist (hormone specialist), urologist (specialist in the male reproductive organs) and/or fertility specialist may be recommended.
Infertility is not related to sexual function. In some men with infertility, there may be a decrease in the size or firmness of the testicles, but in others, there are no physical indications of infertility.
Males who had surgical removal of both testicles will not be able to make sperm, and infertility will be permanent. In other males, the only sure way to check for sperm production is to have a semen analysis performed, which checks the appearance, movement and concentration of sperm in the semen. A semen analysis that shows azoospermia (no sperm in the semen sample) on more than one sample is a likely indicator of infertility.
If semen analysis shows no sperm, and fertility is desired, consult with a doctor who specializes in male infertility. Medical advancements dealing with male infertility are being made. Recently, surgeons have been able to locate areas of active sperm production in the testes of men who were thought to be azoospermic. Surgical harvesting of the sperm has allowed conception with techniques devised for men with absent or very low sperm counts. Occasionally, azoospermia may be unrelated to chemotherapy altogether, and treatment for another disorder may be indicated.
Options for using banked sperm depend on the amount and quality of material saved. Men who banked sperm prior to cancer treatment will need to work with a doctor specializing in reproductive medicine, so that the cryo-preserved (frozen) sperm can be used in an optimal manner.
Although fertility and testosterone production are not usually affected if only one testicle was surgically removed, you should take precautions to protect the remaining testicle from injury by always wearing an athletic supporter with a protective cup when participating in any activities that may potentially cause injury to the groin area (such as contact sports, baseball, etc.). If your remaining testicle was treated with radiation, or if you received chemotherapy that can affect testicular function, the effects of these treatments are the same as discussed above.