Male Reproductive Health Issues After Childhood Cancer


How childhood cancer and its treatment effects male reproductive function depends on many factors including your age at treatment, the type and location of cancer, and the treatment you received. Here's what you need to know to figure out if you are at risk for reproductive problems.

Am I at Risk?

The following treatments can put you at risk for reproductive problems.

Radiation to the…

Chemotherapy Drugs

Surgery Types

Testicles

Alkylators (such as cyclophosphamide and procarazine)

Removal of both testicles

Pelvis

Heavy metals (such as carboplatin and cisplatin)

Retroperitoneal lymph node dissection (RPLD)

Head or brain

Non-classical alkylators (such as dacabazine and temozolomide)

Removal of a tumor in certain parts of the abdomen

Whole body

 

Removal of a tumor in the spinal cord area

 

 

Removal of the bladder or prostate

 

 

Spinal surgery

What Reproductive Problems Can Occur?

A number of reproductive problems can occur in at-risk males, including these:

Infertility 

Infertility in males is the inability to start a pregnancy. It's not related to sexual function.

Males who have had both testicles removed will not be able to make sperm and infertility will be life-long. Infertility caused by radiation is most often permanent, too. However, sterility after chemotherapy may be short-lived or lasting. It's not possible to know if sperm production will resume after radiation. For some it can take up to 10 years to produce sperm again.

Men who have infertility as a result of brain radiation and wish to have children should see a fertility specialist. It is sometimes possible for men to regain fertility with the use of specialized hormone treatment.

Testosterone Deficiency 

Also known as "hypogonadism" or "Leydig cell failure," this condition is the inability to produce enough of the male hormone called testosterone. Testosterone is needed for muscle development, bone and muscle strength, proper distribution of body fat, sex drive, and to have erections. Males with low levels of hormones will need to take testosterone for the rest of their lives. It comes in several forms including skin patches, injections, and topical gel.

Trouble with Sexual Function 

Pelvic surgery, such as retroperitoneal lymph node dissection (RPLD), and spinal surgery may cause nerve damage that prevents ejaculation of sperm. Removal of the prostate or bladder may cause problems having an erection, ejaculating, or both. In these cases, sperm production may be good and fertility still possible by using special techniques. These techniques include sperm harvesting and artificial insemination. If fertility is desired, consultation with a fertility specialist is recommended.

Low Sperm Count 

Sperm counts vary from day to day and sperm counts may improve over time. Men with low sperm counts may benefit from assisted reproductive techniques, such as in vitro fertilization. But even men with low sperm counts should use contraception if they do not want a pregnancy to occur.

Should I Be Checked for Reproductive Problems?

All childhood cancer survivors should have a long-term follow-up visit every year. If you are at risk for reproductive problems your check-up should include careful evaluation of your hormone and puberty status.

Your doctor might order a blood test to check your hormone levels. If any problems are found, you may be referred to a doctor who specializes in hormones (endocrinologist), male reproductive organs (urologist), or fertility. Boys who have both testicles removed should have regular check-ups with an endocrinologist starting at about age 11 years.

Sexually active men who are worried about their fertility should request a semen analysis. Not all insurance companies will cover this test. Be sure to check your insurance coverage for it and ask your clinic or hospital how much it costs. When sperm count is normal, natural conception can occur. If sperm count is low or absent, the test should be repeated.

What If I Have Reproductive Problems?

Many options exist for males with reproductive problems.

  • Men with low sperm counts may benefit from assisted reproductive techniques, such as in vitro fertilization. An infertility specialist can give you information on your options.
  • If you have no sperm in your semen analysis but want to have children, schedule a visit with a doctor who specializes in male infertility. Surgeons have been able to find areas of active sperm production in the testes of men who have no sperm on semen analysis. Surgical harvesting of sperm with techniques designed for men with absent or very low sperm counts has resulted in pregnancies. Other options for males who produce no sperm are to use sperm from a male donor, to adopt, and to live childfree. Sometimes infertility is caused by a non-cancer related disorder that needs treatment.
  • If you banked sperm before your cancer treatment you will need to work with a doctor who specializes in reproductive medicine to achieve a pregnancy.
  • If only one testicle was removed you should take care to protect the remaining testicle. Always wear an athletic supporter with a protective cup when taking part in activities that could injure the groin (such as contact sports and baseball). 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.

Is My Child at Risk If Pregnancy Occurs?

In most cases, risk for cancer and birth defects are not higher in children born to childhood cancer survivors. In rare cases, risk might be higher for cancers that are hereditary. Ask your oncologist if you don't know if your cancer was genetic.

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