Fertility in men after cancer treatment
It can take time to move forward with life after cancer treatment. The decision to try to have a baby is a big one for anyone to make. You may have worries and questions about fertility that did not seem important before cancer treatment. When you are ready, you can talk to your cancer doctor again for more advice.
If you have been told there is a chance your fertility will recover after cancer treatment, you may decide to wait and try to have a baby naturally. Your cancer doctor can give you more information about when your fertility might come back and what to expect. Depending on the type of cancer and your cancer treatment, they may advise you to wait for some time before trying to have a baby. This is to make sure you are producing healthy sperm again.
Often it is hard to know exactly how or when your fertility will recover. Fertility testing can check if you are producing sperm and if the sperm are healthy.
You may be able to store your sperm before cancer treatment. If your fertility does not return after cancer treatment, you may be able to use your own frozen sperm to help you have a baby. If you did not store sperm before cancer treatment, you may decide to use donor sperm.
For some people, deciding to have fertility treatment can be hard. This may be because of moral, cultural or religious views. You may want to talk to a partner, family member, religious adviser of fertility clinic staff about any concerns you have.
Talking to other people can be helpful while you are thinking about your options. Whatever you decide, there are organisations that can support you, such as the British Infertility Counselling Association (BICA).
Worrying about cancer coming back
It is natural to worry about cancer coming back. No one can tell you exactly what will happen in the future. But your cancer doctor may be able to give you information about what is likely to happen. For some people, the risk of cancer coming back gets less as time goes on. They may decide to wait a few years before trying to have a baby.
Cancer and family history
Some people worry about passing on cancer or cancer genes to their children. Cancer cannot be passed from a parent to a child. A small number of people have an inherited cancer gene that increases their risk of getting cancer. But this is rare, and most cancers are not caused by inherited cancer genes. Talk to your doctor if you are worried about the risk of cancer in your family.
If you are single or in a same-sex relationship
If you are single or in a same-sex relationship and you want to have children, you can become a parent through:
- adoption or fostering
- co-parenting – an agreement to conceive and raise a child with someone who is not your partner
There are laws about becoming a legal parent in all these situations. The Human Fertilisation and Embryology Authority (HFEA) has more information. If you are in a same-sex relationship, organisations such as Stonewall and Pink Parents also provide information and support.
Not having children
Some people decide not to have children. This may be a clear choice they are happy with. Sometimes it is more complicated. You may feel the choice has been taken away from you because of cancer. You may find this very upsetting. It may help to talk to someone about this. There is no right or wrong way to feel. Everyone is different.
Your GP can give you support and may suggest a counsellor for you to talk to. Or you can call us on 0808 808 00 00. Other organisations can also provide emotional support, such as:
Below are some questions you might want to ask your medical team after cancer treatment.
- How long should I use contraception for after cancer treatment?
- When should I have tests to check my fertility?
- My partner and I want to try to get pregnant naturally. When can we start trying?
- What are my options for having children?
- Which fertility treatments will help me?
After cancer treatment, you can have your semen tested to find out if you are producing healthy sperm. Being able to get an erection and ejaculate does not always mean you are fertile. Sometimes the semen may not have any sperm in it.
Your cancer doctor or GP can arrange a time for you to give a sample by masturbation. This test is available free on the NHS. You can also pay to have it done privately. If needed, the test can be repeated to see if things have changed. If you had sperm frozen before cancer treatment, you can also ask for this to be tested.
If you cannot give a sample by masturbation, you may be able to have a sample extracted from a testicle. Your fertility doctor can tell you if this is an option for you.
A fertility specialist will talk to you about the results of the tests.
If cancer treatment has damaged your fertility or made it difficult to have sex, you may decide to have fertility treatment. If you have a partner, you can talk with them about this. Your doctor can talk to you about your options.
At the fertility clinic, the doctor will talk to you about your fertility and treatments that may help. They will answer your questions and arrange any tests you need. Your fertility doctor will also ask you questions about your lifestyle. This can help them see if there are changes you can make that might help improve your fertility.
The person you have fertility treatment with will need to have tests and answer questions about their lifestyle too.
Fertility treatment does not always result in a pregnancy. Your fertility specialist will talk to you about this.
Many children have been born using fertility treatments. There do not seem to be any long-term health risks to the child. Your fertility doctor can give you more information about any possible risks of these treatments.
Where to get fertility treatment
This depends on whether you have NHS treatment or private treatment.
Your GP can tell you which clinics offer NHS treatment in your area. If you have already had fertility preservation or fertility tests, you may be able to go back to the same clinic.
For private treatment, you can choose a clinic. You can arrange this yourself, but it can be useful to have a referral letter from your GP.
You can get details of all the fertility clinics in the UK from the Human Fertilisation and Embryology Authority (HFEA). The HFEA also provides advice about choosing a clinic.
How much fertility treatment costs
The NHS may pay for a certain number of fertility treatments. There are rules about funding fertility treatment on the NHS. The rules and funding are different across the UK. If you decide to have fertility treatment with a partner, it is important to remember these rules apply to them too. Your GP, cancer doctor or fertility doctor can give you information about this.
Private fertility treatment
Some people choose to pay for some, or all, of their fertility treatment privately. You may consider this if:
- you are not eligible for NHS treatment
- you are worried about NHS waiting times
- the NHS does not provide the treatment you want or need.
There are no standard charges for private treatment. You can contact clinics directly to find out which treatments they offer, how much they charge and their success rates.
Types of fertility treatment
Fertility treatments you may be offered include:
Intra-uterine insemination (IUI)
This is also known as artificial insemination. A fine tube is used to insert your sperm directly into the womb. This is done at a time when an ovary is most likely to release an egg.
In vitro fertilisation (IVF)
Eggs and sperm are mixed together in a laboratory to see if any eggs fertilise and become embryos. If suitable embryos develop, one or sometimes more are transferred into the womb using a fine tube. Any other embryos can be stored for future use.
Intra-cytoplasmic sperm injection (ICSI)
This is done in a laboratory. Under a microscope, a fine needle is used to inject a single sperm directly into each egg. If any eggs fertilise and become embryos, one or sometimes more are transferred into the womb. Any other embryos can be stored for future use.
Fresh or frozen sperm can be used with any of these treatments.
Sometimes, sperm samples that have been collected using surgery or that have been frozen have a lower sperm count or quality. Intra-cytoplasmic sperm injection (ICSI) is usually used in this situation.
If you decide to use your frozen sperm, it will be carefully thawed in a laboratory when it is needed. If you did not store sperm before cancer treatment, it may still be possible to use your fresh sperm. Your fertility doctor will talk to you about your options.
If your sperm count is low
If you are producing sperm, but not very many, you may be able to start a pregnancy by having sex. But your chances of starting a pregnancy are likely to be higher using ICSI or IVF. You may also decide to use sperm you stored before cancer treatment.
If your hormone levels are lowYour body needs hormones from the pituitary gland and the testicles to produce sperm. Some cancer treatments can affect your hormone levels. Low testosterone levels can make it difficult to get an erection and can leave you with a lower sex drive. It can also cause other problems, such as thinning of the bones (osteoporosis), tiredness and a low mood.
If your testosterone levels do not recover, you can take testosterone replacement therapy (TRT). TRT is usually given as injections or a gel or patch on your skin. TRT can help with sex drive and erections. But your body may not be able to make sperm when you are taking it so you may not be able to make someone pregnant while taking it. It is important to still use contraception, even if you do not want to start a pregnancy.
If you want to start a pregnancy, it may be possible to have gonadotrophin replacement injections instead. These may help start sperm production again. You usually have these injections for up to 2 years. After that, you start taking TRT again.
If your body does not produce sperm
You cannot start a pregnancy by having sex if your body does not produce sperm. If you stored sperm before cancer treatment, this can be used with IVF, ICSI or IUI. Or you may choose to use sperm from a donor.
If the cancer treatment has affected the pituitary gland, but not the testicles, you may be able to have gonadotrophin replacement injections. These may help start sperm production again. You have the injections regularly until you have been able to:
- start a pregnancy by having sex
- give sperm samples to use with IVF or ICSI.
It can take several months of injections to start sperm production. Your fertility doctor will tell you how often they will test your sperm to see if the injections are working. Usually you have injections for up to 2 years. After you stop these injections, you stop producing sperm.
If you cannot have sex
Rarely, cancer treatment causes changes that mean you might not be able to have sex. You may find it difficult to get or keep an erection. This is called erectile dysfunction. This can be very difficult to cope with. If your body is still producing sperm, your doctor may be able to collect sperm for IVF or ICSI. If you stored sperm before your cancer treatment, you may be able to use this. Or you may decide to use sperm from a donor.
If your sperm was not stored before cancer treatment and it has made you infertile, you could use donated sperm. Choosing to use donated sperm can be a hard decision. The fertility doctor will offer you and a partner counselling to help.
You may have to wait to find a suitable donor. Some people decide to use sperm from sperm banks in other countries.
Treatment with donor sperm may not be funded by the NHS in some areas of the UK. The staff at your fertility clinic will know more and can talk to you about this.
Everyone who donates sperm in the UK (a donor) is seen by a doctor at the fertility clinic before they donate. The fertility doctor examines them and asks them questions about their medical history. They also test them for infectious diseases, such as HIV, hepatitis B, hepatitis C and some genetic conditions.
You can be matched to a donor by:
- ethnic origin
- eye colour
- hair colour
- physical build.
The staff at the fertility clinic can give you more information about this.
All UK donors must agree to their details being available in the future. Any child born from fertility treatment using a donor can ask for the donor’s details when they are 18 years old.
Some people ask a family member to be their donor. They still have the same tests as any other donor.
Unfortunately, there is always a risk fertility treatment will not work. This might happen to anyone having fertility treatment, not just people affected by cancer.
Your chance of starting a pregnancy may be affected by the type of cancer treatment you had and your fertility test results. Your fertility doctor will explain this before you start fertility treatment. But it is still upsetting if treatment does not work.
Some people decide to try again. But this can be a hard decision to make. Fertility treatment can be emotional and stressful. And if you are paying for treatment, it can be expensive.
You may want to think about whether adoption, fostering or surrogacy are right for you.
If you would like to talk about how you are feeling, it may help to:
- talk to a counsellor in a fertility clinic for support and advice
- speak to an organisation that offers counselling, such as the British Infertility Counselling Association (BICA)
- ask your healthcare team about support groups in your area.
You can also join our Online Community to talk to other people who are going through the same thing.
Some people cannot have fertility treatment. And some decide they do not want treatment and prefer to have a child another way.
If you are thinking about adoption, fostering or surrogacy, it may help to:
- talk about it with family or friends
- talk to someone who has become a parent this way
- find out more from a support organisation.
Make sure you get all the support and information you need to make the right decision for you.
Adoption and fostering
If you do not want to use medical treatment to help you have a child, you could consider adoption or fostering.
Adoption means becoming the legal parent of a child. Fostering means looking after a child who cannot stay with their own family. This might be short or long term.
People from all backgrounds can apply to be a parent in these ways. Sexuality, gender and disability should not matter. And you do not have to be in a relationship or married.
Adoption and fostering can be rewarding ways to be a parent. An organisation or local authority can arrange this. If you want to find out more, ask:
Surrogacy means a woman, called the surrogate (host), becomes pregnant and gives birth to a baby for you. The pregnancy may be started using IUI or IVF. This might be something to consider if you:
- are single
- have a partner who is unable to carry a pregnancy.
Surrogacy laws in the UK are quite complicated. Organisations can give you more information and support. These include:
Worrying about your fertility may seem hard when you are already coping with cancer. It can be difficult waiting to see if your fertility will return. Some people have a sense of loss and sadness. Others feel angry, anxious, lonely or disappointed.
You may find it helps to talk to a partner, family member or friend. If you prefer to talk to a counsellor, your GP or cancer doctor can arrange this. Many hospitals also have specialist nurses who can offer support. Fertility clinics have a counsellor you can talk to.
Talking to other people in a similar position may help you feel less isolated. Some organisations, such as Fertility Network UK, can provide this, as well as specialist advice and counselling. Or you can talk to people online. Our Online Community is a good place to start. You can also talk to our cancer support specialists free on 0808 808 00 00, 7 days a week, 8am to 8pm.
Below is a sample of the sources used in our fertility information. If you would like more information about the sources we use, please contact us at email@example.com
Human Fertilisation and Embryology Authority. Code of practice. 8th edition. October 2009 (updated October 2017).
National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment. CG156. February 2013 (updated September 2017).
Royal College of Nursing. Fertility preservation: clinical professional resource. 2017.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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