Fertility and Prostate Cancer Treatment

Coping with infertility after prostate cancer treatment is a complex and emotionally challenging journey that requires time, understanding and support. Unfortunately, almost all treatment methods for prostate cancer have a high chance of affecting one’s fertility. It is impossible to have children through sexual intercourse after a prostatectomy, and radiation tends to affect fertility as well. It can be a very tough pill to swallow especially if you have unfulfilled family plans. It is normal to feel a sense of guilt and sadness if you are affected by this. Since many men with prostate cancer are older and could have already finished having children, doctors may not even raise the question of fertility preservation at the time of prostate cancer diagnosis. If family planning is a concern for you or your partner, make sure to communicate with your doctor to find out and understand what measures or actions can be taken before and after treatment to maintain fertility options.

For many men with prostate cancer, it is possible to actively take measures before treatment to preserve their fertility. If you have not started any prostate cancer treatment and are fertile, you might want to consider talking to your doctor about sperm banking to preserve your fertility.

Sperm banking involves the collection and storage of your sperm for future use. It is a relatively easy way to ensure that your options are left open in the future should cancer treatment affect your fertility. Sperm is collected through various methods. The most common method is through ejaculation by masturbation. Men who have problems ejaculating may undergo procedures such as vibratory stimulation or electroejaculation, which uses an electric probe emitting increasing frequencies and amplitudes of energy to stimulate release of semen. In other cases, sperm may be collected from urine or extracted from the testicles.

If you have a fast-growing cancer that has already spread, you will almost always have time to provide sperm banking. This process can now be done at home with kits sent in to centers that provide this service. Aggressive cancers could also render you too ill to be able to produce semen samples.

If your sperm is successfully collected and frozen, you may still have a chance of fathering biological children even after prostate cancer treatment. This may be done through intrauterine insemination (IUI) or in vitro fertilization (IVF). Notably, IVF has variable results based primarily on the female partner’s age. The rate of success of IVF ranges globally from 5–36%

In a retrospective study done on 214 cases of men post-cancer treatment undertaking IVF with their partners, a pregnancy success rate of 26% was seen per egg used, and was noted to be similar to the rate seen in infertile couples.

It is very likely that you may be infertile after prostate cancer treatment due to the nature of the treatment methods. It is normal to feel grief or sadness about losing your fertility, so do give yourself some time and allowance to process the change. If you have done sperm banking before the cancer treatment, you may still have a chance of fathering biological children. When you and your partner are ready, contact a fertility specialist to start the process. The female may need to go through some evaluation to determine the suitability of IUI or IVF.

If sperm banking was not done previously, it may be challenging to have biological children in the future. However, there are other options available should you and your partner still want to become parents.

Sperm retrieval and IVF

Most men after treatment for prostate cancer will still make sperm. After surgery, however, there will be no ejaculate, so no sperm are released from the body. With a minor procedure, sperm can be retrieved in adequate numbers and quality to use with IVF. Some men who are a year or more post-radiation therapy but are not receiving hormonal therapy could have sperm in their semen that can be used for assisted reproduction. If no sperm are present in the ejaculate, then retrieval of sperm is also possible from closer to their production site, the testes. Use of sperm in this setting will require IVF.

Donor sperm

It is possible for a couple to get pregnant with the use of donor sperm, which are donated by volunteers to sperm banks. Volunteers are assessed by factors such as their age, physical health, medical history, family medical history and sometimes genetic testing. Donors are often anonymous unless they state that they are willing to have contact with the child in the future, although genetic testing could identify even anonymous donors. After selection, the donor sperm is thawed and inserted into the female’s uterus using a long catheter. Your fertility specialist will coordinate with you and your partner to determine when the female is most fertile and carry out the procedure then. IVF may also be needed to use donor sperm if simple insemination is not successful.

Using donor sperm is a big decision that should involve both parties. Do have open communication with your partner to prevent any misunderstandings in the future.

Adoption

If you and/or your partner are not comfortable with using donor sperm, adoption could be another option. Many people go through the process of adoption, either through a public or private agency, to become parents. Most agencies are open to cancer survivors and sometimes patients but may have certain requirements regarding treatment and quality of life. If you are unsure about your eligibility, do contact the agency you are interested in to find out more. Be honest about your circumstances as the measures put in place are often for the benefit and protection of the children.

Adoption procedures often take a lot of time. While you and your partner may feel anxious about it, stay hopeful and remember to take your health into consideration. Maintain healthy habits such as a clean diet and regular exercise to ensure you are in good condition to welcome a new member to the family.

Living without children

If none of these options are suitable for you and/or your partner, you may want to consider staying child free. There are many benefits to living without children such as financial freedom and having more time for your career, hobbies and loved ones. Talk to your partner about this possibility. If necessary, do speak to a therapist or a counselor to get a broader perspective on this issue.

If you are diagnosed with prostate cancer and want to father biological children in the future, it's very important for you to discuss fertility concerns with your healthcare team early in the treatment planning process. Fertility preservation measures, when appropriate, can offer you the possibility of having biological children after completing prostate cancer treatment.