Chemotherapy is a common form of cancer treatment that uses powerful medications to kill cancer cells. But chemotherapy also affects healthy cells, including sperm, potentially causing problems with fertility – your ability to have children.
Chemotherapy can cause a low sperm count causing permanent or temporary infertility.
The quality of sperm can also be affected by chemotherapy. This can result in birth abnormalities if you father a child during or shortly after completing treatment with chemotherapy.
Common chemotherapy medications – like cisplatin and doxorubicin – carry a risk of infertility in males.
Sperm banking is an effective method of fertility preservation for males. Talk to your oncologist about your options for sperm banking before starting treatment.
It’s essential to avoid fathering a child while on chemotherapy. You may have to wait months to years after chemotherapy before trying to have children.
How does chemotherapy affect sperm?
Chemotherapy medications target cells that multiply fast. Because cancer cells form new cells more rapidly than normal cells, chemotherapy works well to destroy them.
But, chemotherapy medications can’t tell cancer cells apart from healthy cells. This means both cancer cells and normal cells that grow rapidly get destroyed in the process. Healthy sperm cells divide quickly and become an easy target for damage by chemotherapy.
Chemotherapy medications can affect your ability to father a child by:
- Reducing your ability to make sperm (having a low sperm count).
- Affecting sperm’s motility (ability to reach and fertilize an egg).
- Reducing your testosterone level.
Chemotherapy given to a child can also affect fertility. High doses of certain chemotherapy medications are likely to affect the cells that make sperm causing permanent fertility damage. This is known as a late effect of chemotherapy.
Is male infertility after chemotherapy permanent?
Infertility during chemotherapy may be temporary or permanent. Some men develop a low sperm count while receiving chemotherapy. After treatment, the chance of fertility increases, but this may take months or years. For some, sperm production might completely stop leading to permanent infertility.
In addition to reducing the ability to produce sperm, chemotherapy can harm the cells that make testosterone. Low testosterone may cause you to make less sperm which decreases your ability to conceive a child.
Moreover, research suggests that chemotherapy can affect sperm’s DNA which could result in serious or life-threatening birth abnormalities if you father a child while receiving chemotherapy or shortly after completing treatment.
What chemotherapy medications affect sperm?
Many chemotherapy medications, especially alkylating drugs, can interfere with fertility in males. Some examples of chemotherapy drugs that can lead to infertility in males include:
- Nitrogen mustard (mechlorethamine).
The risk of infertility after cancer treatment depends on factors such as the type of cancer, age, fertility status before treatment, type of treatment, and dose of medications.
For example, if your treatment plan includes a combination of chemotherapy and radiation therapy to the abdomen (belly) or pelvis area, your chances of permanent fertility damage are increased. Likewise, the risks of infertility are higher if you receive high doses of chemotherapy medications.
The commonly used chemotherapy medications below have a low risk of causing infertility in males:
- 5-fluorouracil (5-FU).
- Etoposide (VP-16).
What about fertility preservation?
Sperm count may recover naturally after cancer treatment, and you may have no problem fathering a healthy child. But it’s difficult to know if there is a chance that chemotherapy will affect your sperm. In this case, you may consider fertility preservation.
One type of fertility preservation for males who have gone through puberty is sperm banking. This option involves collecting, freezing, and storing sperm cells before cancer treatment. When you’re ready to start a family, you may use your stored sperm to father a baby.
Not everyone is eligible for sperm banking. If your sperm count is too low before cancer treatment, it may not be possible for you to bank sperm. In other cases, you may need to start treatment immediately and not have enough time to donate and bank your sperm.
It’s important to consider the cost of sperm banking, which averages $500 to $1000 for collection. There is an additional annual storage fee of $150 to $300. While health insurance coverage may be limited, some companies offer financial assistance to cancer patients who need help paying for fertility preservation.
For boys who have not gone through puberty, sperm banking is not possible because they are not yet producing sperm. However, testicular tissue freezing may help preserve fertility. But this option is still being researched and is considered experimental.
If sperm banking is not an option, and you learn that you are infertile after cancer treatment, there are alternatives. For example, you may use donor sperm or consider adoption.
Questions to ask your healthcare provider
If chemotherapy is part of your cancer treatment, talk to your oncologist about the possible effects on your fertility before starting treatment. You can then make decisions about preserving your fertility if it is an option.
Here are some questions to ask your cancer care team:
- Can the treatment increase my risk of infertility?
- Are there other appropriate treatments that will not affect my fertility?
- What are my options to preserve my fertility?
- Will fertility preservation delay my cancer treatment?
- Would you recommend that I talk to a healthcare provider specializing in fertility?
- What are the chances my fertility will return after treatment?
- Where can I find support for coping with infertility?
Chemotherapy can damage sperm quantity and quality. This often results in infertility which can be permanent or temporary. Additionally, chemotherapy can harm an unborn baby by causing birth abnormalities. It’s very important to use barrier contraceptives and avoid unprotected sex during chemotherapy and for a while after finishing treatment. Your oncologist may recommend waiting two to five years after completing chemotherapy before fathering a child. That’s because it may take up to two years for your body to get rid of any damaged sperm.