Understanding the Impact of Testicular Cancer on Fertility
Testicular cancer is known to adversely impact male fertility by disrupting sperm production and damaging sperm DNA. However, thanks to advances in sperm preservation and reproductive technology, many men successfully regain fertility and go on to become fathers after testicular cancer. Maintaining and even improving fertility potential after treatment is possible.
How Testicular Cancer Affects Sperm Health
Treatment for testicular cancer can influence a man’s fertility in several ways. The degree of impact depends on the stage of cancer, treatment type, and the patient’s baseline sperm quality.
Before Treatment
Even before therapy begins, some men already experience compromised sperm count or quality. Azoospermia, the absence of sperm in the ejaculate, affects about 1% of all men and between 10–15% of men with infertility. Research shows that up to half of men with testicular cancer have at least one abnormal semen parameter before treatment begins. Testicular cancer destroys normal sperm producing testicular tissue, causes increased metabolic responses in the testicle, which is adverse for sperm, and many testicular cancers have paracrine effect; they release hormones locally in the testicle that are bad for sperm.
Loss of One Testicle (Orchiectomy)
Most testicular cancer cases involve the removal of a single testicle. In the majority of cases, the remaining testicle produces enough sperm and testosterone to preserve fertility. However, if sperm quality was already low before surgery, fertility may remain affected.
Chemotherapy and Radiation
Chemotherapy and radiation target rapidly dividing cells, including sperm-producing cells. As a result, these treatments can reduce sperm count, impair motility, and damage sperm DNA. Radiation may also affect spermatogonial stem cells or the “healthy” testicle, even with protective shielding.
Surgical Impacts
For some men, additional surgery is needed to remove lymph nodes in the abdomen (retroperitoneal lymph node dissection). This procedure carries a small risk of nerve damage that can interfere with ejaculation, leading to retrograde ejaculation, where semen flows backward into the bladder, or anejaculation, where there is no semen release.
Improving Sperm Health After Testicular Cancer Treatment
The good news is that many men experience improvement in sperm production and quality after treatment. Advances in microsurgery, sperm preservation, and assisted reproductive technology (ART) have made fatherhood increasingly possible after testicular cancer therapy.
Dr. Parviz Kavoussi, Austin-based reproductive urologist, notes that sperm health can improve gradually after cancer treatment, but recovery varies depending on the type of therapy, patient age, and baseline sperm quality. “Sperm production is remarkably resilient,” says Dr. Kavoussi. “For many men, it recovers over a period of months to years once chemotherapy or radiation has stopped. Regular follow-up and semen testing are key to tracking that progress.”
Recovery Timeline
Many men experience a gradual return of sperm production within 18–24 months after treatment. Most specialists recommend waiting at least one year before testing fertility, allowing time for the body to clear damaged sperm and generate new, healthy sperm.
Partial Recovery Is Common
While some men never return to their pre-cancer sperm parameters, they may still produce enough viable sperm to conceive naturally. Others may use assisted reproductive technologies to achieve pregnancy.
Surgical Sperm Retrieval Options
For men who remain azoospermic, microsurgical procedures such as micro-TESE (microdissection testicular sperm extraction) can often locate viable sperm within the testes for use in fertility treatments.
Assisted Reproductive Technologies (ART)
Even when natural conception isn’t possible, men can still father children through intracytoplasmic sperm injection (ICSI) using retrieved or banked sperm. In vitro fertilization (IVF) and intrauterine insemination (IUI) are also used to help with conception.
Practical Steps and Recommendations for Fertility Preservation
Dr. Kavoussi emphasizes that “fertility preservation can help men have children,” even after cancer therapy. Below are key steps and recommendations to consider for maintaining fertility after testicular cancer:
Dr. Kavoussi emphasizes that “fertility preservation can help men have children,” even after cancer therapy. Below are key steps and recommendations to consider for maintaining fertility after testicular cancer:
1. Wait for an Appropriate Recovery Period
Most men are advised to wait 12–24 months before attempting conception or undergoing semen testing to allow time for potential sperm recovery.
2. Bank Sperm Before Treatment (If Possible)
Cryopreserving sperm, optimally prior to surgery to remove a testicle, but certainly before chemotherapy and radiation, provides a valuable safety net in case post-treatment fertility is compromised.
Further Reading:
New Study Finds Link Between Male Infertility and Testicular Cancer
Sperm Quality and Chemotherapy
