Testicular Cancer (TC) Treatments and Fertility
Fertility issues are complex and frustrating for any couple. When you add the dynamic of testicular cancer (TC) to the mix, then the issues become even more complicated. Fortunately, testicular cancer can be treated quite effectively. However, the treatments can often introduce new fertility issues to a situation that may already be fraught with them. Often, men who have TC also have pre-existing fertility problems.
How Orchiectomy Affects Fertility
One of the treatments used in addressing testicular cancer is orchiectomy - the removal of the testicles. In this surgery the penis and the scrotum are left intact and the testicle is removed. It is done to halt the production of testosterone in the man's body. In order for prostate cancer to continue growing, it needs testosterone. The absence of this hormone causes the tumor to shrink and bone pain associated with the cancer is relieved considerably. Although it doesn't always wipe out the cancer, it does prolong life and provide relief. For most men with TC this procedure is fine but if the man has an undescended testicle or one that is atrophied, banking some sperm before the surgery is advised as this surgery can leave a man sterile.
RPLND - Changing Direction
Retroperitoneal lymph node dissection (RPLND) is a method used in the treatment of TC. This procedure removes abdominal lymph nodes to treat the cancer and also to determine stage and type of cancer. Since cancer spreads in a well-known pattern, examining lymphatic tissue determines how far the disease has spread and what treatments can be effectively used. One of the side effects of RPLND is retrograde ejaculation. This is a situation when semen no longer comes out of the penis during ejaculation, but rather backs up into the bladder. The reason for this is the severing of sympathetic nerves during the operation.
In the 1990s urologists developed an approach that allowed the doctors to identify the nerves, and dissect them free of lymphatic tissue before removing any of the lymph nodes. Known as Nerve Sparing Retroperitoneal Lymph Node Dissection, when done properly, it can prevent retrograde ejaculation almost 100% of the time. If, after an RPLND is performed retrograde ejaculation still occurs, it does not mean the man is sterile. The sperm is still there, it just has to be accessed in a different manner. This is where ICSI comes in.
What Chemotherapy Can Do
Fertility is temporarily affected by chemotherapy - which happens to do a very good job at killing testicular cancer - by killing germ cells. Chemotherapy affects sperm growth because sperm are generated by germ cells. Chemotherapy usually results in azoospermia (the absence of sperm) during therapy. In most cases, even though sperm is absent during therapy, it will increase within two to three years following the end of treatments, with about 50% of men achieving normal levels once again. However, many men end up with very low sperm counts even after five years from the end of treatment. The more chemo received, the less likely fertility will return. Since there is such a high probability of infertility for an indefinite period of time after chemotherapy, men are encouraged to bank sperm prior to treatments.
How Radiation Affects Male Fertility
Seminoma (germ cell testicular cancer) has been treated over the years with radiation. Although it has been thought that this kind of treatment will render a man sterile, there is no medical evidence that would occur. Of course, high levels of radiation aimed directly at the testicle will sterilize a man, but this type of treatment is only used in cases of carcinoma-in-situ, where the cancerous cells are all in one place. If high potency radiation is necessary, then banking sperm is necessary as well. There may be a temporary reduction in sperm with regular radiation therapy, no permanent damage normally ensues. Some oncologists recommend waiting one or two years to try conceiving while others say six months is sufficient. It is a good idea to bank sperm before the beginning of treatment just to be sure.
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