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.