Men, fertility and cancer treatment

As a man about to start cancer treatment, you may have concerns about the impact of treatment on your fertility.

The information on this page will help you to find out more about men, fertility and cancer, including ways of preserving fertility.

Fertility in men explained

Put simply, fertility for men is the ability to produce healthy sperm, be able to maintain an erection and ejaculate. The sperm needs to be of good quantity and quality. Pregnancy occurs when sperm is united with a female egg in a fertile woman. 

Theoretically, men are fertile from puberty onwards. However, the sperm quality declines as men get older (40-45 years old).  The chance of their partner (of childbearing age) becoming pregnant lessens, and the risk of miscarriage can increase.

This process can be hampered by many factors.  Fertility needs functioning reproductive organs, and a finely tuned hormone production system.  When cancer and treatments are added, it can have a temporary or permanent effect on fertility.

Cancer and men’s fertility

There are a range of cancer treatments which can affect a man’s fertility.  Your specialist doctors and healthcare team should explore how you feel about fertility issues before you start treatment.  This is so that measures can be taken to preserve your fertility where possible. 

Don’t hesitate to let your team know if you might be planning  another child after your treatment finishes. Sometimes, assumptions may be made that if you already have a child, fertility will not be so important. However, it can be an important consideration.

Preserving your fertility

There are a few ways to help preserve fertility in men. The methods usually focus on sperm collection.  The sperm (in semen) is frozen and stored - known as sperm banking.  Even if you’re not planning a child at present or in the near future, sperm banking is something important to consider.  To teenagers and young adults, the thought of a future family of their own may feel the last thing on their minds.

Sperm collection

Males having cancer treatment are referred to specialist fertility clinics . The specialist doctors will explain the reasons why sperm collection is necessary before treatment,  and the methods of collection. 

Your doctor will explain which procedure for collection is best, based on your age, your cancer type, and the cancer treatments you'll be having. Giving a sample after cancer treatment has started is not recommended, as treatments can damage the sperm. 

The easiest way for a teenager/man of fertile age to collect sperm for collection, is by masturbation. Your privacy will be respected, and the clinic staff will understand that you may feel embarrassed. If you live within a few miles of the hospital, you may be able to produce the specimen at home, and bring it in the clinic.

Not all men are able to provide semen for collection, so doctors can take a specimen of sperm directly from the testes (testicle). This is carried out under sedation or general anaesthetic. 

Some men have retrograde ejaculation.  This is when sperm/semen go backwards, into the bladder. In these cases, sperm can be extracted under special conditions, in a urine sample.

The NHS will store your sperm for ten years. For men with cancer, sperm can be stored up to the age of 55.  If you’re having your treatment privately you'll need to pay for sperm storage.

For some men, infertility may be permanent. However, for others, once cancer treatments have finished, and after a period of time, fertility may return naturally.

It is advisable to take contraceptive precautions whilst on treatment as cancer treatments can damage sperm.  Your doctor will be able to tell you which contraceptive method is most suitable for you alongside your treatment.

Treatments which may affect fertility 

There are a number of cancer treatments which can affect a man’s fertility:

• Surgery -  surgery to male reproductive organs can cause infertility. This includes surgery of the testicles, penis, prostate and some bladder operations.  It may be that you can no longer produce sperm, or are unable to maintain an erection and ejaculate. Specialist doctors will try to preserve fertility wherever possible.
• Chemotherapy - many chemotherapy treatments can affect fertility.  The return of fertility can depend on how old you are, the type of chemotherapy you have, and the dose strength.  Contraception is advisable during your chemotherapy treatment.  It can take some years for sperm production to resume, after chemotherapy.  You will usually still be able to have sex normally.
• Radiotherapy -  if you have testicular cancer, radiotherapy treatment may be aimed at the testicles.  This can stop or damage sperm production. Pelvic radiotherapy can also affect your fertility, as it may impact on your reproductive system. 
• Radiotherapy (prostate) - Brachytherapy (radioactive seeds) may be used to treat prostate cancer, but it doesn't always impact on fertility. However, external radiotherapy to the prostate area may affect fertility permanently.
• Radiotherapy (brain) - used to treat areas in the brain, may impact on the pituitary gland, affecting hormone production and fertility.
• Targeted/immuno/biological therapies - these treatments are relatively new, so there isn’t a great deal of information on how they affect fertility.  Some targeted therapies, however, have been found to cause fertility issues. Your specialists will explain which therapy drugs may be used, and how they impact on fertility.
• Hormone therapy - Hormone therapy is a treatment used for some prostate and other cancers.  They reduce the production of sperm during treatment and also impact on sex lives - as they can temporarily cause impotence, and loss of sexual desire. Fertility usually returns after hormone therapy finishes.
• Bone marrow and stem cell transplants - these treatments usually stop sperm production.  It’s therefore important to discuss fertility before starting this form of treatment.

Fertility after cancer treatment 

After cancer treatment, you may start thinking about having a family. It can sometimes take time to reach this decision.  You’ve been through a great deal, and it takes a while for the mind and body to recover. You may be concerned about what happens if your cancer comes back. 

Your specialist may recommend waiting a period of time before you and your partner try to have a baby. You both may need additional help and support.  You can ask your specialist to refer you to a fertility clinic for help and support.

Some men may find having sex difficult after having cancer treatment - either for physical or psychological reasons.  You can find out more in our section on sex, intimacy and cancer.

You may have some concerns about whether your cancer has a genetic cause, and this can sometimes be a consideration before trying for a family after cancer.  Talk through your worries with your specialist team. They can refer you for genetic counselling if your risk factors are higher than normal.  Read more in our section on cancer in families.

Sometimes, couples decide that having their own biological child becomes less of an issue, after having cancer.  Some people opt to try for adoption, or sperm donation.

If having a child doesn’t happen, you may experience sadness, grief and loss. These feelings can take time to come to terms with, and be difficult, after all that you’ve been through.  There are organisations which can help address these natural feeling - Fertility Network UK, for example.  You can also ask for counselling, which can help resolve and address the range of emotions you’re experiencing.

Cancer, children’s fertility and cancer

Some cancer treatments can cause infertility in children and teenagers, as a late effect. It is something your child’s consultant should discuss with you and your child (if they are at age to understand).  There are a number of preserving fertility measures that can be taken.

For example, researchers are looking at preserving testicular tissue for young boys with cancer. It is a specialised area, and individual procedures are changing as new ways of preserving fertility are found. You can find out more in the links at the bottom of the page, or checking with your child’s specialist team.

How Maggie’s can help

At whatever stage of cancer and its treatments you’re at - you may be finding fertility issues worrying. You might have questions, or need to talk through the emotions you’re experiencing. Personal relationships can be affected by all the stresses cancer brings. 

Maggie’s can provide support and information - as well as ways to relieve stress, and strategies to cope.  You can attend as a couple, or as individuals.  Ask about Maggie’s ‘managing relationships’ workshops. 

You can spend time talking with others, or in a ‘one to one’ with one of our cancer support specialists.  Drop into your local Maggie’s centre to find out more.  You can also look through our online links and blogs to access more information.

Last review: Mar 2022 | Next review: Mar 2023