What is fertility? (guys)

The word “fertility” is used to describe the ability to have children biologically. Some cancer treatments can affect fertility. You may not yet be thinking about whether or not you want to become a parent someday. However, knowing about possible fertility effects of treatment now may help you take steps now to plan for the future.

Cancer treatment and fertility

Some fertility effects may last for a little while; others may be permanent. Risk for future fertility problems include your age at the time of your treatment, and the type and length of your treatment.

Some possible effects of cancer treatment

• High doses of radiation to the brain (and some chemotherapies) can affect your body’s ability to make sperm.

• Alkylating agents—like cyclophosphamide or procarbazine—have the biggest effect on fertility. Other drugs are generally less harmful to sperm-forming cells, but can still cause fertility problems, especially when used as part of combination medicine therapies.

• Higher doses of radiation may cause your body to permanently stop making sperm.

• If radiation is used on or near your testicles, your ability to make sperm could be affected for a while. But it could potentially return to normal later on. The effects of chemotherapy on sperm production may also be temporary.

• Radiation can affect testosterone, the male hormone. This side effect can either delay or speed up puberty. It may also affect your ability to have an erection.

 Talk with your doctor if you think you may be going through puberty early (before age 13) or late (after age 15). The doctor may want to give you medicine to assist with the hormone balance. You can also talk with your doctor about a test to see if your body is making sperm.


Planning for the future

There are options that may be available to you to help you preserve your fertility. Some of these options require action to be taken before treatment begins, while others can wait until during or after treatment. 

Before treatment

Sperm banking. You may be able to donate sperm cells, which can then be frozen and stored. This is called sperm cryopreservation (or sperm banking or donation) and has the highest likelihood of success for male cancer survivors.

It may seem like an embarrassing topic, but your doctor or nurse will work with you to explain the process for collection and delivery, with your privacy in mind.  Our specialists are comfortable talking about this—and can help ease any fears or discomforts you may have about the process of sperm banking.

During treatment

Radiation testicular shielding. If possible, the doctor can put a shield over your pelvic area to protect your reproductive organs from radiation. 


Before or after treatment

Testicular sperm extraction (TESE) Under general anesthesia (where you aren’t awake at all) a surgeon removes a small piece of tissue from your testicle. Any sperm cells found in the tissue can be removed and frozen for later use. TESE can be done before or after puberty. It is still considered an experimental procedure in boys that haven’t yet reached puberty.


After treatment

Donor sperm. When you are eventually ready to start a family, you can use sperm from an anonymous donor to produce a pregnancy through in vitro fertilization.


An important conversation on a sensitive topic

It is important to talk your oncologist about the fertility effects of your treatment, ideally before you start treatment. Our specialists can answer any and all questions—even the ones that feel embarrassing—about fertility preservation.

We will keep your concerns and private information confidential.

It is important to remember that even if you have been told by your doctor that you may have long-term fertility issues, it does not mean that you cannot get someone pregnant or get a sexually transmitted disease. So, always practice safer sex.

What about pregnancy? (guys)

While you are having cancer treatment is not a good time to get your partner pregnant, or have a baby, because chemotherapy medications may damage sperm. The damage to your sperm could cause serious birth defects if you get your partner pregnant. It is important to talk with your oncologist before making plans for a pregnancy or if your partner becomes pregnant.

When am I not allowed to have sex?

For example, it’s not safe to have sex when your blood counts are too low because your body might not be protected from normal bacterial when your immune system is weak.  Also, the thin lining of the vagina and anus can be easily torn – so a low platelet count (platelets help your blood to clot) increases the risk of serious bleeding.  There can still be some risks, even while your blood counts are at an acceptable level. So, in order to protect your health, carefully consider the decisions you make about having sex and talk to your doctor for more information about your situation.

When can I have sex again? (girls)

With time, your usual sexual feelings will return. You may have sex when you feel ready. And it’s okay to wait until you have completely recovered.

When you are ready, take it slow. Let your partner know how you feel. Tell her or him what you would like and what feels good. Depending on your health, you may need to find new ways of pleasing each other. For example, you may need to change positions to make having sex more comfortable.

Talk to your doctor about birth control, if you have questions.

What are some other ways to stay close?

You may feel too tired, weak or unwell to have sex. At the same time, you may be worried that you aren’t satisfying your partner’s sexual needs. Don’t worry. Relationships can survive without sex. You might both enjoy many other kinds of physical touch right now, like cuddling, holding and kissing each other.  You can also show feelings of love and caring through other activities together.

Depending on your counts, you may be able to masturbate but it’s a good idea to check with your doctor first.

Will it help me to talk about it?

Even though it can be hard to open up, you may feel relieved if you tell your partner about your feelings, worries, or fears. Talking helps you understand and support each other . Together, you may find new ways to work around problems and make changes in your relationship.

If you feel stressed out or overwhelmed, you may find it helpful to talk with a sympathetic person. This could be a close friend, family member or another person who has cancer.

Please consider talking to a member of your healthcare team. Although it may be hard to bring up this topic, we are used to discussing sex with patients.

What about changes in my body and mind?

It’s normal to have both long and short-term relationships. If you are in a caring relationship, your partner probably means a lot to you and likely gives you support and affection. When you are faced with cancer, you may feel differently about a lot of things, including your relationship. This is normal.

You might feel differently because your focus has shifted to your health. Or maybe you just don’t feel like yourself. Both are common experiences.

You may not feel like being close in a sexual way with another person when you think that you look different. Cancer treatments can change your body in ways that you think make you less attractive. These changes may include losing your hair, losing or gaining weight, or having scars from surgery. It’s normal not to feel like having sex when you are concerned about how you look.

You may also feel very tired. Having less energy can make you less interested in having sex. Fatigue can last a long time, even after treatment has stopped.

These changes in your body and mind affect how you respond to sexual thoughts and situations. For boys, you may not get as erect (hard) or ejaculate (cum) as usual. For girls, you may not get aroused or be able to orgasm. It’s important to remember most changes are temporary.

What is sexuality?

  • How you see yourself as a man or woman
  • Wanting to be close to someone
  • Feeling horny, wanting to have sex
  • Your body’s response to sexual feelings
  • How to satisfy yourself

Having cancer may affect any of these things.

What does it mean when you talk about sex?

  • It means much more than “having sex.” Having sex means sexual activity, such as vaginal, oral or anal sex and masturbation.
  • It means everything relating to your thoughts, feelings and experiences with sex. This is called sexuality.

Sexuality is a normal, healthy part of life.

What methods of birth control are safe? (male)

It is important to know that event though you may have been told that your treatment could affect your fertility, it is still possible to get your partner pregnant.

Protect yourself by using a latex condom with spermicide every time you have vaginal sex. Condoms also protect you from sexually transmitted infections.

If you have questions about birth control, talk with your oncologist.