Cancer Treatment and Male Fertility

Cancer Treatment and Fertility

• Discuss potential infertility with care team prior to starting cancer treatment and when new treatments are initiated.
• Cancer treatments can damage sperm and germ cells, impacting fertility.
• Sperm is produced in the seminiferous tubules located in the testicles, with continuous production making it susceptible to chemotherapy damage.
• Prior to puberty, sperm production does not occur, but germ cells are present and can also be affected by chemotherapy and radiation.
• Azoospermia (absence of sperm) does not impact sexual function but affects fertility.
• Leydig cells in testes produce testosterone and are less sensitive to radiation compared to sperm and germ cells.
• The pituitary gland produces LH and FSH hormones essential for sperm and testosterone production; damage from brain radiation can compromise this function.
• Cancer diagnosis, especially in conditions like Hodgkin's disease or testicular cancer, can lead to low sperm counts (oligospermia).

Chemotherapy Effects

• Chemotherapy targets rapidly dividing cells, including cancer cells and normal cells like those in the gut and germ cells.
• Side effects from chemotherapy include diarrhea, mouth sores, hair loss, and infertility.
• There is variability in infertility risk depending on chemotherapy type, dosage, and treatment plan, particularly with alkylating agents.
• Chemotherapy drugs like chlorambucil, cyclophosphamide, procarbazine, and cisplatin can significantly affect sperm production.
• Azoospermia and oligospermia may improve over time post-chemotherapy, although genetic damage to sperm may occur and repair over varying durations.

Radiation Therapy Impacts

• High-energy X-rays from radiation therapy can negatively impact fertility by damaging sperm-producing cells.
• Infertility risk is dose-dependent; smaller doses can cause temporary effects, while higher doses can result in permanent infertility.
• Leydig cells are less affected by radiation than sperm cells, though they can still sustain damage.
• Shielding techniques minimize exposure, while fractionation delivers doses in smaller amounts, which may harm sperm differently than single larger doses.
• Total body irradiation (TBI) before stem cell transplants leads to a significant risk of permanent azoospermia, with shielding not an option.

Post-Radiation Fertility Recovery

• Sperm counts typically reach their lowest levels 4-6 months after radiation, potentially returning to pre-treatment levels within 10-24 months.
• Recovery duration may extend for those receiving higher radiation doses.

Surgical Considerations

• Removal of both testicles (orchiectomy) eliminates sperm production, affecting fertility completely.
• Surgeries affecting the prostate, bladder, urethra, or colon can lead to retrograde ejaculation, where semen enters the bladder instead of exiting through the penis.
• Retrograde ejaculation does not harm but affects fertility; sperm can still be retrieved from urine for potential fertilization.

Concerns about Childbearing Post-Treatment

• There are concerns regarding birth defects linked to sperm from cancer survivors; studies show no increased risk of birth defects or cancer in offspring not related to genetic syndromes.
• Sperm DNA may suffer initial damage due to treatments, but the damage generally repairs itself over time.
• Open discussions with the care team about fertility and options for preservation are encouraged before attempting to conceive after cancer therapies.

This quiz discusses the impact of cancer treatments on male fertility. It's essential for men undergoing treatment to understand how their sperm production and overall reproductive health may be affected. Engage with the content to learn about the necessary discussions with your care team.