Can men have children after cancer treatment?

Sometimes. Cancer treatment can lower fertility or end it. The change may be short-term or permanent. Which one you get depends on several things. The treatment, the dose, how long it runs, your age, the type of cancer, and how fertile you were to begin with.

The decision that matters most comes before treatment starts, not after. Research has found that survivors felt less regret if they had met with a fertility specialist. That held whether or not they went on to preserve anything.

Which treatments carry the most risk

Chemotherapy harms germ cells, the cells that become sperm. Alkylating agents are the high-risk class. They damage sperm in adult men and sperm-forming cells in boys. Risk rises with high doses or with several drugs at once.

Radiation depends on where it lands. Radiation to the pelvis can affect both fertility and sexual function. That covers the anus, bladder, penis, and prostate, and it covers brachytherapy. Radiation to the brain can damage the pituitary gland and the hypothalamus. Those glands make hormones that fertility depends on. Proton beam radiation and intensity-modulated radiation therapy may affect fertility less than standard radiation does.

Surgery can interrupt the plumbing. Removing the prostate, both testicles, or the penis all affect semen production. Surgery for anal, colon, or rectal cancer can damage nearby nerves. That can cause retrograde ejaculation, in which semen is made but goes backward instead of out. Removing the bladder along with the prostate and seminal vesicles can cause infertility.

Stem cell transplant is high risk too, because of the high-dose chemotherapy or radiation given first. Hormone therapy can lower sperm count. Among targeted drugs, some studies suggest that tyrosine kinase inhibitors may lower fertility. They appear to affect sperm production and hormone levels. The effects of immunotherapy are still being studied.

The cancer itself can matter before any treatment starts. Men with testicular cancer, prostate cancer, and other germ cell cancers sometimes have poor semen quality at diagnosis. Their sperm count may be low. Men with Hodgkin lymphoma may have a low count, or no sperm in the semen at all.

What can be saved, and how

Sperm banking is the most common method for males past puberty. Semen is collected by masturbation at home, or in a private room at the hospital or clinic. Nerve damage or surgery can make ejaculation impossible. In that case a procedure called electroejaculation can be used. Sperm can be frozen for as long as needed, then thawed for in vitro fertilization.

Testicular shielding places a protective cover outside the body to shield the testicles from scattered radiation during pelvic treatment.

Testicular sperm extraction, or TESE, is surgery that takes a small piece of testicular tissue so sperm cells can be collected. It is an option for boys before puberty. It also suits men who cannot produce semen, have a very low count, or have no sperm in the semen. It can sometimes be done during cancer surgery. MicroTESE removes less tissue. Testicular sperm aspiration, or TESA, uses a needle instead, and suits men with a blockage.

Testicular tissue freezing is an option for boys before puberty and men who cannot give a sample. It is still being studied in clinical trials, so ask what is available near you.

Timing, money, and the question to ask afterward

Ask your oncologist and a fertility specialist together whether starting cancer treatment can safely be delayed for a preservation procedure. That is a real conversation with a real answer, not a formality.

Cost and availability vary. Some states require insurers to cover fertility preservation for people with cancer. The Alliance for Fertility Preservation tracks those laws. Livestrong Fertility runs a discount program and can find you a clinic. The Oncofertility Consortium has patient navigators and a clinic finder. Many hospitals have their own navigators for this too.

After treatment, ask two questions. What are the chances that people who had my treatment are fertile afterward? And how long might it take for my fertility to return? Ask a third as well: how long should I keep using birth control? Lower fertility is not the same as none, and some treatments can harm a pregnancy.

Sources

https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-men

https://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-men