The most important thing a man can do before cancer treatment is see a fertility specialist.
This way we can get an idea of what we really have to work with for fertility preservation. Hopefully this visit will occur before he even starts cancer treatment. Some guys have certain types of testicular tumors that already cause their sperm to be very abnormal so we may very well – even before treatment – have a low sperm count, sperm volume, poor motility or a high concentration of abnormally shaped sperm. Therefore, the most important thing you can do is come see a fertility specialist and let us get a good handle on what is going on and what we have to work with.
Options for men with good sperm prior to cancer treatment
If the patient has reasonable sperm before undergoing treatment, we would encourage him to bank (freeze) as many specimens as we can get before he actually starts treatment. The optimal way to do this is to collect a sperm specimen every other day for as long as he has before he starts treatment. That will hopefully allow us to freeze multiple vials from each specimen that he produces.
Even if guys have really poor sperm counts already, we still encourage them to bank as much sperm as possible, because that may be all the sperm they ultimately have. I say this because a lot of times the chemotherapeutic agents that the oncologists give for the treatment of testicular cancer, lymphoma, leukemia, etc. may unfortunately render guys completely sterile.
After treatment, how do you determine fertility?
The most important thing a man can do is come see us for a semen analysis so that we can assess what we have to work with now, after treatment . The other critically important variable is the type of treatment that the man underwent, because there are a lot of types of cancer chemotherapeutic agents and they all work differently.
- some treatments can wipe out the entire sperm count
- other treatments may alter the DNA in the sperm itself
We need to know how the guy was treated. Usually we will consult directly with his oncologist to find out what they think because sometimes even if a guy has sperm after treatment they may recommend that we wait for a certain period of time to make sure that the sperm that were potentially exposed to treatment are gone, ie. ensure they have all died off or have been ejaculated.
Sometime they may actually recommend that even though a patient may still have sperm in his ejaculate, it’s probably best not to use those (due to exposure to cancer treatment). Instead, they would recommend that we use the sperm he banked before treatment because that way we know the sperm were totally unaffected.
So what can we do if the guy has no sperm?
Donor sperm is always a great option. It works really well and is very effective for fertility. There are so many different types of donors that we can easily match pretty much any guy by race, blood type, height, weight, hair color and eye color so that they will be able to find a donor that really truly resembles them as closely as possible.