Fertility after testicular cancer

Your fertility means being able to make someone pregnant. 

After treatment for testicular cancer, you will usually still be able to make someone pregnant. But this depends on what treatment you need. Some treatments might affect your fertility.

Your doctor will talk to you about this before you start treatment. Even if there is a low risk that treatment will affect your fertility, your doctor will talk to you about sperm banking. This is when you collect and store your sperm for use in later fertility treatment.

How does treatment affect fertility?

Your doctor should talk to you about fertility before starting treatment. The effect on your fertility will depend on what treatment you need. 

After treatment you can have tests to see if your fertility has gone back to normal.

Removing a testicle and fertility

Most men have cancer in one testicle. You have surgery to remove the testicle. 

This doesn't usually affect your ability to have children. But sometimes your remaining testicle might not work so well. This could reduce your  fertility.

It isn't common to have testicular cancer in both testicles.  If you do have cancer in both testicles you need surgery to remove them both. You are infertile after this surgery and won't be able to father children.

Your doctor will talk to you about sperm banking before surgery.

Removing lymph nodes and fertility

You might need this surgery to remove lymph nodes at the back of your tummy (abdomen). This operation is called a retroperitoneal lymph node dissection (RPLND). It is a large operation.

The operation can damage nerves that control the release of sperm (ejaculation). This could affect your sex life and your ability to have children in the future. 

This surgery can make you ejaculate backwards. This is called retrograde ejaculation. Your semen and sperm go back into your bladder instead of coming out of your penis.

If you have retrograde ejaculation you won't be able to have children by natural sexual intercourse. But it may be possible to take sperm directly from your testicles or from your urine after you have had sex. The sperm can be used to fertilise your partner directly or with in vitro fertilization (IVF).

You can ask your doctor about this. 

Chemotherapy and fertility

Chemotherapy for testicular cancer causes temporary infertility in most men who have it.

Usually fertility goes back to normal some months after the chemotherapy ends. But for some men it doesn't recover. This is most likely if you have had very high doses of chemotherapy.

Radiotherapy and fertility

You might have radiotherapy if your cancer has spread to the lymph nodes at the back of you tummy (abdomen).

The radiographer directs the radiotherapy beams at an area down the middle of the stomach or abdomen, and sometimes at the groin. There is a small risk of the remaining testicle receiving a dose of radiation.

The testicles are where sperm are made. Your radiographer uses a lead shield to protect the testicle from the radiotherapy beams but there is still a small chance of damage. 

In a healthy testicle, sperm are constantly being made, so any effects from the radiotherapy should usually only last for a few months after treatment ends.

Your doctors will advise you not to try to father a child when having radiotherapy treatment, and for up to a year afterwards.

What you can do

You might want to talk to someone about permanent infertility. It can be very difficult to learn that you may no longer be able to have children. Some people find counselling helpful.

That Cancer Conversation

That Cancer Conversation is Cancer Research UK's podcast. In the episode exploring infertility and cancer, we chat with people whose cancer journey has had an impact on their fertility.

It also features Professor Richard Anderson, Deputy Director of the University of Edinburgh’s Centre for Reproductive Health. We explore options that are available and what the future of fertility medicine could look like.