Fertility Preservation for Men

This article is useful for people who were born with a penis and testicles.

Cancer treatments can affect your ability to father a child. It is important to discuss your options for fertility preservation with your cancer care team before treatment and any time there is a change to your treatment plan. Options include:

Sperm Banking

Cryopreservation (freezing & storage) of sperm is the only proven method of fertility preservation in men. Frozen sperm can be used later through

• Intracytoplasmic sperm injection (ICSI): Sperm is injected directly into a retrieved egg, outside of the uterus. This is part of the in-vitro fertilization (IVF) process.
• Intrauterine insemination (IUI): Sperm is injected into the uterus.

If you are interested in freezing sperm, you will go to a fertility clinic to have the sperm collected. Sometimes, a collection kit can be given to you to be done at home and mailed to the storage facility. Semen samples are best collected through masturbation after refraining from sexual activity for 2-5 days. More samples can be collected, but you need to wait 48 hours between samples. This will provide an optimal number of sperm. Men without enough sperm in their semen can have sperm removed from the testicle with a needle (called aspiration).

The samples are mixed with a substance to protect them from the freezing and thawing process. They are slowly frozen to the right temperature and stored. When the samples are needed, they are slowly thawed to protect the sperm from damage. It is not known exactly how long sperm can survive the freezing process, but it is thought to be many years.

It is best to collect samples before starting therapy for cancer. However, samples can still be collected after treatment has started. If collection happens after therapy has started, there is a chance of the sperm having genetic damage. This damage and risk to the fetus have not been well studied, so there are no statistics on the chance of problems.

Sperm banking does not take a lot of time and shouldn't cause a delay in starting treatment for your cancer.

Radiation Shielding

Radiation therapy can lead to infertility if the testicles are within the radiation field. In some cases, only one testicle can be protected in the radiation field. A lead shield can protect one or both testicles in certain instances. This is called gonadal shielding or gonadal preservation. This may help maintain fertility. However, you should check with your provider about how long you should wait after treatment has ended to try to father a child.

Other Preservation Techniques Being Studied

While sperm banking is a good choice for many, some men cannot put off treatment by a few days to bank sperm. In addition, boys treated before puberty do not yet produce sperm and cannot bank. The techniques below are being studied, but are still in the research stage.

Testicular Tissue Freezing

In this procedure, testicular tissue is removed and frozen, before cancer therapy starts. This tissue would be thawed for use at a later date. There are a few ways this tissue may be used:

• Sperm stem cells are collected from the tissue and implanted back into the man’s testicles. The hope is that these cells begin to produce sperm and a man can impregnate a female normally.
• The tissue can be implanted in the man - either in the testicle or elsewhere. After the tissue begins making sperm, it is collected using a needle. This sperm is then used through IVF procedures to result in pregnancy.

This technique has been successful in animals, but there have been no live human births yet. Many fertility clinics use this technique, but men should know that this is purely experimental at this time. 

Gonadprotection

One other method that has been tested is called gonadoprotection. This works on the theory that germ cells are harmed by chemotherapy because they are quickly dividing and reproducing. By giving medication to stunt the reproduction of these cells, perhaps they would be safe from the damage of chemotherapy. This did not prove true when tested in humans and sperm production did not get better after therapy in the men studied.

Paying for Fertility Preservation

Fertility-preserving techniques for men can come at a major cost. Many patients will not have coverage for fertility-sparing procedures through their health insurance. RESOLVE: The National Infertility Association provides resources and education.  The cost of collection, freezing, and storage varies greatly. There are fees to store the samples, which can be charged monthly, yearly, or for a period of 1-5 years paid in advance.

In some cases, insurance may cover some costs of fertility preservation, so check with your insurance company. Financial assistance for sperm banking may also be available. Your social worker or navigator can help you with these resources.

It is important to learn more about the options available to you. Have an open conversation with your providers regarding your wishes concerning your fertility.   You can also learn more about how yourtreatments can affect your fertility and find links to resources for more information.