Picking Up The Pieces After Testicular Cancer
Each year, testicular cancer impacts over 9,000 men of reproductive age and is responsible for 470 deaths. If caught and treated early, most men can beat the illness. After cancer treatment, the next step is picking up the pieces and continuing to live a fulfilling life. For some men, this means resuming the dream of starting or growing a family. Yet, with testicular cancer and associated treatments like radiotherapy, the chances of natural reproduction drop considerably. At this stage, men can consult a fertility specialist who can provide several options to increase the chances of parenthood.
How testicular cancer impacts fertility
While relatively rare, testicular cancer occurs when abnormal cells multiply in the testicles, creating a dangerous mass or tumor. The subsequent treatment for the disease significantly impacts fertility. For instance, testicular cancer often means the removal of a testicle to stop the tumor’s spread. The remaining testicle can produce enough testosterone and other hormones for natural conception. However, fertility and sexual function can decrease. Removal of both testicles, while rare, will result in infertility. Furthermore, chemotherapy and radiation therapy to treat the cancer damage sperm health and hormone production, significantly impairing fertility. Men diagnosed with testicular cancer should discuss all fertility options with a doctor before treatment.
Get preemptive with cryopreservation
Given the potential impact on fertility, doctors will recommend fertility preservation options before treatment. Sperm banking through cryopreservation, for instance, allows men to save healthy sperm for future use. A fertility clinic will collect a sperm sample from the patient. The sample is assessed, washed, and preserved using liquid nitrogen storage tanks. Studies show that sperm preparation through washing increases the sperm’s health and motility for future use. The sperm sample can be used later for assisted reproductive technology (ART) treatment, increasing pregnancy chances.
The ART of fertility treatment
For men with testicular cancer, ART, such as in vitro fertilization (IVF), can increase the chances of pregnancy. With IVF, a sperm and egg sample are combined in a fertility lab to create viable embryos. The medical team can use sperm that was saved before cancer treatment. A healthy embryo is then surgically transferred to the woman’s uterus for pregnancy, completing an IVF cycle. There are other options, like intracytoplasmic sperm injection (ICSI), which also helps in cases of testicular cancer. ICSI uses a solitary sperm to fertilize the egg instead of the entire sample. Both IVF and ICSI are also valuable tools for men struggling with fertility after testicular cancer.
Combining ART with sperm retrieval
If a fertility team was unable to cryopreserve sperm before cancer treatment, there are still ways to achieve pregnancy. For instance, if the patient can still produce sperm, a sample will be enough to proceed with IVF or ICSI. However, some men must have sperm surgically retrieved from the testes. Testicular sperm aspiration (TESA) or testicular sperm extraction (TESE) are the most used techniques. A doctor will surgically aspirate the testes or remove testicular tissue. The fertility team can then assess the extracted samples under a microscope to locate sperm cells necessary for ART. Sperm cells can also benefit from preimplantation genetic testing (PGT) to ensure no congenital abnormalities are present.
When all else fails
While different methods can increase the chances of pregnancy, ART is predicated on the presence of cryopreserved or fresh sperm samples. However, in cases where both testicles are removed without preserving sperm, biological pregnancy is impossible. Even without surgery, radiotherapy severely impairs sperm health, leading to infertility. At this point, the fertility team will discuss alternative family planning options. Using donor sperm for surrogacy, intrauterine insemination (IUI), or IVF can make a difference. This donor sperm can come from a sperm bank or a trusted family member. Adoption is also an option that can be explored in detail with all parties involved.\
Don’t give up hope
A testicular cancer diagnosis and subsequent treatment is a long, arduous journey. Early discovery and addressing the problem are keys to success. After treatment, there are multiple ways to start or grow a family, thanks to technology and medical advancements. The many forms of ART are a saving grace for the hundreds of men ready to get life back on track after a cancer diagnosis.