Before treatment 

It's important to talk with your healthcare team about fertility before you start treatment. And you may have to bring up the subject.

Your team can tell you about how treatment may affect your fertility. They can tell you about choices for preserving your fertility. You may want to ask your team about seeing a fertility specialist before you start your treatment.

You may choose to have sperm frozen and stored for future use. This is called sperm banking. Or you may choose a type of cancer treatment that may help protect your fertility. For instance, certain chemotherapy (chemo) medicines are known to affect fertility. So you may want to stay away from them. Talk with your team about your choices.

If you had chemotherapy 

Chemo can harm fertility in these ways:

• Chemo can stop your body from making new sperm. Your testicles may not make sperm for a year or more after chemo. In some cases, they may never make sperm again.

• Your sperm may be damaged during chemo. And they may still be damaged for some time after treatment.

The effects depend on the chemo medicines you get, the dose, and how long you were treated. Talk with your healthcare team about the chemo you had. Ask about the risks of each medicine on your fertility.

If you had targeted therapy or immunotherapy

Researchers are still learning how these types of medicines affect a man’s fertility. They don’t work the same as chemo. Certain medicines may cause birth defects. Healthcare providers recommend using reliable birth control while taking these medicines. Ask your healthcare team what effects the medicines you got may have had on your fertility. 

If you had radiation therapy

Radiation to the belly (abdomen), pelvis, or testicles can harm sperm. High doses can also damage the cells that make sperm. The problems depend on the type of radiation treatment you had, where the treatment was aimed, the doses used, and how long you got treatment, for instance:

• Radiation implants. This is called brachytherapy. These implants damage the tissues they're close to. They're less likely to harm fertility.

• External beam radiation. This treatment to the groin or pelvis has a much higher risk of long-term infertility. And radiation to the brain can damage the hypothalamus and pituitary glands. These glands make hormones that tell your body to make sperm. Damaging them can also cause fertility problems.

Your healthcare team can tell you what effects you may have from your treatment.

If you had surgery

Surgery can change your fertility in these ways:

• You no longer make sperm if you’ve had both testicles removed (orchiectomy). If you have one testicle left and it works normally, it may still make sperm.

• Surgery to remove the prostate gland or seminal vesicles means that you no longer make some of the fluid in semen. This fluid is needed to carry sperm outside the body.

• Surgery may damage nerves or blood vessels. This can cause problems with getting or keeping an erection (erectile dysfunction or ED).

• In some cases, the tubes that carry sperm out of the body may be damaged or cut. This will prevent sperm from coming out during ejaculation. So even if your body is still making sperm, there's no way for them to come out.

• Certain kinds of surgery can cause semen to go into the bladder instead of out the penis. This is called retrograde ejaculation.

Your healthcare team can tell you what to expect based on the kind of surgery that was done.

If you had hormone therapy

Some types of hormone therapy that treat prostate cancer can affect the hormones needed to create sperm. These medicines can cause your sperm numbers to be low. They may also decrease your sex drive. And cause problems getting an erection. Ask your healthcare team what side effects you may experience from hormone therapy. And ask how long they may last.

After treatment 

After treatment, your healthcare team can help you manage any effects to your fertility. They can give you information to help you make decisions. They can help you find a specialist. They may be able to help you find adoption or surrogate resources. 

They can also let you know when it’s OK to start trying for a pregnancy. Talk with your team first if you plan to get your partner pregnant after treatment is done. Ask how long you should wait to start a pregnancy after treatment. Some kinds of treatment may change the genes in sperm for a while. This can raise the risk for birth defects. You may need to wait at least a year or more.

Ask your healthcare team:

• How did my treatment affect my fertility?

• How can we find out if my fertility has been affected?

• When is it safe to start trying to get my partner pregnant?

• Do I need to see a fertility specialist? Can you refer me to one? 

• Did I have a kind of cancer that could be passed on to my children?

Seeing a fertility specialist 

A fertility specialist can help in many ways. For instance, they can help you use sperm you froze before cancer treatment. Or they can help you use sperm from a donor. And sometimes sperm may be retrieved after treatment. Sperm may be collected from urine. Or surgery may be done to take sperm directly out of a testicle. A fertility specialist can help you understand your choices and what may work best for you. 

Working with a fertility specialist may not be covered by health insurance. It’s important to know this. Fertility treatments can cost thousands of dollars. More than one treatment is needed in many cases. Talk with the fertility specialist and your health insurer to find out what your own costs will be. 

Getting support 

Fertility changes can be very stressful and upsetting. You and your partner may want to talk with a counselor. Ask your healthcare team for a referral to counseling. They can also help you find a nearby support group or other resources.