Relationship between male fertility and cancer treatment

Cancer is always challenging, as is its treatment. Fortunately, medicine is advancing and is getting better, not only at treating cancer itself, but also at improving the quality of life for people struggling with the disease.

How cancer treatment affects male fertility

Undoubtedly, fertility is one of the most important problems of life after cancer treatment. For men, this battle is fought on two fronts: fertility preservation to protect men (and boys) from the harmful effects of sperm treatment; and restoring the possibility of parenthood, allowing patients to overcome infertility.

What cancer treatments interfere with fertility?

Fertility may be affected depending on the type and location of the disease, as well as the treatments performed:

Chemotherapy: Chemotherapy can have an effect on fertility by targeting the cells that give rise to sperm. However, this effect varies according to the chemotherapy used, the dose (the higher the risk of becoming sterile) and age, where men over 40 are more likely to be infertile.
Radiotherapy: Radiation therapy directed to the testicles can damage sperm or cause infertility. If directed towards the head, it can reach the regions responsible for producing hormones that influence the production of testosterone and sperm, also affecting the ability to have children.
Hormone Therapy: Some hormone therapies used in prostate cancer affect fertility and other sexual issues, such as decreased erection and libido. However, the effects usually subside with the end of the treatment.
Targeted immune therapies: Drugs such as thalidomide and lenalidomide are used, among other things, to fight cancer cells in some types of cancer. It is known that men who use such drugs should avoid the pregnancy of their partners, since these substances reach the semen and expose the fetus to a high risk of birth defects.
Surgeries: Surgery to remove the testicles or prostate to remove cancerous tissue can make a man infertile.

How to preserve male fertility?

There are some classic techniques to preserve the sperm of men who are considering paternity, while others are still being studied but have already shown to be quite promising.

Among the traditional techniques to preserve fertility, there is the protection of the testicles with lead-based devices in the treatment with radiotherapy, which allows protecting the testicles against radiation.

Another known means for the conservation of spermatozoa is the freezing of semen. The most performed technique is by cooling with nitrogen to a temperature of up to -196°C.

In cases where surgery to remove the testicle is indicated, nowadays it is no longer necessary to remove both testicles. Therefore, the man remains fertile having only one of them. But in case of total removal, freezing the semen is recommended beforehand.

Microsurgical Biopsy (micro-TESE) is a refined method to check for sperm in the testes, even if they are not found in the ejaculatory fluid of men already considered infertile. It is a very effective but invasive technique.

Testicular Mapping has the same purpose as micro-TESE and can be performed before the latter, as it is a non-invasive and simpler alternative. Although it is not a 100% accurate technique like micro-TESE, it offers excellent reliability whether or not sperm are present.

In men with nerve damage from surgery that affects their ability to ejaculate, a special medical device can produce ejaculation for fertility research purposes, a process called electroejaculation.

One of the most exciting areas of health research involves stem cell technology. The promise of stem cells in treating disease is likely to find its way into the field of fertility as well.

In the future, it may be possible to freeze stem cells from the testes before starting cancer treatment. After thawing, these same cells can be used to create sperm, after their maturation in a Petri dish, or after being returned to the testes. The studies were performed in animal models and not in humans. However, the results are very encouraging.

In this context, there is still the possibility of taking skin cells from a sterile man, converting them into stem cells, and then directing them to become sperm. Therefore, with the advancement of medicine soon the preservation of fertility by stem cells may pass from science fiction to reality.