Male Fertility Preservation

This article may be useful if you were born with male reproductive organs (prostate, testicles, penis).

Cancer treatments can affect your ability to get someone pregnant. 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 if you were born with male reproductive organs. 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.

Frozen sperm may not work as well after thawing, so IVF with ICSI may be more successful.

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 use at home and then mailed to the storage facility. Semen samples are best collected through masturbation after not having sex 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. If you don’t have enough sperm in your semen, it can be removed from the testicle with a needle (called aspiration).

The samples are mixed with a substance to protect them during 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 cancer treatment. 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 apron or 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 get someone pregnant. You may need to wait 3-6 months after treatment.

Paying for Fertility Preservation

Fertility-preserving techniques 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 financial 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 provider about your wishes concerning your fertility.   You can also learn more about how your treatments can affect your fertility and find links to resources for more information.