After cancer treatment, your medical team will look at a sample of your semen to assess how many sperm you are making, how healthy they look and how well they move (motility).
Learn more about:
- Overview
- Checking fertility after treatment
- Natural conception
- Intrauterine insemination (IUI)
- In-vitro fertilisation (IVF)
- Donor sperm
- Finding information about the donor
Overview
Depending on the results of these tests, your options include:
- conceiving naturally
- intrauterine insemination or IUI
- artificial insemination or IVF using your own sperm frozen before treatment or fresh sperm collected after treatment
- testicular sperm extraction, if you can’t ejaculate normally or there is no sperm in the semen
- banking sperm after treatment ends, if you are still fertile
- using donor sperm.
Checking fertility after treatment
After treatment, you may be able to have an erection and ejaculate, but this doesn’t necessarily mean you are fertile. Before trying to conceive, you may want to do some tests to see how your fertility has been affected. These can be arranged by your fertility specialist or reproductive endocrinologist. The results will help the specialist recommend the best options for having a child after cancer treatment.
Semen analysis (sperm count)
This test can show if you are producing sperm and, if so, how many there are, how healthy they look and how active they are. You will go into a private room and masturbate until you ejaculate into a small container. The semen sample is sent to a laboratory for analysis. The results will help the fertility specialist determine whether you are likely to need help to conceive.
Follicle-stimulating hormone (FSH)
A blood test can measure levels of FSH. This hormone is produced by the pituitary gland in the brain. In males, FSH controls sperm production.
If FSH levels are higher than normal, this is a sign that fewer sperm are being produced. If FSH levels are lower than normal, this indicates that the pituitary gland is damaged. This will affect the number of sperm produced. This does not necessarily mean that sperm production is too low for a pregnancy, but it is a sign that fertility may have been affected.
Luteinising hormone (LH) and testosterone
A blood test can measure LH and testosterone levels.
LH is important in fertility, because it:
- maintains the amount of testosterone that is produced by the testicles
- helps with sperm production
- promotes muscle strength
- boosts general sexual health including sex drive (libido).
Like many hormones in the body, LH and testosterone levels can vary depending on the time of the day. They are highest in the morning, so the test is done earlier in the day. It is important to tell your doctor whether or not you’ve been using marijuana, as this will lower LH and testosterone levels.
If you stored sperm in a sperm bank before cancer treatment, your doctor can compare this sample to your sperm sample after treatment.
Natural conception
You may be able to get your partner pregnant naturally after finishing cancer treatment. This will only be possible if your semen production returns to normal and you are making healthy, active sperm. As fertility declines with age, it will also depend on the age of you and your partner. If treatment has permanently affected your ability to produce sperm and have erections, you will no longer be able to conceive naturally.
Your medical team will do tests to assess your fertility and check your general health. Depending on the treatment you’ve had, they may advise you to wait 6 months to 2 years before trying to conceive. Discuss the timing and contraception options with your specialist.
The pituitary gland makes hormones that tell the testicles to make sperm. If cancer treatment has damaged the pituitary gland, you may be able to have medical treatment to trigger the production of sperm. This is called sperm induction.
Intrauterine insemination (IUI)
Also called artificial insemination, this technique places the sperm directly into the uterus. IUI increases the chance that the sperm will fertilise an egg. The sperm may be fresh or it may have been frozen. The sample is washed and faster-moving sperm are separated from slower sperm.
Insemination is usually done in a fertility clinic. Once your partner is ovulating, the sperm are inserted into their uterus using a small, soft tube (catheter). This takes only a few minutes and may cause some mild discomfort to your partner. You should know in a few weeks whether fertilisation took place.
In-vitro fertilisation (IVF)
IVF uses either sperm collected and frozen before treatment or fresh sperm to fertilise an egg outside of the body. Intracytoplasmic sperm injection (ICSI) is a specialised type of IVF in which a single, good- quality sperm is injected into an egg.
Learn about the general IVF process and see a diagram of how IVF works, or ask your fertility specialist to explain the process in more detail.
Donor sperm
If you are infertile after cancer treatment, you could try for a pregnancy using sperm donated by another person.
Using donor sperm
In most cases, sperm are donated by a family member or friend. Your fertility clinic may have access to donor sperm, but there is usually a waiting list. You may be able to advertise for your own donor. It’s possible to use sperm from overseas, but there are strict rules about importing donor sperm into Australia.
Sperm donors have voluntarily contributed sperm to a fertility clinic. They are not paid for their donation, but you can cover (reimburse) their travel or medical expenses. The donors are usually aged 21–45. Some states and territories may have a limit on how many people can have children from the same sperm donor. The limit includes the donor’s partner. Ask your fertility clinic for more information.
All donors are required to complete health tests, answer questions about their genetic and medical information and have counselling.
Personal information is also collected, including details about ethnicity, education, hobbies, skills and occupation.
Samples are screened for genetic diseases or abnormalities, sexually transmitted infections (STIs) and overall quality, then quarantined for several months. Before the sperm is cleared for use, the donor is checked again for infectious diseases.
The sperm is frozen and stored in liquid nitrogen in individual containers. When the sperm is ready to be used, insemination is usually done in a fertility clinic. The sample is thawed to room temperature and inserted directly into the uterus using IUI or combined with an egg using IVF.
Finding information about the donor
In Australia, fertility clinics can only use sperm from donors who agree that people born from their donation can find out who they are. This means that the donor’s name, address and date of birth are recorded.
All donor-conceived people are entitled to get identifying information about the donor once they turn 18.
In some states, details about donors and their donor-conceived offspring are recorded on a central register.
Parents of donor-conceived children, and donor-conceived people who are over the age of 18, can apply for information about the donor through these registers. In other states and territories, people who want information about their donor can ask the clinic where they had treatment.
It is important to discuss possible issues for donor-conceived children with a fertility counsellor.
→ READ MORE: Preserving fertility in children and adolescents
More resources
Prof Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne and Director, Gynaecology Research Centre, The Royal Women’s Hospital, VIC; Dr Sally Baron-Hay, Medical Oncologist, Royal North Shore Hospital and Northern Cancer Institute, NSW; Anita Cox, Cancer Nurse Specialist and Youth Cancer Clinical Nurse Consultant, Gold Coast University Hospital, QLD; Kate Cox, McGrath Breast Health Nurse Consultant, Gawler/ Barossa Region, SA; Jade Harkin, Consumer; A/Prof Yasmin Jayasinghe, Director Oncofertility Program, The Royal Children’s Hospital, Chair, Australian New Zealand Consortium in Paediatric and Adolescent Oncofertility, Senior Research Fellow, The Royal Women’s Hospital and The University Of Melbourne, VIC; Melissa Jones, Nurse Consultant, Youth Cancer Service SA/NT, Royal Adelaide Hospital, SA; Dr Shanna Logan, Clinical Psychologist, The Hummingbird Centre, Newcastle West, NSW; Stephen Page, Family Law Accredited Specialist and Director, Page Provan, QLD; Dr Michelle Peate, Program Leader, Psychosocial Health and Wellbeing Research (emPoWeR) Unit, Department of Obstetrics and Gynaecology, The Royal Women’s Hospital and The University of Melbourne, VIC; Pampa Ray, Consumer; Prof Jane Ussher, Chair, Women’s Health Psychology, and Chief Investigator, Out with Cancer study, Western Sydney University, NSW; Prof Beverley Vollenhoven AM, Carl Wood Chair, Department of Obstetrics and Gynaecology, Monash University and Director, Gynaecology and Research, Women’s and Newborn, Monash Health and Monash IVF, VIC; Lesley Woods, 13 11 20 Consultant, Cancer Council WA.
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