Testicular Cancer

The testicles, also known as the testes, are part of the male reproductive system. Their function is to produce the male gamete spermatozoa, commonly known as sperm. They are also responsible for producing male hormones, most notably testosterone. Healthy and normal functioning of the testicles is, therefore, vital to a high level of male fertility. Many factors can affect the performance of the testicles in producing sperm. This article concentrates on the impact of testicular cancer on male fertility.

Testicular cancer is a rare disease and yet it is the second most common form of cancer affecting males in the age range 18 to 40, with the peak age group for new cases of the disease occurring to men in their thirties. These age ranges also reflect the time when many men will be considering starting a family with their partner, meaning fertility issues could be particularly sensitive to a sufferer of testicular cancer. Testicular cancer is known to be more prevalent in white males than in black and Asian males.

The cause of testicular cancer is generally unknown. There are certain risk factors that are known to contribute to an increased risk of the disease. One of these causes is male infertility itself. This, in turn, could be caused by undescended testicles (Cryptorchidism) or a history of male infertility. Testicular cancer can in itself be a cause of low sperm count in a man. Following successful treatment for testicular cancer, sperm count figures can improve.

In the last 20 years the incidence of testicular cancer has risen in both the USA (4.3%) and UK (3.4%). However, due to advances in medical treatments for the disease the resulting mortality rates have fallen. The survival rate one year after diagnoses is now 97.7% and five years after diagnoses it is above 95%. Treatments include chemotherapy and low-dose radiation therapy. For some individuals testicular cancer may result in radical surgery where the removal of one, or both, of the testicles may be necessary. It is not common for both testes to be found to have cancerous cells, so treatment of both testes is rare. The removal of a single testis (orchidectomy) will not hinder a man’s fertility or sexual performance.

Following chemotherapy for testicular cancer most men undergo a temporary period of infertility. In seventy to eighty percent of men, fertility is restored in three to five years following the end of the chemotherapy regime. However, some men do become infertile after chemotherapy. Prior to entering in to a programme of chemotherapy for testicular cancer, men should discuss with their medical advisers the fertility issues that may arise and consider having a sample of sperm and semen frozen for future use.

Where radiation therapy is required, the healthy testis will be shielded from the effects of the radiation. However, following successful radiation treatment for testicular cancer contraception should be used during any sexual intercourse for two years to avoid impregnation. This is important because the radiation from the therapy can damage germ cell precursors that develop in the sperm. (Germ cell precursors are genes concerned with tissue and organ development. i.e. the radiation therapy could cause genetic damage). It is, again, highly recommended that men entering into a course of radiation therapy discuss with their medical advisers fertility issues and having a sample of their sperm and semen frozen for future use.

Sometimes, the development of testicular cancer requires an operation to remove lymph nodes located at the rear of the abdomen. This is called retroperitoneal lymph node dissection. This operation can be required if, after a course of chemotherapy or radiation treatment, the lymph nodes are still enlarged. Whilst new surgical techniques are reducing the possibility it can unfortunately result in infertility due to retrograde ejaculation. This means that the ejaculation reverses its route into the bladder rather than outward through the penis.

Doctors can prescribe drugs to treat this condition. However, the drugs do carry risks to the heart and blood-pressure and so may not be suitable to all men. There is also is a procedure whereby sperm can be extracted from urine in the bladder following a retrograde ejaculation. The sperm could then be used for artificial insemination. In case retrograde ejaculation cannot be reversed the freezing of sperm and semen samples should be considered with your medical experts.