The aim of the game with testicular cancer treatments is to save your life and to make sure you can live as healthily and happily as possible. But, of course, like any treatment, there are side effects.

Sometimes treatments can make it harder (or even impossible) to have kids naturally. When we say 'naturally' we mean by having sex, ejaculating (or cumming) and your partner getting pregnant. You know — all that birds and the bees stuff.

Treatment can really change the quality of your sperm, so work with your doctor to understand the risks. Once you understand your situation, you can then put together a plan to save and store sperm in advance.

Before having treatment

Fertility should be a part of the first conversation you have with your team. If it’s not, make sure you’re discussing it as soon as you can. You might feel nervous or strange about bringing it up. You may also wonder if it's too soon. Don’t worry about any of that, now is exactly the time to chat through all of this and your team have had these conversations a thousand times before.

Make sure your doctor (probably urologist or or oncologist) knows how you feel about your sex life and having kids. Your doctor needs this info to recommend the best treatment option.

Talk to a fertility specialist

Don’t be afraid to ask your team if you can be referred to a fertility specialist before having treatment. A specialist is a specialist for a reason — they’ll be able to give you the full picture and can answer any and all fertility questions you might have. Even if you’re not sure whether or not you want kids, it doesn’t hurt to have the conversation and be prepared in case you change your mind further down the track.

Already had treatment?

If you’ve already had treatment, all hope is not lost. You can still meet with a specialist after treatment to see what options might exist. While the ideal time to see a specialist is before treatment, don’t be discouraged from having this conversation afterwards. It can’t hurt to ask.

Here's how each treatment can impact your fertility

Orchiectomy (surgery to remove one or both testicles)

People often ask: Can you have kids with one testicle? If you’ve only had one testicle removed, and the other testicle is still producing healthy sperm, then great. This typically means you’re going to stay nice and fertile. But to be safe, your team may still talk to you about storing sperm (or sperm banking) in advance. Better to be safe than sorry.

In rare cases, if both testicles are removed, you won’t be able to produce sperm anymore. But don’t worry, sperm banking can help ensure you still have a chance to have kids.

In addition, if either of your testicles were ever undescended or if one of them is much smaller (or as the doctors say, atrophic), your team will guide you on preparing to save sperm before surgery.

Basically, if you’re having surgery, it’s best to talk to your team beforehand and discuss the benefits of sperm banking.

Chemotherapy

Chemotherapy or “chemo” works by killing cancer cells in the body. It looks for cells that divide quickly, so it may also target cells that don’t have cancer. Unfortunately, because of this, sperm cells are an easy target for chemo attacks.

Depending on the type of chemo you have and the dose, your sperm count may or may not be affected. It can be pretty hard to tell upfront. In most cases, sperm counts rise within 24 to 36 months after finishing chemo — but this isn’t always the case. Again, this is why many experts will advise storing sperm before chemo just to be safe.

It’s also super important that you use protection (like condoms) while on chemo. This is to protect you, and your partner, from sexually transmitted infections (STIs). Chemo will bring your immune system way down, so an infection is the last thing you need. In fact, it actually can be really dangerous. Using protection will also shield your partner from some effects of chemo and help avoid pregnancy.

It’s really important to stress that you should not have a kid while undergoing chemo. You may need to wait up to a year after treatment. When it’s safe again, your doctor will tell you it’s OK to start trying for a healthy pregnancy with your partner.

Radiation therapy (or radiotherapy)

During radiation, high energy X-rays are targeted towards the testicle that has cancer. Meanwhile, the healthy testicle is shielded to help protect it from the rays. As long as the healthy testicle isn’t damaged by the radiation — and this is the only type of treatment you’re having — your fertility likely won’t be affected.

But in reality, even with the shield, losing fertility in the healthy testicle is still possible. Can you guess what we’re going to say next? To be safe, talk to your doctor or specialist about saving sperm beforehand.

Similar to chemo it’s really important to not have a kid while having radiation treatment. Use protection (like condoms) any time you have sex, to avoid both sexually transmitted infections (STIs) and pregnancy. Again, like with chemo, you may have to wait for up to a year after radiation to start trying for children. Your doctor will advise on when it’s safe.

RPLND (surgery to remove lymph nodes)

Retroperitoneal lymph node dissection (RPLND) is a complex surgery. During the procedure, the lymph nodes in your abdomen (or lower stomach area) are removed. You can read more about it here.

During RPLND, there’s a risk that the nerves that control how semen leaves your body can be affected.

It’s rare, but if there’s enough nerve damage, you may experience something called retrograde ejaculation. This means semen will no longer come out of your penis during ejaculation, and rather, it’ll go backwards into your bladder. Now don’t worry, that’s not as painful as it sounds and should not hurt. But it does make it much harder to have kids naturally.

If you’re having RPLND after chemo, this can make retrograde ejaculation more likely. This is because chemo can cause scar tissue, making it harder to see the nerves during RPLND and prevent damage.

Talk to your team about saving your sperm before surgery. Your nerves need time to recover, and it’s not 100% certain your fertility will return afterwards.

Having a combination of treatments?

If you’re having multiple treatments, (like a combo of surgery and radiation), talk to your doctor about the fertility risks. Each treatment has a risk on its own, but you’ll want to understand upfront how to best prepare. The easiest, and safest thing to do, regardless of treatment, is to store sperm beforehand.

How do I know if my fertility has returned?

Even if your body is still making semen after treatment, this doesn’t automatically mean your fertility is back on track. Your little swimmers may still not be running at 100%. The only sure-fire way to figure out your fertility status (the number and quality of sperm cells in the semen) is to have a semen analysis. Your regular doctor, urologist, or fertility specialist can order a test for you.

For a semen analysis, you’ll need to give a semen sample. The lab staff will then analyze it. This might feel awkward, but don’t stress — lots of men have to do this for various reasons and the staff won’t bat an eyelid. The staff may also have you do this test a few times, to ensure the results are as accurate as possible.

You may be told to wait a while (about 6 to 12 months after cancer treatment) for the analysis. This gives your body time to settle back into a normal rhythm. If your test results aren’t as they should be, don't stress. The andrologist (a doctor who specializes in male health) or your fertility expert will talk about your options and next steps. It may feel like a lot of back and forth, but it’s still possible that your fertility will improve over time.

If your fertility doesn't return (infertility)

If your doctor advises that your fertility is not going to come back and is permanent, this is called infertility. It can be very hard to hear and accept.

If you find yourself down, stressed out or angry, talk to a close friend or family member. You don’t have to hold it in. A counselor or other health professional can tell you about other options too, like adoption.

In time, some guys realize they’re OK with a child-free life. It’s a process, and it’s different for everyone. Most importantly, just remember that you can get through this. Time, counseling, and support from your friends and family will help.

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