Testicular Cancer and Family Planning: Can You Have Children After Treatment?

Testicular cancer and some treatments can affect the ability to have children. People may experience an inability to produce sperm, reduced sexual activity or reduced fertility.

Testicular cancer  occurs in the testes, which store sperm and produce testosterone. Although the disease and its treatment may impair reproductive ability, some people can preserve their fertility. 

Effects of Testicular Cancer Treatment on Reproduction

Testicular cancer is highly treatable, but different treatments may cause temporary or permanent reproductive changes. Options include radiation therapy, chemotherapy, lymph node removal and removal of the testes:

• Radiation Therapy: When used for testicular cancer, radiation may reduce sperm counts and testosterone. It can destroy sperm cells and sperm-producing stem cells.
• Chemotherapy: Chemotherapy drugs, particularly the commonly used alkylating agents, can damage sperm and sperm-producing cells.
• Lymph Node Removal: During lymph node dissection, or lymphadenectomy, a surgeon removes nodes and checks them for cancer. The operation may affect nearby nerves and structures involved in semen release and ejaculation, causing retrograde ejaculation—semen flowing backward into the bladder—or anejaculation, the inability to ejaculate.
• Removal of the Testes: Removing only one testis generally does not affect sexual ability. Removing both, however, means a person cannot produce sperm and becomes infertile. They also cannot produce testosterone, which may reduce erectile function and sexual desire. 

Testicular Cancer and Sexual Life

Testicular cancer may affect sexual activity through direct physical effects of the disease or treatment, or through mental and emotional challenges.

It can affect:

• The ability to achieve an erection
• The ability to ejaculate
• Sexual desire
• Confidence and self-esteem
• Anxiety about sexual activity

Discussing sexual and reproductive concerns with the doctor before treatment can help the process proceed well. Communication with a partner may increase intimacy and reduce sexual anxiety. People who want children may also consider storing sperm in a sperm bank before treatment. 

Recovery Time After Treatment

People with testicular cancer should discuss with their doctors how long to wait after treatment before trying to have children. 

Research suggests that most treatment-related infertility concerns resolve after approximately 2 years. Experts generally recommend waiting 6 months to 2 years before trying to conceive. Contraception is also recommended during treatment and for a period afterward.

Is There a Risk of Congenital Abnormalities?

The risk of congenital abnormalities, or birth defects, is low. A 2019 study found that children of men with testicular germ cell cancer (TGCC) had approximately 30% more congenital abnormalities than other children. However, radiotherapy or chemotherapy for TGCC did not increase the risk in their children, suggesting that the abnormalities are unlikely to result from these treatments. 

People concerned about congenital abnormalities and having children can consult a specialist about specific risks.

Sperm Banking

Sperm storage, or banking, can help preserve reproductive options. Before treatment that might damage sperm or sexual function, a person may consider banking sperm. 

A sperm bank collects samples for use in  in vitro  fertilization (IVF) when the person is ready. Storage may enable someone who becomes infertile after treatment to have biological children later. 

Reproductive Treatments After Cancer

Testicular cancer usually affects one testis, and the other generally provides enough testosterone. If both are affected, testosterone treatment may be needed. Options include monthly injections, nasal sprays, gels, patches or oral tablets. For someone whose testes have both been removed, these treatments improve general health rather than restore fertility. Banking sperm before treatment is the most effective way to preserve the possibility of having children.

Is Testicular Cancer Genetic, and Is Treatment Lasting?

Most people with testicular cancer have no family history. However, an affected relative can increase a person's risk. 

Treatment is highly effective and may remain effective over the long term.

Summary: Can People Have Children After Testicular Cancer?

The disease and its treatments may affect reproduction. Radiotherapy and chemotherapy can damage sperm and sperm-producing cells. People receiving these treatments are generally advised to consult a specialist and wait before trying to conceive with a partner.

Banking sperm before treatment can be an effective way to preserve the opportunity for parenthood. From diagnosis onward, people should feel able to discuss sexual and reproductive health with their cancer care team.