Preserving fertility with cancer treatment in men

Cancer treatment can affect your ability to have a child in the future. Planning ahead gives you more choices. This guide explains what fertility means, how treatments can impact it, and steps you can discuss with your care team to help protect your options.

What is fertility?

For men, fertility means the ability to get a partner pregnant. Preserving fertility after cancer treatment means taking steps before or during treatment to increase your chances of getting a partner pregnant later.

Which cancer treatments can cause fertility problems?

Chemotherapy: Cancer-fighting medicines can damage the testicles. This can lower the number of sperm, reduce how well sperm move, or harm sperm quality. Risk depends on the medicine, dose, and your age.
Radiation therapy: High-dose X-rays to the pelvis or testicles can reduce or stop sperm production. Radiation to the brain can affect hormones that control sperm production. Risk depends on the dose and the body area treated. Scatter radiation can reach nearby areas.
Surgery: Removing both testicles stops sperm production. Removing one testicle may still allow pregnancy. Surgery near the prostate, bladder, or nerves can cause problems with ejaculation (semen not coming out) or cause semen to go backward into the bladder (retrograde ejaculation).
Stem cell transplant/intensive therapy: Very high-dose treatment often leads to long-term or permanent sperm problems.
Newer or targeted therapies: Some may affect hormones or sperm, but research is still ongoing.

Not everyone who gets chemotherapy or radiation will have fertility problems. Some effects are temporary and improve over time. Others can be long-lasting.

How treatment can affect sperm

Lower sperm count: Fewer sperm in semen.
Lower motility: Sperm do not swim well.
DNA damage: Sperm may be present but not healthy.

Sperm production may recover months to years after treatment. Your care team may suggest semen analysis testing over time to check recovery. During treatment and for a period afterward, you may be advised to use reliable birth control because some medicines can harm a developing fetus.

What should I do if I want children someday?

Tell your oncology team as early as possible, ideally before treatment starts. Even if treatment needs to begin quickly, options may still be available.

Ask for a referral to a fertility clinic or a reproductive urologist.
Share your goals and timeline for having children.
Ask how your specific cancer and treatment plan could affect fertility and for how long.
Discuss the best time to try for pregnancy after treatment.

Ways to preserve fertility (before or during treatment)

Sperm banking (cryopreservation): You provide semen samples, usually by masturbation, before treatment. The sperm are frozen and stored for future use. If you cannot ejaculate or there is no sperm in the semen, a specialist may remove sperm directly from the testicle or epididymis with a minor procedure.
How sperm banking works: Many people give 1 to 3 samples over a few days. Banking can often be arranged quickly, sometimes the same day. Frozen sperm can be stored for many years. While there is no guarantee, sperm banking is the most effective way to preserve fertility for most men.
Shielding during radiation: When possible, a protective shield is placed over the testicles. Treatment teams also plan radiation fields to reduce exposure to the testicles when safe to do so.
Procedures to help ejaculation: If you have retrograde ejaculation or cannot ejaculate, specialists may retrieve sperm from urine after orgasm or use medical stimulation techniques. Ask your team about available options.
Hormone shots: Medicines to “shut down” the testicles have not been shown to protect fertility in men.

Talk with your team about costs, insurance coverage, and any financial assistance that may be available through cancer support organizations.

If I still can’t get my partner pregnant

If you have trouble after treatment, a fertility specialist can evaluate you. This often includes a semen analysis and hormone testing. Some people go on to have a child naturally after recovery. Others use assisted reproductive technologies.

Using banked sperm: Can be used for insemination (IUI) or in vitro fertilization (IVF). When sperm numbers are low, a method called ICSI (injecting a single sperm into an egg) may be used.
Fresh sperm after treatment: If sperm are present, assisted methods may still help even with low counts.
Donor sperm: Some couples choose sperm from a donor through a licensed sperm bank.
Adoption or fostering: These can also be loving ways to build a family.

These choices can be emotional and complex. You might find it helpful to talk with a counselor, social worker, or support group experienced in oncofertility.

Practical tips to discuss with your team

Ask how soon you should start banking and how many samples to store.
Confirm how long you should use birth control after treatment.
Plan follow-up testing to check if sperm production returns.
Ask about sexual health support if you notice erection or ejaculation changes.
Discuss lifestyle steps that support sperm health, such as avoiding tobacco and excessive heat to the testicles.

Common questions

Will treatment delay sperm banking? Most clinics can arrange banking quickly. In urgent cases, even one sample is better than none.
How long should I wait to try for a pregnancy? This depends on your treatment and recovery. Your team may suggest waiting several months or longer to lower the chance of using sperm with DNA damage.
Can fertility return? Sometimes. Recovery can take months to years. Repeat testing can show changes over time.
Is sperm banking guaranteed? No. It improves your chances but does not promise a future pregnancy.

You are not alone

Fertility is an important part of your life and future plans. Talking early and often with your oncology team can help you understand your risks and options. You deserve clear information and caring support as you make decisions that are right for you.

References and helpful resources

Last reviewed: 2025-12-04