Infertility is a medical term used for people who have not achieved a pregnancy after one year of trying. The compromised testicular function is a common issue men encounter fertility-wise, such is the case of testicular cancer patients. While, gladly, this type of cancer has a very high survival rate, unfortunately, it tends to appear in your twenties and thirties, an age when a lot of men think of fatherhood. Fortunately, there are reported cases of successful paternity in testicular cancer patients, some by natural means and some via assisted reproductive technology.
Treatment and post-treatment fertility rates
Treatments and their impact on fertility health vary. And the damage may not be permanent.
In radical inguinal orchiectomy and partial orchiectomy, semen parameters may be impaired. One healthy testicle, if no further complications exist, means that the man is still fertile and able to conceive.
Chemotherapy drugs or regimens’ impact on fertility is not entirely clear. Platinum-based chemotherapy agents pose an intermediate level of risk for permanent azoospermia. Alkylating agents pose the highest risk for permanent azoospermia. Vinca alkaloids typically result in temporary azoospermia or oligozoospermia.
In radiation therapy, testicles are protected by gonadal shielding during sessions but are still subject to scattered radiation. Appropriate gonadal shielding protects fertility.
Retroperitoneal pelvic lymph node dissection may lead to ejaculatory issues, but modern techniques lower the prevalence rate to less than 10% of patients. A non-nerve sparing method may have a more significant impact on fertility.
Post-treatment fertility rates amongst survivors may vary, making some men turn to assisted reproductive technology. Testicular cancer is very detrimental to sperm concentration and total sperm count pre-treatment. It also increases the likelihood of men experiencing symptoms of sexual dysfunction (erectile dysfunction, decreased libido, poor body image, decreased overall sexual satisfaction). The former is physiological and the latter psychological.
Nevertheless, not all patients are aware of fertility preservation options or possible surgical complications before initiating treatment or are advised to receive counseling or psychological support. These significantly hinder their informed decision-making ability to prepare and plan for future fertility outcomes.
Cryopreservation of sperm
Cryopreservation of sperm is the most typical, highly reliable method of fertility preservation in adult males. It is commonly performed before treatment since the quality of sperm when undergoing treatment can decrease due to sperm aneuploidies, oxidative stress, and DNA fragmentation.
Cryopreservation ensures a way to parenthood for those who want to conceive while undergoing treatment or have impaired fertility potential. When patients are informed about how treatment can negatively affect their fertility and how preserving their sperm can overcome that, they have a better understanding of the problem and act more accordingly. Some patients even report that sperm cryopreservation has emotionally helped in the battle against cancer. However, the worries about infertility do not merely disappear once sperm is cryopreserved.
Emotional struggles and proper psychological support
Men who had or have cancer struggle because, on their battlefield of life, cancer meets infertility. Besides the understandable fears of possible decreased quality of life or life expectancy, men may experience a multitude of self-esteem doubts (like perceived lack of manhood and virility), and social obstacles (like having to use a barrier method – normally condoms – if they have sex during treatment). They require and deserve adequate support!
Men may be reluctant to seek psychological help, depending on age, background, prejudice, expectations, etc. Therefore, accessible, acceptable interventions for men are needed. Interventions (online or offline) that build a safe and flexible space for openness and promote autonomy, self-control, regulation, and sufficiency work the best.
For example, sexual counseling can be beneficial once a diagnosis is made and throughout treatment. Discussing concerns, expectations, day-to-day reality, thoughts, emotions, and actions regarding intimacy helps men cope, understand how and when sexual dysfunctions naturally improve and accept that tiredness and worry may lower libido.
I want to give special attention to the Goal-focused Emotion-Regulation Therapy, which aims to improve distress symptoms, emotion regulation, goal navigation skills, sense of meaning and purpose, and stress-sensitive biomarkers in testicular cancer patients. It focuses on three core things. One is to work on setting realistic and manageable goals, consistent with identified values/purposes the patient holds, and gather resources to achieve them (in opposition to focusing on stirring away from avoiding obstacles). There is an emphasis on career, education, and self-growth-related goals. The second is to increase agentic thinking, believing in your potential, and being confident in your abilities to control your actions, goals, and present/future. And the third is emotion regulation, achieved through the training of adopting effective coping mechanisms and implementing cognitive restructuring.
Men’s issues and struggles with fertility are real and very common.
The type of cancer dictates the type of treatment applied. And the type of treatment and its duration create different fertility consequences.
Due to the point made on number 2, fertility preservation options must be discussed with patients. The most common is cryopreservation.
Fertility preservation is not enough to make patients feel well and secure, often they still feel like they are psychologically and emotionally struggling. Battling cancer and fertility at the same time is a warrior’s journey.
Psychological help is available, whether it’s individual, in a couple, or in a group. You can try sexual counseling to address sexual dysfunctions you have been experiencing or fear you might experience. And you can try Goal-focused Emotion-Regulation Therapy, which has been designed especially for adult men with testicular cancer, whether you’re cured or still going through it.
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