Men suffer from infertility too – Testicular Cancer

The TTC community is an incredible space for those who are struggling to conceive, to unite. It is however still a space dominated by women. However, infertility does not only affect women – male infertility causes up to one-half of all cases.

In this article, Beatriz Regina de Oliveira Trigo, the Redia IVF emotional support expert talks about Testicular Cancer and infertility. 

Testicular cancer can affect anyone with testicles and although this type of cancer has a very high survival rate, it tends to appear in your twenties and thirties, an age when a lot of men are thinking about fatherhood. Fortunately though, testicular cancer does not always mean the end of your dreams to become a parent – there are reported cases of successful paternity in testicular cancer patients, some via assisted reproductive technology and some via natural conception.

Of course the first thing you want to know if you have been diagnosed with Testicular cancer, is how can it be treated and whether or not it will affect your fertility. I want to stress here before I go further, that treatments and their impact on fertility health vary from man to man.

Treatment and the impact on fertility

• In radiation therapy, testicles are protected by gonadal shielding during sessions but are still subject to scattered radiation. Appropriate gonadal shielding protects fertility.
• 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.
• 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.
• 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.

So what happens after treatment if you want to become a father?

As I mentioned, treatments and their impact on fertility health vary from man to man. However, testicular cancer is very detrimental to sperm concentration and total sperm count pre-treatment which is why some men turn to assisted reproductive technology. 

Treatment can also increase 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.

Both elements – the physiological and the psychological affects of cancer should be discussed before initiating treatment as well as conversations about fertility preservation options. 

This psychological support alongside comprehensive information about the disease and its affects will allow for a better informed decision-making ability, to prepare and plan for future fertility outcomes.

Before I talk about the emotional support that really is so key to a man’s wellbeing, lets look first at  the 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.

How does it work?

Sperm is provided by the patient which is then followed by the use of a microscopic to check the sample. After this, the sample is pre-prepared using the suitable materials, which aim to protect the spermatozoa during the process of freezing. In rare instances, the taking of sperm is performed through intervention methods when there is an inability to or difficulty with ejaculation.

Having prepared the sample appropriately, it is then transferred onto a small phial, and the temperature is gradually reduced and controlled from room temperature to -196C which is then placed in containers for long-term storage.

The sperm may remain cryopreserved theoretically indefinitely, on condition that the cryobiology lab carries out continuous checks to ensure the safeguarding of the samples in the right conditions.

Before the procedure of freezing the sperm or testicular tissue, an immunology check must take place for any infectious diseases of the interested party (for hepatitis B, C, AIDS virus and syphilis).

Some patients have reported 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

To be faced with not only a life threatening disease, but also the possibility that you may never become a father if you do survive, is a massive blow.

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.

Goal-focused Emotion-Regulation Therapy

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.

Take-away messages:

• Men’s issues and struggles with fertility are real and very common.
• 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.
• The type of cancer dictates the type of treatment applied. And the type of treatment and its duration create different fertility consequences.
• 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.

For more information about male cancer, visit the following support sites:

• Cancer Research
• Macmillan
• The Testicular Cancer Network

To talk to Beatriz Regina de Oliveira Trigo, the Redia IVF emotional support expert, click here