Common Male Cancers
Several forms of cancer may influence fertility due to the adverse effects of these malignancies (even before treatment) on the testis or other endocrine glands. In fact, in many cases infertility may be the first symptom of these cancers.
Hodgkin’s disease is the most common lymphoma during the reproductive years. The condition is almost twice as common in males as in females. As in several other malignancies, decreased fertility exists in males suffering from Hodgkin’s disease before treatment or diagnosis.
Testicular cancer is a common malignancy among men in their third or fourth decade. Patients who suffer from testicular cancer show sperm abnormalities at diagnosis, before initiation of treatment. Several studies have indicated that most of these patients already have low sperm count prior to treatment initiation. Furthermore, infertility is at least three times more common in men with germ cell tumors than in the general population.
The Impact of Cancer on Male Fertility
Among the most common long-term consequences of cancer treatment in men is testicular dysfunction. Infertility in these patients can be due to chemotherapy, radiotherapy, surgery or a combination of these treatment modalities.
Pelvic or groin surgery can impair fertility. Extensive removal of lymph nodes during surgery for testicular cancer can cause nerve damage, and the inability to ejaculate. Treatment options include drug treatment, to which approximately 30% of men respond. Alternatively, electro ejaculation can be used in combination with in vitro fertilization.
Radiotherapy is used to treat a number of malignancies, either alone or with chemotherapy. Radiation directed at or scattered toward the male reproductive organs inflicts potentially irreversible damage to sperm-producing cells.
The testes are highly susceptible to the toxic effects of chemotherapy and testicular dysfunction is the most common long-term side-effect of chemotherapy. In general only 20 to 50% of cancer patients resume sperm production 2 to 3 years after completion of treatment. However, the recovery of fertility in patients is dependent on the site of malignancy, with testicular cancer having the worst recovery rates. Fertility recovery depends on sperm quality before treatment and also on chemotherapy doses and treatment cycles.