What are the options if you want to have children after cancer treatment?

Cancer treatment does not always cause permanent sterility. Neither does sperm cell production stop completely in all men undergoing cancer treatment. It is, however, difficult to predict how your body will respond to the treatment.
   
Infertile?
Sexual activity?
Fertile again?

Infertile?  

In Gonadal toxicity in men we discussed that, in adult men, all maturation stages are simultaneously present in the testicle, from stem cell to mature sperm cell. The later stages are less susceptible to radiation and chemotherapy damage than stem cells and sometimes survive after cancer treatment. Because the maturation process may take three to four months, sperm cells may persist during or after treatment, when this treatment is short. The chance of a genetic defect in these cells is, however, increased. In case of fertilization there is a higher risk of miscarriage.
But you have to be aware that you are not by definition infertile during or (shortly) after cancer treatment. Therefore it is recommended to keep this in mind when you have sexual intercourse.

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Sexual activity?  

In this context it is also important to know that the Leydig cells, the testicular cells responsible for the production of the male hormone testosterone, are highly resistant to cancer therapy. That is why men, unlike women, do not have an increased risk of symptoms that may mimick a phenomenon of 'premature menopause'. Unless cancer treatment affects your mood, there should be no loss of libido and you can be sexually active.

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Fertile again?   

Whether or not you will be able to father a child naturally after cancer treatment, with your own sperm cells, depends on the damage inflicted by the treatment. Chemotherapy and radiotherapy often destroy the largest part of the stem cells in the testicle. And because sperm cells develop from these stem cells, sperm cell production usually ends.
Nevertheless, a part of the stem cells may survive the treatment and sperm cell production may resume. In case of chemotherapy resumption of sperm cell production may occur years after cancer treatment, sometimes even up to ten years.
That is one of the reasons why in case of an orchiectomy sometimes only a part of the testicle is removed (for cryopreservation) and at least one testicle is left in place. Depending on several factors there is a chance that sperm cell production will resume in the testicular tissue that is left in place.

Whatever the case may be, if the production of sperm cells resumes, your partner may conceive naturally. However, in practice we often find reduced fertility to be the case, even if sperm cell production returns.

Before you try to fulfil your desire to have children after cancer treatment we recommend to talk to your oncologist or haematologist. He or she will be able to give advice based on your specific health situation.

In How to check fertility in men we discussed how you to have your fertility assessed by means of a blood test and sperm analysis. You can have these tests performed as of six months after the end of cancer treatment or as soon as you are planning to have children.
If the results show that sperm cells are actually being produced but not in sufficient amounts for a real chance of spontaneous conception, you can still decide to undergo fertility treatment together with your partner.

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Cancer treatment does not always cause permanent infertility: the chance of a natural pregnancy is not unthinkable after surviving cancer. If you are not confronted with premature menopause after cancer treatment, the chances are real that your menstrual cycle will resume. This usually means that egg cells will start to mature and can be fertilized, where appropriate. The age at which you have undergone cancer treatment plays an important role, as well as the type, dose and duration of cancer therapy.

The potential of spontaneous recovery of fertility is also the reason why we leave one ovary in place in case of an ovariectomy (removing an ovary for cryopreservation). This will allow the menstrual cycle to recover spontaneously, if applicable.

If the menstrual cycle starts up again – and this can take some time, sometimes even years – it may be possible to get pregnant spontaneously.
Before you try to become pregnant after cancer treatment we recommend to talk to your oncologist or haematologist. He or she will be able to give advice based on your specific health situation.

At the same time we have to conclude that women are less fertile after cancer treatment, even when the normal menstrual cyclicity returns.
In Checking your fertility in women you can read which tests have to be performed to check the status of your fertility. You can have these tests performed as of six months after the end of your cancer treatment.
If the results show that your fertility is reduced, ART (assisted reproductive technology) may offer a solution to see your desire to have a child fulfilled quicker.