Infertility After Prostate Surgery
Infertility after prostate surgery, specifically a prostatectomy, is a side effect patients should be informed about prior to surgery. During a prostatectomy, surgeons remove the prostate along with the seminal vesicles, which are the main source of semen, and the vas deferens. The removal of these structures makes a man unable to ejaculate and infertile.
The fact that a radical prostatectomy makes a man infertile is usually not a concern for men who are middle-aged or older who have already had their children. But for others, infertility after prostate surgery is important, and a side effect of the surgery that they need to consider when making a choice for treating prostate cancer.
In addition to infertility after prostate surgery, most men no longer produce sperm about three years after undergoing radiation therapy for prostate cancer. Sperm cells are also very sensitive to radiation, and doses as low as 600 cGy can cause irreversible damage. Lower doses may cause a temporary decline in the quality and number of sperm produced and have only a short-term impact on fertility. Some chemotherapy drugs used alone or in combination also can impact fertility.
What are the Options to Infertility?
For men who want to have children, one option is to bank their sperm before they undergo either prostatectomy or radiation treatment. It is a simple procedure: a man goes to a sperm bank and provides a sperm sample by masturbating into a cup. The semen is frozen for future use. Two or three specimens are often collected on different occasions because about half of sperm die during freezing, so having several samples can help ensure there is enough viable sperm. Before providing a sperm sample, men should refrain from ejaculation for two to four days, which allows time for a good supply of sperm to be produced.
For men who do not use a sperm bank, another option is sperm extraction. After the testicles and scrotum are numbed with a local anesthetic, a physician uses a needle to extract a tiny amount of tissue from each testicle. The tissue is analyzed for sperm content, and any available sperm is frozen for future use.
Men who are concerned about maintaining the ability to father children should question their healthcare providers about the possibility or certainty of infertility after prostate surgery or radiation treatment. Similarly, physicians should make a point of informing men about the impact of any treatment or procedure on fertility.