How is a man's fertility affected if he has had childhood cancer?

We see many men who have a history of childhood cancer and come to us wanting to know what their fertility potential is. And many of these men want to go a routine evaluation and find out their hormones are normal, their sperm concentration and motility and morphology are normal—these are semen parameters that we routinely look at. And we’ll find that from a reproductive standpoint, they’re intact. However, there are a number of men who we see who’ve undergone cancer therapy for childhood or adolescent cancers, and these gentlemen are not so fortunate. They may have ongoing issues with diminished testosterone or diminished sperm production, and this can indeed lead to impaired fertility. And many of these men unfortunately did not have the option provided to them to bank sperm ahead of their cancer therapy.

So in some instances these men may have very low sperm concentrations, and we can use things such as intrauterine insemination or in vitro fertilization to help them achieve a pregnancy. In other instance, the patients may have no sperm at all in the ejaculate. Even for these men, there is still some hope. We will provide them with the procedure where we look through the testicle using an operating microscope and literally search through the tubules in the testicle where sperm are produced, hoping to find sperm. And in about 40–50% of these men, we can find sperm that can then be frozen and used in the future with assisted reproductive techniques—and that’s more specifically known as in vitro fertilization with ICSI or introcytoplasmic sperm injection.