Despite the best efforts of surgeons and radiation oncologists, it is nearly impossible for a man to retain his ability to father children through sexual intercourse after initial treatment. During prostatectomy, both the prostate and the nearby seminal vesicles are removed. The seminal vesicles are two small structures that lie at the base of the bladder. Together with the prostate, they provide semen that carries the sperm down the urethra and out the penis during ejaculation. The loss of semen following surgery makes ejaculation impossible, so the sperm cannot physically make it out of the body to reach the woman’s egg for fertilization.
With radiation therapy, fertility is nearly always impaired. Radiated prostate cells and seminal vesicles tend to produce semen that cannot transport the sperm well. In addition, the sperm, which is made and housed in the testicles, can be damaged, but this is seen far less frequently with more accurate dose planning.
Fertility Options After Treatment
For men who wish to father children after treatment for prostate cancer, the best chance for fertility is sperm banking. Semen containing sperm is frozen in liquid nitrogen and, although the cells are technically still alive, all cellular activity ceases. After thawing, up to 50% of sperm will regenerate and can be used for artificial insemination.
As an alternative to banking sperm, extracting sperm directly from the testicles might be an option. After harvesting sperm from testicular tissue, a single microscopic sperm is injected into a single microscopic egg. If an embryo forms, it is implanted into the woman’s uterine wall and allowed to grow.
Although technical advances in assisted reproduction have dramatically improved the conception rates, the success rates for the two procedures combined—sperm extraction followed by injection of the sperm into the egg—is less than 50%.