Some cancer treatments might affect your fertility. Sperm banking is a way of storing your sperm for use in later fertility treatment.
Fertility and cancer
Some cancer treatments cause infertility in men. These treatments include:
- some chemotherapy drugs
- radiotherapy to particular parts of the body, including the abdomen
- surgery to particular parts of the body, such as removal of the testicles or some types of prostate surgery
Before you start cancer treatment, your doctor will tell you whether it is likely to mean you can no longer father children.
Your fertility might be affected permanently or temporarily. If it is temporary, you will become fertile again after treatment. The time this takes varies from person to person. It also depends on the type of treatment you have had. It usually takes at least a few months after the end of treatment.
What is sperm banking?
Sperm banking is the name for the collection and storage of semen. Semen is the fluid that contains sperm. Sperm banking is also known as sperm cryopreservation or semen storage.
Some cancer treatments can affect your fertility. This might affect your ability to father children in the future. Collecting sperm before treatment means you might still be able to have children in the future if you want to. The sperm is frozen and stored until you decide you want to use it to have a baby.
Who needs to bank sperm?
You might consider storing sperm if you think you might want to have children in the future and your cancer treatment might prevent this. You need to store sperm before starting treatment.
The National Institute for Health and Care Excellence (NICE) recommend that doctors should offer sperm banking to any man having cancer treatment that may affect their fertility. Teenage boys who have been through puberty can also collect and store sperm.
Some men are not well enough to bank sperm. Others may not be able to bank sperm if they have a type of cancer that needs treatment as soon as it is diagnosed. This includes some types of leukaemia and lymphoma. If treatment needs to start quickly there may not be enough time. Or there may only be time to collect one sample.
Some kinds of cancer can affect the quality and number of sperm you produce. A laboratory will analyse your first sample, to check the quality and number of sperm.
If your sperm count is low
You can still bank sperm if your sperm count is low. A technique called intracytoplasmic sperm injection (ICSI) uses a single sperm to fertilise an egg in a test tube. So you may still be able to father a child in the future.
If you can't get a sample
Occasionally, men can't produce a sample. In this situation you may be able to have some fluid or tissue taken from your testicle. If you're making sperm, they will be in the fluid or tissue, and that can be frozen for later use. This treatment takes time, so if you need cancer treatment quickly this might not be suitable for you.
If you have started treatment you can't bank sperm. This is because some treatments, such as cancer drugs or radiotherapy, may damage sperm temporarily.
Research is looking at collecting tissue from the testes in young boys who haven’t been through puberty. This may mean they are able to father children in the future.
Collecting and storing sperm
Most people go to a specialist fertility clinic or a clinic that is part of the hospital. There are a number of steps to sperm banking.
Before you can bank sperm you need to have blood tests to check for infections. These are the same checks you have when giving blood. They include blood tests for HIV, hepatitis and a virus called cytomegalovirus (CMV).
You need to sign a consent form for sperm banking. This includes information about:
- what happens to the sperm if you are no longer able to make decisions for yourself or if you die
- how long you want to store the sperm for – this is usually 10 years
- whether your partner can use the sperm to have a baby if you die
- whether you want to be named as the father if a child is born
- whether your sperm can be used for research or donated for use in someone else’s fertility treatment
- any other conditions you want to state about how the sperm can be used
To get the best sample you shouldn't have sexual intercourse or masturbate for 3 or 4 days beforehand. This helps you collect the highest number of sperm.
Most men feel some embarrassment when they go to the clinic. Some men find it difficult to produce a sample. It can be a rather pressurising situation. You may find it helpful to take your partner along. Or you can take things that you know will help you, such as magazines.
It can be especially difficult if you're a teenager. Think carefully about whether you want anyone to go to the clinic with you and who you'd like to take. It might be easier to take a friend or older brother than your parents.
At the clinic a nurse will show you into a private room. You produce the sample by masturbating. Don’t use any lubricant, spit, saliva or a condom because it can kill the sperm. You collect the sample in a sterile container. The nurse will tell you who to give the container to.
The clinic will test the sample to see:
- how many sperm it contains (the sperm count)
- how many of the sperm can swim (motility)
- how many sperm have a normal shape (morphology)
The clinic staff makes sure the sample is labelled correctly and then it is freezen it in liquid nitrogen.
Most clinics recommend collecting at least 2 samples, and if possible 3. This depends on how quickly you need to start cancer treatment. You need to leave at least 2 days between each collection.
Costs of sperm collection and storage
In some areas of the UK, sperm banking is available free on the NHS. In other areas you have to pay for it. The National Institute for Health and Care Excellence (NICE) recommend that sperm storage is available to men who might become infertile because of cancer treatment. But each area can choose whether they store sperm for free or whether you need to pay.
It is important to consider costs of:
- collecting samples
- storage (usually an annual fee)
The clinic storing your sperm will write to you once a year. They check whether you want to continue storing your sperm. If you do, either you or your local NHS pay the yearly fee. It's important to let the clinic know of any change of details, such as a change of address, so that they can still contact you. If they can’t find out whether you still want to carry on storing the samples they will destroy them.
The Human Fertilisation and Embryology Society (HFEA) code of practice says that clinics should give you a cost plan before you start fertility treatment or storage of sperm. This should include an idea of the tests you need and how much they'll cost, as well as the treatment plan.
How long can I store the sperm?
The usual time you can store sperm is 10 years. You can extend this up to a maximum of 55 years if you stay infertile.
If you don’t use the samples they can be discarded or donated for research.
When you want to start a family
Not everyone becomes infertile after treatment. Some men have temporary infertility but become fertile again after a time. So, when you and your partner decide you want to start a family, you might want to try for a pregnancy naturally. You can ask your doctor for a sperm analysis. This shows whether you have enough sperm to try for a baby naturally. To do this you need to give a fresh sample of semen.
If you have no sperm, or your sperm count is low or poor quality, your doctor can refer you to a fertility specialist. The specialist can work out the best way for you and your partner to try to become pregnant.
You may have one of the following:
- intra uterine insemination
- in vitro fertilisation (IVF)
Intra uterine insemination
The doctor thaws the sperm and puts them into your partner’s womb with a thin, soft tube (catheter) when her ovaries are producing an egg (ovulating).
In vitro fertilisation (IVF)
Your partner needs to have hormone injections to encourage her ovaries to produce eggs. A doctor collects the eggs and then either injects a single sperm into an egg or mixes the eggs with the sperm in a test tube. The doctor then puts the fertilised eggs into your partner’s womb.
In some areas of the UK, fertility treatments are funded by the NHS. The National Institute for Health and Care Excellence recommend that if the woman is aged 39 or under, a couple should be able to have 3 full cycles of in vitro fertilisation (IVF) or ICSI if cancer treatment means they're unlikely to have a baby naturally.
If the woman is between 40 and 42 and hasn’t already had IVF, NICE recommends that one cycle is offered free. But this guidance is not followed in all areas of the UK. The Infertility Network UK has detailed information about NHS funding across the UK.
Success rates for having a baby
The success rates using thawed sperm vary and depend on the quality of the sperm once it's thawed. Freezing and thawing sperm damages some of them. Sperm banking has produced thousands of babies but it doesn’t guarantee that you'll be able to father a child.
There are no known risks to the man, or to any babies born from using frozen sperm.
The following success rates are from the Human Fertilisation and Embryology Society and include healthy people having treatment using insemination and IVF.
- under 35 the success rate is around 25 births out of 100 treatments (25%)
- aged 35 to 39 the success rate is between 15 and 20 births out of 100 treatments (15 to 20%)
- aged 40 to 42 the success rate is between 10 and 15 births out of 100 treatments (10 to 15%)
Coping with possible infertility
It can be very difficult to cope when you're worried that you might not be able to have a child after cancer treatment. Most fertility clinics have counsellors you can speak to. You can also ask your specialist cancer nurse. They can arrange counselling for you and your partner.
Questions to ask
Here are some suggestions for questions you might like to ask your doctor about cancer treatment and sperm banking.
- Will my treatment make me infertile?
- Can I have sperm banking?
- Where do I go to give a sperm sample?
- Do I have to pay for sperm banking?
- If I have to pay, how much will it cost for collection and storage?
- Will I be able to get fertility treatment within the NHS when I want to start a family?
- How soon after my treatment can I have tests to find out whether I can have a child naturally?