Late effects of cancer treatment
“Late effects” of cancer treatment refer to side effects or complications that arise months or even years after the treatment has been completed. These effects can impact various aspects of health, including reproductive health, abnormal hormone levels (hypogonadism) and can contribute to male infertility.
Dr Sangster specialises in fertility preservation and lectures widely across the world on strategies to help men either before or after cancer treatment.
Chemotherapy Gonadotoxicity: Chemotherapy drugs, particularly alkylating agents (e.g., cyclophosphamide, ifosfamide), can damage the germ cells in the testes, leading to reduced sperm production or complete azoospermia (absence of sperm in semen).
Chemotherapy can affect the endocrine system, leading to disruptions in the hormones that regulate spermatogenesis (sperm production).
Radiation Therapy: Radiation directed at or near the pelvic area can harm the testes, impairing their ability to produce sperm. The extent of damage depends on the radiation dose and field. Radiation can also damage blood vessels and nerves involved in reproductive function.
Surgery:
Removal of Reproductive Organs: Surgical procedures for cancers of the reproductive system (e.g., testicular cancer, prostate cancer) may involve the removal of one or both testes, the prostate gland, or parts of the reproductive tract, directly affecting fertility.
Pelvic Surgery: Surgery in the pelvic area can sometimes damage nerves and blood vessels critical for erection and ejaculation.
Hormonal Therapy:
Androgen Deprivation Therapy: Used primarily in prostate cancer treatment, this therapy reduces levels of male hormones (androgens) that can impact sperm production and libido.
Bone marrow Transplantation:
High-dose Chemotherapy/Radiation: Prior to transplantation, patients often undergo high-dose chemotherapy or total body irradiation, which can severely impact spermatogenesis.
Treatments
- Hypogonadism treatment.
- Induction of spermatogenesis – using different medicines or hormonal stimulation can be used to induce spermatogenesis. This can be very effective in men who have abnormal hormone levels after their cancer treatment.
- Surgical sperm retrieval.
- Advice on donor sperm or adoption routes.