Testicular cancer and its treatment can affect fertility and sexual activity. But if you received a testicular cancer diagnosis, there are steps you can take to increase your chances of having children.

Many factors can affect one’s ability to conceive a child — from testicular injury and infections to testicular cancer and cancer treatments.

This article explores how testicular cancer and cancer treatments can affect a person’s reproductive health and what steps you can take to preserve your fertility.

Fast facts about testicular cancer

  • Testicular cancer is the most common cancer type that occurs in young adults.
  • The most common age range for the appearance of testicular cancer is between 25 and 29 years old.
  • The lifetime risk of testicular cancer in people assigned male at birth is about 1 in 250.
  • An estimated 9,190 people will receive testicular cancer diagnoses in 2023, making up about 0.5% of all new cancer diagnoses for that year.
  • An estimated 470 people will die from testicular cancer in 2023, accounting for 0.1% of all 2023 cancer deaths.
  • Testicular cancer is one of the most curable types of cancer, with a 5-year survival rate of about 95%.
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Testicular cancer is the most common cancer type in young people assigned male at birth. It’s also curable.

If you’ve received a testicular cancer diagnosis, your chances of survival can be good with proper treatment, but there are some trade-offs to the positive outlook.

Testicular cancer and its treatments can affect your ability to conceive a child. A 2018 research review showed that 6% to 24% of people produce no sperm when they have a testicular cancer diagnosis, and about 50% have lower than usual sperm counts.

Beyond these initial challenges to future fertility, cancer treatments may further decrease your ability to conceive a child after testicular cancer. Overall, cancer treatments may further reduce fertility levels by about 30%, and it’s impossible to predict who will produce no sperm after treatment.

A cancer diagnosis and subsequent treatment aren’t the only things that can affect fertility after testicular cancer. Your precancer fertility levels, age, and overall health can also play a role.

Precancer fertility level

Your fertility level before a testicular cancer diagnosis plays a role in your chances of conceiving a child after diagnosis and treatment. If you already have no sperm or low sperm counts at the time of diagnosis, treatment can decrease the amount and quality of your sperm even more.

Overall health

There are lots of health concerns beyond cancer that can affect fertility. Some of these include:

Age at the time of diagnosis and treatment

Your age can affect your ability to conceive a child. The chances of developing erectile dysfunction or other health concerns that affect ejaculation can increase with age.

Drops in testosterone and testicular volume can also occur with age and health conditions that can be common in older adults — like high blood pressure and an enlarged prostate — that can make conceiving more difficult.

Cancer type

Many forms of cancer affect your body beyond the individual organ or body system where the cancer begins. Cancer strains your entire body, frequently causing symptoms like fatigue, weight loss, and gastrointestinal health concerns.

Testicular cancer, in particular, can affect fertility since the testicles produce sperm and testosterone.

Type, dose, and duration of treatment

Cancer treatments are designed to attack rapidly reproducing cells — a trait typical of cancer cells. But other cells in your body reproduce rapidly, too. Chemotherapy and radiation are toxic to sperm cells and the germ cells they form from.

Hormone therapies may also treat testicular cancer, and these are known to decrease sperm counts.

Time after treatment

How long you wait after treatment to try and have a child matters, too. Studies have found that most infertility health concerns stemming from cancer treatment resolve about 2 years after treatments finish.

But your age at diagnosis and the time it takes to treat your cancer — along with a 2-year recovery window — can delay conception efforts beyond people’s peak reproductive years.

Can you still conceive if you’ve had surgery to remove one testicle?

When a doctor removes one testicle during cancer treatment, or it’s missing due to an injury or never descended from the pelvis, your body usually finds ways to compensate.

People with a single testicle typically produce an excess amount of a hormone in that one testicle compared with the amount produced in people with two testicles. This boost in hormone production can help create adequate sperm and testosterone to conceive a child.

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It’s a good idea to begin discussions about preserving fertility at the time you receive your testicular cancer diagnosis. A 2020 research review showed that 48% of men treated with certain types of chemotherapy might conceive a child compared with about 90% who treat their cancer with surgical removal of a single testicle.

Additionally, 22% of men need assistance from a medical professional to conceive a child after testicular cancer.

Despite the odds that your fertility can reduce after testicular cancer, less than 50% of medical professionals treating testicular cancer talk with their patients about fertility preservation before beginning treatment.

Since both testicular cancer and the ways to treat it can result in lower sperm counts, sperm banking is a common choice — especially if your cancer develops before you’re considering reproduction.

Freezing sperm in a collection bank can be a good option since cold temperatures usually don’t damage sperm during long-term storage.

But about 70% of people with testicular cancer offered sperm banking at the time of diagnosis pass up the opportunity — probably due to a combination of cost, timing, and shock over their diagnosis, according to the research review above.

Can testicular cancer affect sexual activity?

In addition to decreasing sperm counts and quality, testicular cancer itself and therapies used to treat it can also affect sexual activity.

Anxiety, decreased libido, changes in blood flow, and ejaculation health concerns are all possible sexual activity challenges that people report facing after testicular cancer.

Can testicular cancer cause developmental issues for a fetus?

Chemotherapy and radiation treatments are known to affect sperm counts, quality, and sexual activity, but experts have not studied the effect of these treatments on a developing fetus.

One 2019 study found that while experts can assume developmental issues for the fetus can occur, there doesn’t appear to be a significant increase in these issues among children conceived by people after testicular cancer in general.

But people with one particular form of testicular cancer — testicular germ cell cancer — did conceive children with higher rates of developmental issues for the fetus, regardless of their cancer treatment.

Can testicular cancer make it harder to conceive?

Yes, testicular cancer can affect sperm health, quality, and the ability to conceive. These side effects can come from the cancer itself and cancer treatments.

Talk with your doctor about ways to preserve your fertility when you receive a diagnosis. Harvesting and banking sperm as soon as possible after diagnosis and before cancer treatment may help you conceive a child after your recovery.

Is testicular cancer curable?

Testicular cancer is highly curable. Many people — about 95% — are still alive 5 years or more after diagnosis. In 2023, an estimated 9,190 people will be diagnosed with testicular cancer, and roughly 470 people will die from testicular cancer or its complications.

Testicular cancer is the most common type of cancer among young people, but it’s also highly curable. The trade-off is how cancer treatment affects your fertility. Testicular cancer and its treatments can have a negative effect on your sperm counts, quality, and your sexual activity.

Sperm banking at the time of diagnosis is a highly effective way to preserve your fertility, but not every medical professional suggests this at the time of diagnosis.

If you have testicular cancer and worry about your chances of conceiving children in the future, be sure to talk with your doctor at the time of diagnosis about options for preserving your fertility.