I want to become a father

– please help me !
• I have been treated for testicular cancer in 2003 and one of my
testicles is removed with a surgery. Before and after the surgery
I have undergone 4 cycles each of chemotherapy. Every 6
months I get the blood tests done and everything seems to be
normal for me. Last year April I have undergone testicular
biopsy and it resulted in azoospermia. Last month I got the FSH
blood tests done and it came out as 23.51.I have consulted
many doctors and they have suggested ICSI for us. As FSH is
high one of the doctor has referred us to sperm donor program.
• I want to know what are the chances of getting my sperm in this
case for ICSI.
• Also as of now I am ready for sperm donor concept. But out of
your experience how many couple are happy with a baby out of
sperm donors and how feasible is it practically.
• “I am a cancer survivor – but I am also a Dad.
When I look at my three beautiful children and
realize that they would not be here if I wasn’t
told to bank my sperm, I feel overwhelmed with
gratitude. They are my life – they are my
legacy. Every cancer survivor deserves the
chance to be a parent!”
Lance Armstrong, Chairman, Lance Armstrong
Foundation
 Cancer, sex and fertility –
love, life and death.
The importance of Information
Therapy !

Dr Aniruddha Malpani, MD
www.drmalpani.com
 Cancer – still some taboo topics

• "Cancer is not a death sentence, but rather it

is a life sentence; it pushes one to live."
Marcia Smith
• “Getting cancer can become the beginning
of living. The search for one's own being,
the discovery of the life one needs to live,
can be one of the strongest weapons against
disease. “ Lawrence Leshan
 Cancer – it’s all about living !
• “This diagnosis is a reminder that this is the
life you’ve got. And you’re not getting another
one. Whatever has happened, you have to take
this life and treasure and protect it. “ Elizabeth
Edwards
• “That is the beauty of cancer, it tells you that
your days are limited, that you could die at any
point. It is that perspective that allows you to
live a better life while you're here.” Shelley
Hamlin
• Fertility is an expression of life’s longing
for itself; and sexuality is the ultimate
expression of being alive.
• Having cancer does not change this
• Unfortunately, cancer patients ( and their
loved ones) are often ashamed to talk about
these natural desires
• Don’t know whom to talk to – or how to
talk
 Fertility

• Hope for the future

• A new beginning !
 Your feelings about losing your
fertility
• Infertility can be very hard to come to terms with.
• Some seem to accept it easily and feel that beating
cancer is more important
• Others seem to accept the news calmly when they
start treatment but find it hits them later when the
treatment is over
• You may feel you have lost a part of yourself and
are less manly or less feminine if you can't have
children.
• You may be very sad or angry that the disease and
the treatment ( surgery or drugs ) have damaged
your fertility
 How chemo affects women's
fertility
• Chemotherapy can stop your ovaries from
working for a while, or possibly permanently.
Whether your infertility is temporary or
permanent depends partly on the drugs and
doses that you have.
During chemotherapy, it is best to continue
using reliable contraception even if your
periods do stop. The chemotherapy drugs
could harm a baby if you do get pregnant.
 Temporary infertility

• If the infertility is temporary, your periods

may become irregular or stop during
treatment. But they will go back to normal
once your treatment is over. This happens
in about a third of all women whose periods
stop because of chemotherapy. It takes
about 6 months to a year for your periods to
go back to normal after your chemotherapy
has finished.
 Early 'menopause'

You may have an early 'menopause'. Your periods

become irregular and then stop completely.
You may also have
• Hot flushes; dry skin; Vaginal dryness ; Loss
of energy ; Less interest in sex
• Your doctor may prescribe hormone replacement
therapy (HRT) to reduce menopausal symptoms.
This is started after the chemotherapy and helps to
prevent the symptoms of the menopause. But the
hormones don't mean you start producing eggs
again. They cannot stop the infertility.
 Ways to keep your fertility

It is not as easy for women to preserve their fertility

as it is for men, but there are ways of doing it,
such as
• Freezing embryos
• Freezing eggs
• Freezing ovarian tissue
• These techniques are done before the
chemotherapy starts and involve having eggs
collected.
•
 Ways to keep your fertility

There are 3 possible problems with this.

Firstly, you can't have this type of treatment with

some types of cancer. If you have a
hormone dependent breast cancer for example,
your specialist may advise against it.
Secondly, it can take a few weeks to stimulate your
ovaries and collect the eggs. Your specialist may
not want you to wait to start your chemotherapy
for that long.
These are expensive techniques; not easily available;
and some are still experimental
 Ways to keep your fertility

The approach to infertility treatment that has been

used the longest is the 'test-tube baby' technique or
IVF. The embryos that are created are then frozen
until you want to have a baby.
It is also now possible to have just your eggs frozen
using a new technique called vitrification. The
process is much the same as for IVF.
Some research is looking into removing ovarian
tissue ( by laparoscopy) and freezing it before
chemotherapy starts. The idea is that after
treatment, the ovarian tissue can be put back. If
the ovarian tissue then starts working normally,
eggs may be produced and so fertility is
IVF
ICSI
Vitrification – Egg Banking
 Getting pregnant after treatment

• Most doctors will advise women that it is best to wait for

2 years after chemotherapy treatment before becoming
pregnant. They recommend this because, if your cancer
is going to come back, it is most likely to recur within
the first 2 years after your diagnosis. If the cancer came
back, you'd need more treatment. As you might expect,
this could be very difficult if you were either pregnant or
had a young baby.
There is no evidence that pregnancy increases the risk of
breast cancer or melanoma coming back - two of the
types of cancer that women are often told can be affected
by pregnancy hormones.
How chemo can affect male fertility

Chemo kills all rapidly dividing cells, including the sperm

producing cells
Not all drugs affect your fertility. But some can
• Reduce the number of sperm you produce
• Affect the sperm's ability to fertilise the egg
If this happens it may be temporary or it may mean that you
will no longer be able to father children. However, it is
important to use contraception throughout your treatment
as it is not advisable to father a child while you are having
chemotherapy - the drugs could harm the baby.
Chemotherapy drugs don't normally have any permanent
effect on your sexual performance or your enjoyment of
sex.
 Sperm banking
If your chemotherapy treatment is likely to cause infertility, you
may want to store some of your sperm before you start your
treatment. The sperm can be frozen and stored for many years
in a sperm bank.
If you later want a baby, the samples are thawed and used for
IVF/ICSI ( since these are precious sperm and worth their
weight in gold !)
It is important to talk to your doctor about the risk of infertility
before you start your chemotherapy treatment. You can
then make decisions about whether to use a sperm bank. Even
teenage boys can store sperm.
Sometimes your doctor may want to start your treatment very
quickly. In this case it may not be possible to store only one
sample.
 Checking your fertility

• If chemotherapy has made you infertile it can

be difficult to predict whether your sperm
production will go back to normal or not
• Some men stay infertile
• Others find their sperm returns to normal and
their fertility comes back
• It can take a few months or sometimes years
for fertility to return to normal. Your doctor
can do regular sperm counts for you when your
treatment is over.
 What to ask your doctor about
fertility and chemotherapy
• Will the chemotherapy make me
infertile? Will it be permanent?
• Do I have any choice about the drugs I
can have?
• How can I bank sperm before my treatment
starts?
• Is it possible for me to store eggs or embryos
before my treatment?
• Will the treatment affect my periods?
 What to ask your doctor about
fertility and chemotherapy

• If I do become infertile, are there ways I could still have

children?
• Can you tell me about ovarian tissue freezing?
• Is there someone I can talk to about how I feel about
infertility?

• Explore all your options ! IVF technology has improved

dramatically in recent years – and many cancer specialists
are still not aware of these advances
 Coping with losing your fertility

Infertility can be very hard to come to terms with. The

sense of loss can be strong for people of all ages.
Discuss this risk with your doctor before you start
your treatment. Your partner (if you have one) will
probably want to join in during the discussion.
Then you both learn all the facts and have the
chance to talk over your feelings and choices for the
future.
 Talking about your sexuality and
sex life
• Some patients find it difficult to talk about their sexuality
and sex life. Your diagnosis of cancer may mean that you
can't have sex or just don’t feel like it. These issues are
very private.
• If you’re in a relationship and try to keep your concerns to
yourself, your behaviour may confuse your partner. They
may feel rejected or think that you no longer love them or
feel attracted to them.
• If you and your partner stop having sex it often means that
other types of intimacy also suffer. You may avoid
hugging and kissing because you worry that it may arouse
your partner and then upset them because you don’t want
to go on and have sex.
 Talking about your sexuality and
sex life
• Sometimes people with cancer avoid physical
contact with their partner, because they are so
unhappy with the changes to their body caused
by cancer or its treatment. Changes in your
appearance or physical ability (if you have had a
breast removed or have scars from surgery) to
have sex may make you feel less confident about
sex. If you are single you may avoid getting into a
relationship as a result.
If you’re able to talk to your partner about your
worries, you’ll both gradually get used to your
new situation and things will feel less awkward.
A caring and loving partner can help to ease your
concerns.
 How cancer can affect your
sexuality and sex life
• Does cancer always affect your sexuality and sex life?

• How cancer and treatment can affect your sex life

• How practical issues can affect your sex life

• Loss of confidence and self esteem
• Changes in your ‘body image’
• Emotional and psychological changes
• What if I don’t have a partner?
• Getting help and support
 Does cancer always affect your
sexuality and sex life?
Not everyone who has cancer will have changes in
sexual desire or how they feel about themselves
sexually.
You may find that the changes cancer causes to your
body image affect the way you feel about yourself
and having sex. At the other end of the scale,
some people say that they want to make love more
than usual. If you are in a relationship, a crisis can
sometimes bring couples very close together.
Because we’re all so different and have different
sexual needs, it’s impossible to say exactly how
cancer will affect each person’s sexuality and sex
life.
 How cancer and its treatment can
affect your sex life
• Having cancer or its treatment can cause:
• Tiredness (fatigue); Irritability ; Low mood or
depression , Anxiety or tension ; Pain Bowel
problems such as diarrhoea ; Bladder problems ;
Mouth problems ; Breathing problems ; Skin
changes or scarring ; changes in your sex hormones
• If you have any of these side effects or feelings, you may
not feel like having sex.
• Conversely, your partner may not feel like having sex with
you
• But most people come out of this phase once their
treatment is over, or their symptoms are better controlled.
 How cancer and treatment can
affect your sex life
• Simply touching can help you feel cared for and reduce
any anxiety and depression you may have. So if you have
a partner, you can focus on showing your feelings for one
another in other ways by
• Enjoying being close to each other ; Touching and
stroking ; Kissing ; Massaging ; Talking ; Holding
hands
• It may help to know that even if you don’t feel like having
sex, a caring partner may still be able to arouse you and
help you enjoy sexual activity.
• It is important that you both agree on what is acceptable to
each of you. Do talk to each other about your worries and
fears. Don't be afraid to ask each other what is OK and
what is not. While talking about sex can be difficult,
checking out each other's feelings and what they want can
 Emotional and psychological
changes
• Cancer doesn't just change you physically. It can
cause many different emotions such as fear,
depression and anger. These intense feelings may
also affect how you feel about sex and about
yourself. You might find that you look at the world
differently after having cancer. Some people really
do find that they can use cancer as a new
beginning. However your outlook on life changes,
you and the people close to you will need time to
get used to it.
 What if I don't have a partner?

• If you’re single, you still need to feel sexual

and attractive to others. This means first
getting used to the changes yourself. It can
be more difficult when you don't have
someone close to support you and reassure
you. Try talking to a close friend or family
member who can help you deal with the
changes that cancer and its treatment have
caused. Talk to them and explain how you
 Getting help and support

• You will probably find that any problems you have with
sex after cancer will get better with time and a little
patience. But some people need a bit of help.
Remember - problems with sex are very common. They
just aren't always talked about much.
Talking about sex can be difficult and many people find
it very embarrassing.
Talking to a counsellor or seeing a sex therapist can help
you to find ways of overcoming difficulties. You can see a
sex therapist if you are single. If in a relationship, you can
go alone or with your partner. It may be better to talk
things through as a couple, if you can.
• Not talking is the worst option
 Vaginal dryness

• This is very uncomfortable. It can make the

vagina become very sore, especially during
intercourse. And it can also make you more prone
to vaginal infections because the natural lubricating
and cleaning process is not working. Even if you
can't take HRT, you may be able to use vaginal
oestrogen. This is oestrogen in a cream or tablet
(called a pessary) that you put into the vagina about
twice a week.
Or you can use KY jelly or other water based
lubricants just before you have intercourse.
 Sexuality and breast surgery

• Whether you have had part or all of a breast removed, it will be an

emotional time for you. You may feel relieved and happy that your
cancer has been found and removed. Maybe you will feel some grief
and anger about what you have had to go through. And the surgery
might affect your sexual feelings.
• The first milestones will be when you first see your scar. It will take
time to deal with your changed appearance. And this goes for your
partner too.
• But you may feel a greater loss if your breasts are important to how
you respond sexually. The breast cancer treatments surgery and
radiotherapy will cause a certain amount of loss of feeling in that
breast. Obviously if you have had a mastectomy, you will have lost
the feeling along with the breast. This can't be brought back and it
will take time for you to mourn the loss. If you have had a double
mastectomy, there may be an even greater sense of loss.
 Breast reconstruction

• You may be able to have more surgery to

reconstruct a new breast shape. This won't
bring back lost sensation, but it may help
you to recover from your mastectomy.
Everyone is different, but if you think this
would help you, then talk to your surgeon.
 If you have advanced cancer

• Having advanced cancer means that your cancer

can’t be cured. But it very rarely means that you are
already terminally ill. But whatever your situation,
you will still have needs and desires. Even if you
don’t feel like having sexual intercourse, you may
still have sexual feelings even if you are very ill.
If your cancer is in the advanced stages you may
have an even stronger need for intimacy in your life
than before you had cancer. Physical closeness,
sharing your feelings and touching may become
very important.
 Help and support

• If you are at all worried about anything to

do with your sex life and sexuality you may
want to talk through how you feel with a
counsellor or therapist.
 Surgery to the pelvis or genitals

•
Some operations for cancer can affect your sex life.
These include
• Having prostate surgery
• Having bowel or rectal surgery
• Having both testicles removed
• Having your bladder removed
• Having all or part of your penis removed
• Surgery to remove lymph nodes from the back of the abdomen
 Ejaculation and fertility problems

If you have a radical prostatectomy you will no longer

produce semen at all. If you have dry orgasms, you will
not be able to have children by natural sexual intercourse
because your sperm cannot be passed into your partner's
vagina during sex. If you want to have children, it may be
possible to take sperm directly from your testicles . The
sperm can be used for IVF/ICSI.
Problems with erections
Depending on the surgery you have, there is also a risk
of difficulty getting or maintaining an erection. This
is called impotence. After any surgery to the prostate you
may be impotent temporarily. Impotence is more likely to
be permanent if you had a radical prostatectomy.
 Coping with a low sexual desire

• Cancer and its treatment can make you lose interest in

having sex.
Your sexual desire may be lower because of Tiredness (
fatigue); Anxiety about having cancer ;
Loss of confidence and self esteem ; Side effects from
other treatments such as chemotherapy ; Changes in the
male sex hormones
• Many of these problems will disappear once your
treatment finishes and your desire for sex will return to
normal. But it may take a bit of time, so don’t worry too
much if you don’t feel like having sex for a while.
• If you’re in a relationship it will be important to talk about
this with your partner. Kissing and touching can be very
comforting and relaxing, as long as you’re both clear about
how far you’re expecting to go.
 Managing erection problems

• Even if you can't get a full erection, you can still have a sex
life. You may find you can still get a partial erection and are
able to have intercourse. If your erection problems are caused
by surgery, they may get better with time.
Even if you can't get an erection at all, it is worth talking to your
doctor or urology nurse specialist, if you have one. There are
treatments that may help you including
• Drugs
• Injections or pellets
• Vacuum pumps
• Implants
 Sex and cancer for partners

• Talking to and supporting your partner

• Physical changes
• Sexuality
• More information and support
 Talking to and supporting your
partner
• You can do a lot to help your partner come to
terms with the effect their cancer and treatment
has on them. The most important way you can
help is being prepared to listen. It is also
important to talk openly and honestly to your
partner. They need to know that you still love
them and find them attractive, and that you are
prepared to give them the time and space to
recover.
 Physical changes

• It will help them if you are able to face obvious

changes like scars. You may also need time to get
used to this sort of change. New scars tend to be
more visible at first. With time, they will settle
down and become less obvious. If your partner
has had a mastectomy, for example, she will
almost certainly worry that you find her less
attractive, and may worry that you actually find
the scar ugly and that it 'puts you off'. It can be
very healing for a partner to touch or stroke a scar
as it shows that you have accepted these body
changes.
 Sexuality

• It may be helpful (or necessary) to put intercourse

on hold for a while and concentrate on showing
each other affection. Kissing and touching can be
very comforting and relaxing, as long as you are
both clear about how far you are expecting to go.
Many men are afraid of causing a woman with
cancer pain, even by touching them. Worries like
this can get in the way of a relationship. Talking
with each other will help. Ask your partner to
guide you either by words or actions and be
prepared to go at her pace. And for women who
feel rather shy at taking the lead some gentle
encouragement may help.
 Sex and cancer if you are single

•
This page has information on sex and cancer if you
are single. There is information on
• Your feelings
• Starting a new relationship
• If the relationship gets more serious
• If you can't have children
• Involving your partner in check ups
• What if someone rejects me?
• If you have advanced cancer
 Your feelings

• If you are single and have cancer you still need to feel
sexual and attractive to others. The physical and
emotional changes cancer may cause can sometimes make
it very difficult for a single person to feel comfortable
about their sexuality and starting a new relationship.
• You need time to get used to any changes yourself. Try
talking to a close friend or family member who can help
you deal with the changes treatment and cancer have
caused. If you want to speak to someone outside your
circle of family and friends you can try counselling.
Take your time and don’t feel you must rush into a new
relationship. You have been through a lot with having
cancer and its treatment. And you will need time to accept
any changes to your body yourself before trying to share
them with a new partner.
If the relationship gets more serious

• Starting a new relationship is one thing, but if it becomes

more serious and there is a possibility of staying together
long term, there are other worries you may have. As your
relationship deepens and you become more secure in being
with the person, hopefully you will feel more comfortable
discussing your cancer.
You may feel that you don’t want to risk upsetting your
partner or changing their views of you. But this isn’t
always the best way to handle things. There are certain
things that need to be discussed before you decide to plan
a life together. Refusing to talk about these things may
cause problems for both of you.
 If you can't have children

• You may have lost your ability to have children (your

fertility) because of the side effects of your treatment.
This can be very painful to deal with. Finding the right
time to tell your partner about this can be extremely hard.
Even if you can still have children you may worry that
your cancer will come back and you won’t live long
enough to see your children grow up. Talking to your
partner about these issues is very important for you both.
A loving partner will be supportive and continue to love
you as you are.

Involving your partner in check ups

You may need to go for regular follow up appointments
for several years after your cancer treatment. So it will be
important to let your partner know about this.
 What if someone rejects me?

• Sadly, some people may reject you because of your

cancer and its treatment. If this happens it can be very
upsetting and shocking. It’s likely to really knock your
confidence. You may think that everyone is going to
react in the same way and you’ll never meet anyone who
will love you for what you are. It is hard, but try not to
feel too hurt. Most of us face rejection from a partner at
some time during our life. It may be hard to believe at
the time, but often the best way to deal with it, is to tell
yourself they just weren’t the right person for you. You
are probably better off without them. Try not to let it
put you off going on to meet someone else.
 Some common questions

• Can I catch cancer from my partner?

• No. If your partner has a cancer, you cannot catch it from any sexual
activity. You cannot catch cancer from sex.
• Could sex make my cancer worse?
• No. On the contrary, sex and all the love and caring that goes with it
can be helpful to those who have cancer. Many people feel depressed,
unlovable, guilty or afraid when they have cancer or are having
treatment, and their partner's affection and acceptance can make a big
difference.
• Are there times when sex should be avoided?
• Yes, there are. First of all, it's safest either to avoid sex or to be sure to
wear a condom or use some other form of barrier contraception
during, and for a few months after, chemotherapy. We simply do not
know enough about whether chemotherapy drugs can be present in
semen or vaginal fluids.
 Some common questions

• Are there any good positions for making love after cancer?
• Maybe making love side by side, or swapping who's on
top, will be better.
• How can I overcome problems of tiredness?
• Be flexible about the time of day you make love.
Experiment with less demanding positions for lovemaking.
And agree with your partner that lovemaking need not
always mean a long session.
• I'm embarrassed about my scars but still want to make
love. Any ideas?
• It is a good idea to first talk things through with your
partner. Most people find their lovers are much less
concerned by their scars than they imagine, and once the
subject has been discussed openly they can feel more
relaxed about the changes in their bodies.
 The Serenity Prayer

• God grant me the serenity

to accept the things I cannot change;
the courage to change the things I can;
and the wisdom to know the difference.
• Reinhold Niebuhr
Humour
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