9 November 2022

Does testicular cancer affect fertility?

Doctor physician consulting with male patients in hospital exam
Medical Director
Cesar Diaz-Garcia
MD PhD Assoc Prof
IVI London


Around 2,300 men are diagnosed with testicular cancer every year in the UK. The diagnosis can come as a particular shock because it tends to affect younger people, most commonly seen in men of reproductive age. Firstly, the good news is that the cure rate is very high at around 95%. However, this cancer is likely to affect your fertility, which could naturally be more of a concern for younger men who may not have started or completed their families.

In this article, we will be looking at some of the common questions about testicular cancer:

  • What are testicular cancer symptoms?
  • What does testicular cancer look like?
  • Is testicular cancer painful?
  • What does testicular cancer feel like?
  • How is testicular cancer treated?
  • How does testicular cancer impact on fertility?

What are the symptoms of testicular cancer?

It’s easy to check yourself for testicular cancer because the most common symptom is a lump or swelling in one testicle. This usually takes the form of a painless palpable mass (i.e. you should be able to feel it). The mass should be a significant size of a few centimetres. Small non-palpable masses are more likely to be benign tumours or cysts. In a few cases, since the condition can lead to reduced sperm production, the only noticeable symptom is infertility.

What does testicular cancer look like?

Most men have one testicle slightly larger than the other, but in the case of testicular cancer you may see a hard lump on the side or the front of one testicle. You may notice that the difference between the two testicles has become more pronounced. The NHS advises that it’s important to know your own body so you are familiar with what is normal for you, and be alert to any changes.

Is testicular cancer painful?

Very often the lump in your testicle will be painless, but where pain does occur it is likely to be a dull ache in your testicles or scrotum. This ache may be sporadic. A feeling of heaviness in the scrotum is also quite common. If the cancer has spread to the lymph nodes, there can be other symptoms such as a pain in the lower back or abdomen.

How is testicular cancer treated?

There are three main treatments for testicular cancer. These are an orchiectomy (the surgical removal of a testicle), chemotherapy or radiotherapy. These treatments remove cancerous cells as well as reduce the risk of the cancer recurring.

  • Orchiectomy: The only way to obtain a definitive diagnosis is to remove all of the affected testicle. After removal, a pathologist examines the tissue for cancer cells, which will also reveal the type of cancer you have. You may only need surgery, or it could be followed up with chemotherapy and/or radiotherapy.
  • Chemotherapy: Your oncologist may prescribe chemotherapy after surgery to reduce the risk of the cancer returning, or to treat any cancer that has spread outside the original site.
  • Radiotherapy: Radiotherapy is a targeted treatment. It aims to destroy cancerous cells while avoiding or minimising damage to adjacent cells and structures. It can be an alternative to chemotherapy. Oncologists sometimes prescribe both radiotherapy and chemotherapy in particular cases.

How does testicular cancer impact fertility?

Testicular cancer can be the cause of a low sperm count. But the most significant impact on a man’s fertility comes mainly from the treatment, rather than the cancer. In most cases, boys and men develop cancer in one testicle only. After removal of the testicle, it’s possible that the remaining testicle will produce enough testosterone for general health. The treatment may not affect your fertility. The problem is, before surgery, there is no way of knowing whether further treatment will be required. Treatment for testicular cancer doesn’t normally affect your ability to have sex. It may not affect your fertility. However, there is no guarantee.

Protecting your fertility before testicular cancer treatment

In light of these uncertainties, fertility preservation is often strongly recommended. If you think you might want children in the future, you should take steps to preserve your fertility. Even if the probability is low, testicular cancer treatment can affect your fertility. Your specialist is likely to advise that you freeze sperm just in case.

What is sperm banking?

Sperm banking, also known as sperm freezing or cryopreservation, is the process of collecting, freezing and storing sperm for use in the future. It can then be thawed and used in an assisted fertility treatment such as intrauterine insemination (IUI) or, depending on your specific circumstances, with in vitro fertilisation (IVF). A specialist will assess your sample to ensure it is of a high enough quality. You may need to produce another sample if the quality of the sample is low.

What is the sperm banking process?

Experts advise freezing sperm even if you are having surgery to remove one testicle. Although testicular cancer can lead to semen abnormalities, you may experience decreased fertility following surgery. Your specialist may recommend freezing sperm pre- versus post-surgery for this reason. If you require further treatment such as chemotherapy or radiotherapy, it is vital that you consider preserving fertility before commencing treatment. The process is very simple. A member of staff will ask you to produce a sperm sample in a private space in your doctor’s surgery or fertility clinic. A clinical specialist will then freeze your sample immediately. If producing a sample is not possible, there is a surgical option to extract sperm from the testicular tissue.

IVI and the preservation of fertility

At IVI, we are leaders in the field of fertility preservation. We not only help adults, but children and young people diagnosed with cancer. Our donations support the Oxford University Hospitals NHS Foundation Trust to help advance research into the uses of cryopreserved ovarian and testicular tissue in future fertility treatments. This research has helped thousands of children and young adults preserve fertility to build their future families.

You can find out more about this project here, or if you would like to speak to one of our specialists about fertility preservation, just get in touch using our online contact form.

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