Testicular cancer is most common in men aged 25 to 39 — that’s also the age range of most first-time dads. Treatment for testicular cancer can impact male fertility, but your outcomes depend heavily on which treatment you need, at what dose, and what your sperm parameters look like before treatment started. Here’s what you need to know about testicular cancer and infertility.
Surgery (orchidectomy): What does removing one testis mean for fertility?
Testicular cancer usually affects just one testis (testicle). Surgery to remove the affected testis (an orchiectomy) is almost always the first treatment. If the cancer hasn’t spread, it might be the only treatment you need. On its own, this surgery doesn’t usually cause infertility. Your other testicle takes over sperm and testosterone production, and for most men that’s enough. In patients with low-risk cancer receiving standard therapy, infertility prevalence is only 4%. This suggests that most men retain fertility after orchidectomy.
In some rare cases, both testicles are removed (bilateral orchidectomy). This causes permanent infertility because you will no longer produce sperm.
The bigger risk to fertility comes from further treatment such as chemotherapy, radiation, or additional surgery. However, doctors recommend all men with testicular cancer bank their sperm before any treatment.
Retroperitoneal lymph node dissection: What is it and how does it affect fertility?
If cancer has spread to nearby lymph nodes, you may need an operation called retroperitoneal lymph node dissection (RPLND). This involves the removal of lymph nodes that may contain cancer cells from the back of the abdomen. This procedure can damage the nerves that control ejaculation, so there is an increased likelihood of developing a condition called retrograde ejaculation. This is when semen travels into the bladder, rather than out through the penis and can hamper your ability to conceive naturally. If you have retrograde ejaculation, sperm retrieval can find sperm for fertility treatments like in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).
Chemotherapy and male fertility: Is the impact temporary or permanent?
Chemotherapy is the use of certain medications to destroy cancer cells. It usually works by slowing down and eventually stopping the cancer cells from growing. Chemotherapy is gonadotoxic, meaning it damages the cells in your testes that produce sperm. The amount of damage depends on the type of drugs, the dose, and how many cycles you need. In most cases, the damage is only temporary and sperm production recovers. Recovery may take up to a few years. In up to 1 in 10 patients, damage may be permanent and sperm production never returns to normal.
If you’re having chemotherapy, your treating team will generally advise you to avoid trying to conceive naturally for six to 18 months afterwards.
Radiotherapy: Temporary effects, dose-dependent outcomes
Radiation therapy uses high-energy particles or waves (usually X-rays) to slow down the tumour growth and destroy the cancer cells. It also damages the sperm-producing cells in your testes, and the extent of the impact depends on the dose and whether the treatment directly exposes the testes. Radiation to the pelvis carries a higher fertility risk than radiation to other parts of the body, and shielding (using protective lead coverings over the testicles) can reduce but not eliminate that risk.
Does your fertility status before cancer treatment matter?
Yes. Your age, baseline sperm parameters, and overall health before treatment all influence what your fertility looks like after it. There is currently no reliable way to predict which patients will become permanently infertile after treatment — which is exactly why sperm banking before treatment is so important. However, it’s also important to remember that semen parameters are in men before testicular cancer treatment.
What can you do to protect your fertility before treatment?
Sperm banking
Sperm banking, or cryopreservation of sperm, involves collecting and freezing semen samples before treatment begins, so you have the option of using them for fertility treatment in the future. Australia’s clinical guidelines for the management of male infertility say that sperm cryopreservation before elective orchidectomy is mandatory. This means your treating team should raise this with you but if it doesn’t come up, bring it up yourself. If you need chemotherapy or radiotherapy, it’ll start soon after diagnosis — which can mean you have days, not weeks, to arrange sperm banking.
How does sperm banking work in practice?
A doctor will refer you to a fertility clinic or andrology unit, where you’ll provide a semen sample in a private room. If you can’t provide a sample on-site, then you can bring a sample that you collect at home. If you collect semen at home, keep the sample warm and take it to the laboratory quickly, ideally within 30 minutes. You will still need to book an appointment if you are dropping off your sample, so the lab is ready. If you have azoospermia or severe semen abnormalities, your specialist should recommend sperm extraction during your orchidectomy.
What about after treatment?
When should you get a fertility assessment?
If starting a family is an immediate priority, see your GP after completing treatment. They’ll refer you for a semen analysis and blood tests to help determine your options.
Depending on the result, your options include:
What if sperm production doesn’t return?
If you have zero sperm count after treatment, surgical sperm retrieval is an option. Micro-TESE (microsurgical testicular sperm extraction) is the preferred approach. Surgical retrieval success rates depend on the type, dose, and duration of the cancer treatment, as well as other individual risk factors.
Your fertility specialist will help you work through what’s right for your situation.
What does sperm banking cost in Australia — and does Medicare cover it?
The ART Storage Funding Program
Since 1 July 2023, the Australian Government has funded the cost of cryopreservation for eligible cancer patients through the Assisted Reproductive Technology (ART) Storage Funding Program.
If you’re eligible, registered clinics claim funding on your behalf — meaning no out-of-pocket costs for the storage itself. Eligibility requires:
Funding covers the storage of sperm for up to 10 years.
Programs for younger Australians
The Sony Foundation’s You Can Fertility program offers free fertility preservation — including testicular tissue cryopreservation — for Australians aged 25–30 diagnosed with cancer. The program operates through the National Ovarian and Testicular tissue Transport and Cryopreservation Service (NOTTCS) at The Royal Women’s Hospital in Melbourne.
In New South Wales, the Fertility and Research Centre at the Royal Hospital for Women in Randwick provides free oncofertility consultations and preservation procedures for eligible patients.
Patients anywhere in Australia can access the NOTTCS program via telehealth, and tissue extraction can be performed at any public hospital under Medicare. Enquiries: (03) 8345 3227 or NOTTCS@thewomens.org.au.
Your GP, urologist, or oncologist can provide a referral.
The emotional side of this
A testicular cancer diagnosis touches on some deeply personal concerns — mortality, body image, masculinity, sexual function, and the ability to have children in the future. Anxiety is common. It can affect your sex drive and your mental health, even when the physical side effects are manageable. That’s not unusual, and it doesn’t mean something is wrong with how you’re coping. If you’re finding it hard to process what’s happening, psychologists, fertility counsellors, and genetic counsellors can all help — as can the people already around you. MensLine Australia offers 24/7 telephone support on 1300 78 99 78.
Talk to your doctor about your options — before treatment starts
The most important thing you can do right now is raise fertility preservation with your treating team as early as possible — ideally before any treatment begins. If that conversation hasn’t happened, ask for it. If you’re not sure where to start, your GP can refer you to a fertility specialist or andrologist.
People also ask
Are men with one testicle less fertile?
While fertility is reduced, many men with one testicle can still father children.
