Infertility after cancer

[allthesharks]

My partner had cancer 7 years ago and was treated with surgery and chemotherapy. We haven't been trying to conceive but we want to in the future and we knew it was a chance that it could be a problem. Given his history, his GP referred him for a semen analysis. He got the results yesterday and although his sperm count is good, none of the sperm were "normal". The GP said it's very unlikely he could conceive a child. Prior to chemo, he had a sample frozen so we would have the option of using this. I have two children already (with my ex husband) so we assume that my fertility is still ok. On this basis, I wonder is IUI would be a viable option for us using his frozen sample. I also know, and understand the reasons why, fertility treatment on the NHS is most likely not an option for us as I have children already. From what I understand, IUI is more affordable than IVF and if it has a reasonable chance of working, I would rather go with that option. At least initially. Both of my children were born premature so I don't know if that would make me a suitable candidate for fertility treatment anyway.

I know that I am incredibly lucky to have two children already and as much as my DP loves them both too, I still can't help feeling devastated that I may not be able to have a child with the man I love.

I don't really have one specific question. I haven't met with a consultant so my knowledge is sparse, but I wondered if anyone had any advice or information they could offer me.

Hi. We are in a similar situation. We are facing male factor infertility after my husband was treated with chemo 10 years ago. Slightly different in that our SA showed zero sperm. We have been referred for fertility treatment and are just waiting on our second appt. We don't qualify for NHS funding because I'm 4lbs heavier than I'm allowed to be to qualify (pisses me off as I'm healthy and run alot but I'm just a heavy person!) so we are self funding.
We have been told that if his frozen sample is of good quality and quantity then they might try IUI but not if there isn't enough as they wouldn't want to waste it on a procedure that has a poor success rate. So we may well jump straught to IVF.
We thought there where no problems with me but I don't have good egg reserve on scans that I've had, which just complicates things more. I can keep you updated in what our clinic say when we have our appt next week if you like? Also I'm a NICU nurse, and I've never heard of fertility treatment being an issue, infact I know couples who have had a second child via fetlility treatment after the first was born prem so I wouldn't worry too much. The clinic would likely just try a little harder to make sure you didn't end up with twins

Thank you for your reply. I think the news has sunk in now. We have decided to start "trying" at this point. The GP asked why not start trying which, we both thought was a strange question because we thought "what's the point?" But from reading up a bit more, it seems that morphology is likely to be the problem (still don't have the written report yet and we will know more once we do) and from what I've read and what the GP said, it seems as though it's unlikely we would conceive naturally but not impossible. So we will start trying as we really have nothing to lose. He is due to see his oncologist next spring so at that time we will ask for a referral to a fertility clinic where his frozen sample is stored and find out more about our options. I was very fortunate to conceive my two children with my XH very quickly so my fertility was previously fine and hopefully it has stayed that way.

Thank you for the information about IVF most likely still being an option with a history of pre-term delivery. And I can't thank you enough for the wonderful job you do as a NICU nurse.

Do you know what time scales you are looking at for starting treatment? As I say, this is all brand new to me so I have no idea about the process.

Whether IUI is a good idea will depend on how many samples you have. Probably IVF would be a better idea so as not to waste the samples.

We are in the same situation and are waiting to start IVF. We were told no to IUI because we don’t have any children yet it will use too much of the sperm banked with less chance of success.

I was also told that DNA fragmentation can cause genetic issues in a baby conceived naturally so if you are successful that is something to take in to account with screening options etc.

Good luck!

I was under the impression that a frozen sample could be broken down. Is that not the case? Or is it that so much of the sample would need to be used each time that it's best to go for the option with the best possible chance. Does one sample equal one treatment?

What is DNA fragmentation? Sorry for being thick. I'm sure I'll learn more along the way.

@Holly19 with your DP, is it a case of poor morphology? Or is it a different problem with the semen?

The sample gets split in to vials normally about 3 vials from a sample but once it’s gone it’s gone an I think IUI requires more than one vial to be defrosted.

DNA fragmentation is alterations in the DNA of the sperm. For some men they are born with naturally high fragmentation but for men who have had chemo - chemo works by altering the cells in the DNA and that can sometimes cause DNA damage. If a sperm fertilises an egg with DNA damage it can cause miscarriage or a baby to be born with genetic disorders. They say most sperm is regenerates after 2years but there are some studies showing this 10+ years after chemo.

We have zero count but my DH is only 9months post chemo

Thank you for explaining that. I didn't realise that could be a factor. Is DNA fragmentation tested as part of the semen analysis? We are still waiting to hear back from the GP about getting the written report.

I think it costs a bit more. I think given he has chemo quite some time ago it will probably be ok no so don’t worry too much just I would suggest not declining the screening tests at a 12 week scan x

Oh yes, absolutely, I'd get all screening tests done regardless. Thank you for your responses.

Do you know how long you can expect to wait to start IVF?

Well we submitted our paperwork in July but an admin error saw it left in a tray at the hospital for seven weeks so we don’t even have our funding confirmation letter yet 😭 so frustrating but I’m learning NHS IVF is full of bumps in the road.

IF you are going privately I think it’s quite quick / sometimes as soon as day 21 of your next cycle. I agree with the GP to try for a bit though as miracles really do happen. I was watching a programme earlier and a woman had two miscarriages, four failed attempts at IVF and the a surprise pregnancy that was twins!

what type of cancer did you dp have?

Yes, we will try for a while. I think DP is still of the opinion that it won't happen naturally but for some reason I feel a bit more hopeful.

It was testicular cancer that he had. It was before we were together and children weren't even on his radar, but he froze the sample before chemo as he knew he wanted them one day.

There are loads and loads of studies online about fathering children after testicular cancer and even though you would think it would be the type to have the most effect on fertility it doesn’t!! So 🤞🏻🤞🏻

Whether IUI is a good idea will depend on how many samples you have. Probably IVF would be a better idea so as not to waste the samples.

This.

IUI has low success rates generally. It’s most useful for women who have either a same sex partner or who are single. You need to undergo fertility testing too and discuss things with a specialist so you can make an informed decision about what to do and whether IUI is a sensible option or a bad idea.

Thanks @EarlGreyT. We have a plan to go down the route of having me tested and considering our options down the line, after trying naturally for a while. As I said, this is all very new to me and, theoretically, I thought IUI might have been the best option but I now understand that might not be the case thanks to this thread. Would you advise to get the ball rolling with my fertility testing sooner rather than later? I had some gynae issues earlier this year for which they couldn't find a cause and seemingly resolved itself. At the time I had some bloods done to check hormone levels and FSH and LH were both normal. Obviously I know there's more to it than that, and given the issues I had I was/am concerned that there could be an issue with my fertility too.

IUI is only an option for very young women with absolutely no fertility problems and perfect unlimited sperm, and even then it can take many cycles to get a positive as it has a much lower success rate than ICSI and IVF. In your position with a limited sperm sample I wouldn’t take any risks - I would go for ICSI right from the start.

@Teddybear45 that's quite a sweeping statement to make. I'm 30 and our clinic are not ruling out IUI until they knew how much sperm we had frozen. Turns out from my husbands 2 visits pre chemo we have nearly 50 straws! So although we arnt "unlimited" we arent bad! And it's good quality. The thing with IUI is yeah its not the most effective way and like you say is useful for single people and same sex couples, but because my DP has zero sperm we fall into the same category really. I've never technically had a single cycle of trying! So we are planning on giving IUI a shot and our clinic support this

I just wanted to update for anyone who is in a similar situation, that in the first month of trying we have managed to conceive naturally. My DPs normal morphology on the report was 0%. I know we are incredibly lucky, but it is possible and I hope that gives others hope who are experiencing the same.

Congratulations 🥳

I just wanted to update that I have miscarried at 7 weeks. We fear that this is a result of the abnormal morphology, but of course there's no way of knowing. We don't know what we will do now, as we don't know if this is destined to be the outcome each time. I suppose all we can do is try the natural solutions to improve morphology and try and hope.

I am so sorry to hear that. Please look after yourself. I’ve been there and I know it’s tough. Your would think after cancer life would give you a bit of a break!! That’s how felt but. Keep trying and best of luck!

Hello,. Really pleased to have found this chat. I have just started ivf long protocol last Wednesday and currently on day ten of injections. My husband was diagnosed with bowel cancer last Sept and has had chemo. We thanku froze some sperm before his op. I am so anxious about ivf, cancer returning and today feel about to crack. Pretty sure it's hormones but also has opened up stuff about the cancer and all the trauma of the past year. Really hope ivf works. It's a lot of pressure isn't it. Sending hugs x