Prostate Surgery and Fertility: What You Need to Know

Does prostate surgery affect fertility?

Yes – radical prostatectomy (surgical removal of the prostate) causes permanent infertility. The prostate and seminal vesicles are removed, which produce 90-95% of semen volume. Without these structures, ejaculation is "dry" – no semen is produced.

However, men who have banked sperm before surgery can still father biological children using assisted reproductive technology (ART).

What is dry ejaculation? (Anejaculation)

Dry ejaculation (anejaculation) is the absence of semen during orgasm. After radical prostatectomy:

• The prostate (which produces 20-30% of semen) is removed
• The seminal vesicles (which produce 60-70% of semen) are removed
• The vas deferens (which transports sperm) is cut
• Result: No semen is produced during ejaculation

Important facts about dry ejaculation:

• Orgasm still occurs – the sensation of orgasm is unchanged for most men
• It is permanent – semen production does not return
• It does not affect erectile function – erections may still be possible (with nerve-sparing)
• It causes infertility – natural conception is impossible

Can I still have children after prostate surgery?

Yes – but not through natural intercourse. Men who have banked sperm before surgery can father children using:

• Intrauterine insemination (IUI): Sperm is placed directly into the partner's uterus (requires good sperm quality)
• In vitro fertilization (IVF): Egg is fertilised with sperm in a lab, then embryo is transferred to the uterus
• Intracytoplasmic sperm injection (ICSI): A single sperm is injected directly into an egg – used for poor sperm quality or low sperm count

If you did not bank sperm before surgery:

• Sperm extraction (TESA/PESA): Sperm can be extracted directly from the testicles or epididymis using a needle
• Success rate: 50-70% for obtaining sperm
• ICSI is then used to fertilise eggs

Sperm banking before surgery – process, success rates, cost

The process:

1. Contact a sperm bank or fertility clinic
2. Provide a semen sample (masturbation into a sterile cup)
3. Sample is frozen (cryopreserved) and stored
4. Sample can be stored for many years (decades)
5. When ready to conceive, sample is thawed and used for IUI, IVF, or ICSI

Success rates:

• Sperm survival after thawing: 50-70%
• Pregnancy rate per IVF cycle: 40-50% (depends on partner's age)

Cost:

• Collection and freezing: $500-$1,000
• Annual storage: $200-$500 per year
• IVF/ICSI cycle: $12,000-$20,000 (may be covered by insurance)

Fertility after radiation therapy

Radiation therapy (external beam or brachytherapy) affects fertility differently than surgery:

• Sperm production is temporarily reduced or stopped – radiation damages sperm-producing cells in the testicles
• Ejaculation is preserved – semen is still produced (prostate and seminal vesicles are not removed)
• Fertility may return after 18-36 months – but sperm quality may be permanently reduced
• Radiation does NOT cause dry ejaculation – semen volume is normal

Recommendations:

• Bank sperm BEFORE radiation therapy
• Use contraception during and for 6-12 months after radiation (to avoid genetic damage)
• Consider paternity after 18-36 months when sperm quality may improve

Fertility after hormone therapy (ADT)

Androgen deprivation therapy (ADT) causes temporary infertility:

• Sperm production stops – testosterone is needed for spermatogenesis
• Ejaculation may be reduced or dry – but not permanent
• Fertility returns after stopping ADT – typically 6-18 months after testosterone recovers
• Sperm quality may be reduced – especially after long-term ADT (>2 years)

Recommendations:

• Bank sperm BEFORE starting ADT (if possible)
• If ADT is short-term (<6 months), fertility may return naturally
• If ADT is long-term (>2 years), sperm banking is strongly recommended

Options for having children after treatment – IVF, ICSI, sperm extraction

Intrauterine insemination (IUI):

• Sperm is washed and placed directly into the partner's uterus
• Requires good sperm quality (count, motility)
• Success rate: 10-20% per cycle

In vitro fertilization (IVF):

• Eggs are retrieved from the partner after ovarian stimulation
• Sperm and eggs are mixed in a lab to fertilise
• Embryos are transferred to the uterus
• Success rate: 40-50% per cycle (depends on partner's age)

Intracytoplasmic sperm injection (ICSI):

• A single sperm is injected directly into an egg
• Used for poor sperm quality (common after cancer treatment)
• Success rate: 50-60% fertilisation rate per egg

Sperm extraction (TESA/PESA):

• For men who did not bank sperm before treatment
• Sperm is extracted directly from the testicles (TESA) or epididymis (PESA)
• ICSI is then performed
• Success rate: 50-70% for obtaining sperm

When to discuss fertility preservation – before treatment

Fertility preservation should be discussed before any prostate cancer treatment that may affect fertility:

• Radical prostatectomy (surgery): Discuss at the time of surgical consultation
• Radiation therapy: Discuss before starting radiation
• Hormone therapy (ADT): Discuss before first injection
• Chemotherapy: Discuss before first cycle

Questions to ask your urologist/oncologist:

• Will this treatment affect my fertility?
• Is it permanent or temporary?
• Should I bank sperm before treatment?
• Can you refer me to a fertility clinic or sperm bank?

Interactive FAQ – Prostate surgery and fertility

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Disclaimer: This information is for educational purposes. Discuss fertility preservation with your urologist BEFORE starting prostate cancer treatment. Consult a specialist at Vivekananda Hospital.