Bowel Surgery and Male Fertility

[Nak]

Hello,

This is my first post to a forum - I hope I am in the right place and not breaking any rules

My husband (27) had emergency surgery to remove a tumor obstructing his descending colon and install a temporary stoma (4 months). Pathology came back better than expected, with no spread to surrounding lymphs/vessels and a good margin of clean tissue around the malignancy. In his follow up colonoscopy 11 benign polyps were revealed and removed. Prior to this he had displayed no symptoms whatsover, aside from the sudden stomach pain and vomiting that took us to the doctor.

He was started on Xeloda as it offered 5% improvement in survival rates and as he was perfectly healthy otherwise there was no reason not to. After the first round, he developed an unusual side effect (artery spasms). So now the risks outweigh the benefits he is not going to continue with Chemotherapy. He has further tests to search for any microscopic cells in three months.

We organised semen storage prior to starting chemotherapy and found counts and motility were both low. After thawing, the little guys could only be used for IVF. Both GP and oncologist feels that sperm production was affected by bowel surgery and prescence of cancer, but the fertility nurse encouraged us to pursue IVF immediately, without trying to concieve naturally.

All we can really do is another analysis in a few months time but but it's on my mind a lot! If anyone has been in a similar position I would love to hear your story.

[SkiFletch]

Welcome Nak, you've definitely come to the right place. No topic is too taboo here, so fear not . My story was similar to your husband's. Surgery, wait 4 weeks, store some sperm, counts/motility low, stored it anyway and started chemo (12 rounds folfox). Re-test 6 months following chemo, counts/motility still lowish, but better than pre-chemo. Re-tested again, a year from that and counts/motility all back to normal. For the most part, CRC chemos do not affect longterm fertility in men. Surgery can sometimes cause retrograde ejaculation where the bladder sphincter does not close and the sperm/semen go back up into the bladder instead of out the way they're supposed to. You don't need a Dr to diagnose that one .

Were I in your shoes, I don't know if I'd be trying to conceive anyway you slice it right now, but that's just me.

[beccab1]

Hi Nak. Hope your husband and you are doing well!

My husband also banked sperm prior to treatment. His counts were really bad at the time which is normal when you have cancer from what I've been told. Anyway, we tested him about 9 months ago and fertility had still not returned. Could be the surgery, radiation or chemo and I've read that it can take years to return if it ever does.

We started an IVF cycle in August of last year. His counts were so bad and he only had one frozen sample so they actually scraped a little section off instead of thawing the whole sample so that we'd be able to try again if we needed to. We are using a procedure that is pretty common now - ICSI - where they actually take one sperm and inject it directly into the egg. It's fascinating to say the least and can help people have success with hardly any sperm at all. The first cycle didn't work so I'm starting a new one next week. It was stressful and I can totally understand Skifletch saying that you may not want to do it right now having just gone through everything with your husband. It's a lot of stress, injections and a lot of hormones that take you on quite an emotional roller coaster. On the other hand, if you know this is something that you both really want then you may want to start getting your preliminary tests done. If I'd had myself checked, we may not have waited an extra year to try. I never realized that my fertility could be so diminished at 35 but I guess it's way more common than people know. You guys are young so if all of your numbers look good, then you guys could always try on your own for a while and see what happens. It was a lot of thinking and talking and thinking and talking before we decided. I struggled with the idea of trying to have a baby knowing that Eric's cancer could recur but it is what it is and we both really want a baby. At the end of the day, nobody knows when their time will be up so we are choosing to live life and take things as they come

Good luck to you guys with whatever you choose! If you ever need any IVF details, PM me.

[nkoske]

I also banked before treatment started and my counts were low-ish as well. Your body is in stress, so between the emotional stress (You have cancer) and physical stress (tumor, recovering from surgery), it's not surprising that counts are low. Surgery normally doesn't do harm to future sperm generation, the problem lies in the nerves. During the surgery nerves can be injured, the ones that control ejaculation and erection. If both of those things are working post surgery it's highly likely that once your body recovers from the drugs everything will be fine, regarding sperm production. Both my Rad Onc and Med Onc suggested that I wait six months after the final chemo treatment to 'do it the old fashioned way'. Sperm life cycle is 60 days and they suggested waiting 3, 60 day periods to ensure there were no 3 eyed swimmers left.

Our hope is to start trying conceive "the old fashioned way" 6 months after my last chemo treatment. The sperm banking was for worst case scenario (regarding my fertility). I just feel if everything is working properly, I don't want to do any artificial means of conception. With that said we already know things work as we had a little boy 2 years ago. I know timing is important to people and it would be a drag to wait the six months after chemo and find out a year after trying the 'old fashioned' way that you need to do IVF anyways. It took my wife a little while to get there, as she wanted our kids to be closer in age, but in the end she agreed with me. You know how it is, once you heart is set on something it's disappointing to have to change it.

Just one other thought regarding IVF. Seems strange to me that the nurse is 'encouraging you to do IVF immediately'. In the end it's your decision. Keep in mind everyday is a good day to buy a house for a realtor, everyday is a good day to buy a car for a car salesman, and I'm sure everyday is a good day to do IVF for an IVF nurse.

[Nak]

I am so sorry for the lateness of my reply, I thought I responded to this months ago!

Skifletch, beccab and nkoske - Thank you so much for sharing your experiences, insights and advice. Your different perspectives provided plenty of food for thought.

I thought I would provide an update on our situation as there wasn’t much follow up available when I first started looking into this.

My husband’s first sample was taken post-surgery and pre-chemo (he was also sporting a temporary stoma at the time). His results were poor, the sperm was only usable for IVF treatments. He then had 1½ rounds of Xeloda before his oncologist cancelled them due to side effects. We returned to the fertility specialist last month with a view to starting IVF in mid-2014 (In the meantime going the ol’ fashioned way). We were both checked out and his levels had restored completely.

Hindsight: My pap-smear revealed some abnormal CIN 2 (not cancer) cells in my cervix, so I have been booked into a colposcopy for closer inspection and to remove the misbehaving cells. It’s not serious by any means, but it requires 8 weeks abstinence to heal. So to anyone in a similar situation my advice is to get a pap smear so you can address any issues – that way you are out of action together.

Just to complicate things, yesterday my GP confirmed that I am pregnant . I’m still waiting to hear back from the specialist about what happens now, but whatever happens it is good to know that we were able to conceive ‘the old fashioned way’.

Thanks guys

[mm66ny]

Post surgery, radiation and chemo, I somehow managed to knock up my wife (the kid looks a lot like me, so I'm 99 per cent sure). So, it's possible.

[Nak]

This post recently came to mind and I am compelled to write another update - we are living life large with TWO awesome healthy kids and my husband has been in good health too. Hope everyone here is doing well in life.

[boxhill]

Great news!!

[CF_69]

I think the radiation is the biggest factor. My equipment seems to be working fine post surgery, and I was pretty concerned about that beforehand. All I have noticed is that, and forgive me if this is TMI, but my output at that special moment is very little.

I haven’t been tested as I had no plans for more kids as my wife and I are in our 40’s already.

Doctors said it could happen but that after enough time things can return to normal.

We shall see.