I can share a bit of my experience on the fertility side. I was diagnosed with stage 4 rectal cancer at 36 years old. Before I started treatment I froze some sperm, and then had chemotherapy, pelvic radiation, and several surgeries.
After I finished treatment earlier this year, I did a semen analysis and my sperm count was zero. This was apparently most likely due to the radiation as it’s way tougher on that area than chemo, but the chemo may have also contributed. I was told however there is a chance that sperm production an recover in 6-12 months, especially if only chemo was done.
My wife and I have been considering IVF, and had my previous stored sperm tested. The count was very good (300 million), but the quality fairly poor - the ‘morphology’ (shape) of the sperm is normally >15% normal, and mine was only 1%. The fertility doc speculated this may have been because I had cancer and was under a lot of stress at the time. So on this basis she doesn’t recommend we try insemination, but IVF is fine as they only need a few good speed, and even at 1% that means my sample still has 3 million decent ones.
So I would definitely suggest freezing sperm before treatment, but it’s only chemo then I think there’s still a decent chance of recovering some fertility.
Male 38; Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2, May-20=1.9.
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic VMAT radiation; complete metabolic response
07/19 ULAR (robot), temp ileo, 1/27 LN
08/19 Missed a liver spot
08-11/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resection #2
02/20 Ileostomy reversed
03/20 PET & MRI = NED!