Richard was 35 years old when a urologist told him something did not feel right on one of his testicles.
An ultrasound and subsequent biopsy revealed masses that were highly suspicious for cancer on both testicles, which is extremely rare. Richard had surgery to remove one testicle and was advised by his urologist to remove the other testicle as soon as possible to prevent spread of the cancer from the testis to the other parts of the body.
“That led to a series of problematic events because the second testicle was not producing sperm, and I wanted to have a kid in the future, “Richard says. “I just wasn’t willing to give up the dream of having a biological child.”
Richard was in a race against time.
His cancer was confined to the testicles, but it could have quickly spread. He was referred to Ranjith Ramasamy, M.D., director of reproductive urology at Sylvester Comprehensive Cancer Center, by one of the leading experts in testicular cancer Lawrence Einhorn, M.D., at Indiana University Health.
Richard, a South Florida resident, would learn that Dr. Ramasamy is one of a few surgeons in the country to perform a procedure in which he is able to identify tubules within the testis that has potentially viable sperm to preserve for future in vitro fertilization (IVF).
“We did not know if I was producing sperm in any part of the testicle, so it was a make it or break it moment,” Richard says. “I woke up from the operation and Dr. Ramasamy was successful in identifying sperm in the testis.”
In fact, Dr. Ramasamy was able to retrieve sperm from a part of the testicle that did not have cancer. Sylvester doctors were able to preserve the sperm with cryopreservation.
Three years later, Richard and his wife had a baby girl. She is now 6 months old.
“Dr. Ramasamy basically created a miracle, and I’m very thankful,” says Richard who is now cancer-free. “My advice to people is to get second opinions and go to a research hospital. Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine do a lot of research. That is why they have access to this cutting-edge technology. If I would just go to a general urologist who does not specialize in male fertility, they may not really have the breadth and depth of a University of Miami specialist.”
Testicular cancer impacts young males, usually between ages 20 and 40, according to Dr. Ramasamy.
“The treatments for testicular cancer are to remove the testis, or administer chemotherapy or radiation,” Dr. Ramasamy says. “All treatments can affect reproduction--both fertility and sperm parameters as well as testosterone production in the future. One of the first things that we advocate for at the Sylvester Comprehensive Cancer Center is to make sure we offer fertility preservation and sperm cryopreservation for patients with testicular cancer.”
Fortunately, most men – 99% – survive localized testicular cancer.
“Since the majority of men will live after treatment, we need to think about cancer survivorship which should address both fertility preservation and testosterone production,” Dr. Ramasamy says. “It is important for men to be aware of the cancer and to perform self-exams. If they notice anything abnormal, they should speak with their doctor right away. And if they do undergo treatment for testicular cancer, they should ask about early fertility preservation and the importance of checking their testosterone levels to ensure normal levels after surgery or treatment.”
Infertility is common, even in couples that do not have a cancer diagnosis.
“One in 6 couples in the U.S. will suffer with some sort of fertility issue. It is about a 50/50 split between male versus female factors,” Dr. Ramasamy says. “People might think there are no treatments to improve sperm counts or improve egg quality. But there are lots of good treatments.”
Especially men with testicular cancer need to know that even in the most dire circumstances, there are treatment options for men to go on to have biological children.
“It is important to exhaust all options before giving up on biological parenthood,” Dr. Ramasamy says.
By Lisette Hilton
Dr. Ranjith Ramasamy, director of Reproductive Urology at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System, discusses the benefits of fertility preservation counseling for newly-diagnosed patients with cancer. Learn more.