Can a man who has undergone a prostatectomy (prostate removal surgery) still produce sperm and impregnate a female?

Fertility After Prostatectomy: Sperm Production and Impregnation Capability

A man who has undergone a prostatectomy cannot produce sperm capable of impregnating a female through natural intercourse because the surgical procedure removes essential structures required for normal ejaculation and sperm transport.

Anatomical Impact of Prostatectomy on Male Fertility

Radical prostatectomy involves removal of:

• The prostate gland
• Seminal vesicles
• Part of the vas deferens
• Often portions of the ejaculatory ducts

These structures are critical for:

1. Sperm transport: The vas deferens and ejaculatory ducts form the pathway for sperm to travel from the testes to the urethra
2. Semen production: The prostate and seminal vesicles produce approximately 90% of seminal fluid

Post-Prostatectomy Sexual Function

Ejaculation

• Complete absence of ejaculate (dry orgasm) is the norm after radical prostatectomy 1
• The removal of seminal vesicles and disruption of ejaculatory ducts prevents normal ejaculation
• Even with nerve-sparing techniques, the anatomical pathway for sperm transport is permanently disrupted

Erectile Function

• Erectile dysfunction is common after prostatectomy (56-65.6% at 18+ months post-surgery) 2
• Even with bilateral nerve-sparing techniques, only 44% of men maintain potency 2, 3
• Age significantly impacts recovery of erectile function (39% of men <60 years vs 15-22% of older men regain potency) 2

Fertility Preservation Options Before Prostatectomy

For men diagnosed with prostate cancer who wish to father children in the future:

1. Sperm banking before surgery is the most established and effective method 1, 4

   • Should be offered to all men prior to prostatectomy who have interest in future fertility
   • Multiple samples should be collected when possible

2. Counseling about fertility preservation should be part of routine pre-treatment discussions 1, 4

   • Only 20-50% of men bank sperm prior to cancer treatments due to inadequate counseling 1

Alternative Pathways to Fatherhood After Prostatectomy

For men who have already undergone prostatectomy:

1. Surgical sperm retrieval may be possible directly from the testes or epididymis 1

   • Testicular sperm extraction (TESE)
   • Microsurgical testicular sperm extraction (micro-TESE)
   • Percutaneous epididymal sperm aspiration (PESA)

2. Assisted reproductive technologies are required to achieve pregnancy 1

   • In vitro fertilization (IVF)
   • Intracytoplasmic sperm injection (ICSI)

Key Considerations and Caveats

• Sperm production in the testes continues after prostatectomy if the testes were not damaged during treatment
• The issue is not sperm production but rather the inability to deliver sperm through ejaculation
• Success rates for assisted reproduction using surgically retrieved sperm vary based on:
  • Female partner's age and fertility status
  • Quality and quantity of retrieved sperm
  • Experience of the fertility center

Clinical Implications

• Men diagnosed with prostate cancer who desire future fertility should discuss sperm banking before surgery 1, 4
• Men who have already undergone prostatectomy should be referred to a reproductive urologist to discuss surgical sperm retrieval options 1
• The combination of surgical sperm retrieval and assisted reproductive technologies has made biological fatherhood possible for men after prostatectomy 4

In summary, while natural conception is not possible after prostatectomy, fatherhood remains achievable through medical intervention combining surgical sperm retrieval and assisted reproductive technologies.