Can a man post-prostatectomy (prostate removal surgery) father a biological child?

Biological Fatherhood Options After Prostatectomy

Men who have undergone a prostatectomy cannot father biological children through natural conception, but can still achieve biological fatherhood through assisted reproductive technologies using sperm that was banked before surgery or retrieved through specialized procedures.

Impact of Prostatectomy on Fertility

• Radical prostatectomy removes the prostate gland and seminal vesicles, which are essential for semen production, making natural ejaculation of sperm impossible 1
• After prostatectomy, men experience anejaculation (no ejaculate) due to the removal of these reproductive organs 2
• By definition, this creates a form of obstructive azoospermia, as sperm production may continue in the testes but cannot reach the ejaculate 2, 1

Pre-Surgery Fertility Preservation Options

• Sperm banking before prostatectomy is the most reliable method for preserving fertility and should be offered to all men concerned about future fertility 2, 3
• Studies show that approximately 20% of prostate cancer patients would choose to bank sperm before radical prostatectomy if given the option 4
• Multiple specimens should be collected when possible to maximize future fertility options 2
• This approach is particularly important for younger men diagnosed with prostate cancer who may wish to father children in the future 3

Post-Prostatectomy Fertility Options

Sperm Retrieval Techniques

• For men who did not bank sperm before surgery, surgical sperm extraction may be possible through:
  • Testicular Sperm Extraction (TESE) or Microdissection TESE (micro-TESE) to retrieve sperm directly from the testes 2
  • These procedures have reported sperm retrieval rates of 40-60% in men with non-obstructive azoospermia 2
  • Retrieved sperm can be used with Intracytoplasmic Sperm Injection (ICSI) as part of In Vitro Fertilization (IVF) 2

Rare Post-Prostatectomy Scenarios

• In extremely rare cases, spermaturia (sperm in urine) has been reported after radical prostatectomy, potentially due to fistula formation between the vas deferens and urinary tract 5
• There are isolated reports of successful sperm recovery from urine in men with retrograde ejaculation following transurethral resection of the prostate (TURP), but this is not applicable to most radical prostatectomy cases 6

Success Rates and Considerations

• When using banked sperm with assisted reproductive technologies:
  • IVF treatment typically allows for a 37% live delivery rate per initiated cycle 2
  • Success rates decline with increased female partner age (particularly over 35 years) 2
  • Multiple pregnancy attempts may be possible from a single banking session if additional embryos are available for cryopreservation 2

Special Considerations

• Men undergoing brachytherapy (rather than prostatectomy) for prostate cancer may retain fertility, with some patients able to father children after treatment 7
• However, it's recommended to wait 3-4 months after brachytherapy before attempting conception due to radiation exposure concerns 7
• Genetic counseling should be considered before using retrieved sperm, particularly for men who underwent gonadotoxic therapies, as there are concerns about potential genetic mutations 2

Clinical Recommendations

• Fertility preservation discussions should be a standard part of pre-treatment counseling for all men with prostate cancer, regardless of age 3, 4
• Dedicated fertility preservation services should be established for prostate cancer patients 4
• For men who have already undergone prostatectomy without sperm banking, referral to a reproductive urologist is recommended to discuss sperm retrieval options 2