Cancer’s Second Hit

Posted on by Paul Turek, MD

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“This is as hard on me as having cancer was. The difference is that being infertile is not life threatening; having cancer is.”
These are the words of a young cancer survivor sitting in my office who is now dealing with infertility, a common consequence of cancer treatment. Yes, he is very happy to be alive. Yes, he is grateful for each new day and knows exactly what it feels like to look death in the face and skirt it. But, what is also clear is that the infertility hurts, hurts a lot, and hurts all over (again).

Surviving Cancer: The Numbers

Thankfully, surviving cancer is now quite common. Over 80% of childhood cancers are overcome and well over a million people in the U.S. are alive 25 years after cancer treatment. This means two things: 1) cancer defines quality of life among many of us, and 2) cancer and reproduction are bed partners in younger survivors.
The Effect of Infertility on Life
It is my belief that infertility affects a man’s quality of life as profoundly as cancer does. My patient’s statement is simply another reminder of this truth. But this is hard to prove, because the “tools” and “instruments” used to assess the impact of cancer on quality of life do not exist for infertility. And, for academic reasons, they are hard to compare mano e mano.
As a start, we studied how infertility affected men who were not necessarily cancer survivors. In 357 infertile couples, we looked at the “strain” (personal, social, sexual, and marital) caused by having a male factor infertility diagnosis. Importantly, these men underwent formal face-to-face interviews and filled out questionnaires as they were battling the infertility problem. In this way, the immediate impact of having the diagnosis was assessed in couples and not the memory of infertility, which is often softened by time.
What we learned was that infertile male partners had a lower personal and sexual quality of life compared to men without male infertility. Examples of how we defined personal issues are: lack of control, missing something in life, inability to meet life goals, or feeling defective. Examples of sexual issues are: level of sexual enjoyment, perceived attractiveness to partner, failure with sex because of fertility problems, and persistent thoughts of having a child during intercourse. I would wager that cancer affects personal and sexual quality of life in similar ways.
Infertility: An Owner’s Checklist
So, being infertile matters to men. And it matter a lot, sometimes more than anything else.  What can you do about it? Here’s the checklist for surviving infertility:

  • Get information. It helps control of the situation. You need to “own” it.
  • Talk openly with your partner and trusted others. Get the support you need.
  • Keep the lines of communication open with your partner. This may be the most significant threat your relationship will ever see.
  • Keep doing the things that you do best. They are not likely the cause of infertility and can keep the routine in your life.
  • Take time to “blow off” stress through exercise, sports, yoga, massage or whatever works for you.
  • Maintain that critical balance as you tackle this issue like you have tackled others, and as you will tackle future issues.