Medical Oncologist
CION Cancer Clinics
Fertility and sperm after RPLND | CION Cancer Clinics
RPLND does not stop your body making sperm. The risk to fertility comes from ejaculation: if the nerves that push semen forward are disturbed, semen flows backwards into the bladder instead. Many men still father children naturally afterwards, and when they cannot, sperm can usually be collected for fertility treatment. The simplest protection is banking sperm before the operation. This page explains the options and what to ask your team. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Can you still father a child after RPLND?
- What actually affects fertility around RPLND?
- How does sperm banking work before surgery?
- Which words will you see on a semen report?
- What if nothing comes out after the operation?
- What do families get wrong about fertility after RPLND?
- What can this page not tell you?
- Common questions about fertility after RPLND
The short answer
Can you still father a child after RPLND?
Often, yes. RPLND does not stop your body making sperm. The risk is to ejaculation: if the nerves that push semen forward are disturbed, semen flows backwards into the bladder instead of out. Many men still father children naturally after the operation. When they cannot, sperm can usually be collected for fertility treatment.
Why the operation touches fertility at all
RPLND removes lymph nodes from the back of the abdomen, around the large blood vessels in front of the spine. The nerves that control ejaculation run through that same area. Your surgeon will try to find and protect them, which is called nerve-sparing. Whether that is possible depends on how much disease there is, where it sits, and whether you have had chemotherapy first.
The one step that keeps every option open
Banking sperm before the operation. It takes a few visits, it does not delay surgery in most cases, and it means your future options do not depend on how the nerves behave afterwards. If no one has raised it with you yet, raise it yourself at the next appointment. It is a normal question, and your team expects it.
Erections and the feeling of orgasm are controlled by different nerves. RPLND does not usually change them.Four separate things
What actually affects fertility around RPLND?
Families tend to blame the operation for everything. In practice four different things play a part, and only one of them is the surgery.
The operation
It can change where semen goes, not whether sperm are made. With nerve-sparing, most men keep normal ejaculation. Without it, a dry orgasm is common.
Chemotherapy
If you had chemotherapy before or after RPLND, your sperm count may fall for a while. In many men it recovers over months or years. In some it does not, which is another reason to bank first.
The remaining testicle
After the first operation to remove the affected testicle, the other one does the work. Some men already had a lower count at the time of diagnosis, before any treatment began.
Time, and your partner
Fertility is shared. Your partner's age and health matter as much as your own results, and a fertility specialist will look at both of you together.
Not sure whether this applies to you?
Ask an oncologistBefore the operation
How does sperm banking work before surgery?
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Ask early
Raise it at the first surgical appointment. Ask your team which sperm bank or fertility laboratory they work with, and how soon it can see you.
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A first sample and a test
You give a sample in a private room at the laboratory. The lab checks the count and movement before freezing, and tells you if more samples would help.
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More samples if needed
The lab will tell you how long to wait between samples. Several samples give more material for future treatment, but even one is worth storing.
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Consent and storage
You sign forms about how long the samples are kept and who may use them. Ask about yearly storage charges, as these continue for as long as the sample is kept.
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If a sample is not possible
Stress, pain or religious reasons can make this hard. Tell the lab. There are other ways to collect sperm, and the fertility specialist will explain them.
On your report
Which words will you see on a semen report?
- Semen analysis
- A laboratory test of a sample. It measures how many sperm there are, how well they move and what they look like.
- Motility
- How well the sperm swim. Low motility makes natural conception harder but does not rule out treatment.
- Azoospermia
- No sperm found in the sample. After chemotherapy this can be temporary, so the test is often repeated later.
- Retrograde ejaculation
- Semen travelling backwards into the bladder at orgasm. Sperm are still made and can often be found in urine.
- Anejaculation
- No ejaculation at all, forwards or backwards, even though orgasm happens.
- Cryopreservation
- Freezing sperm for storage. Frozen sperm can be kept for many years.
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After the operation
What if nothing comes out after the operation?
A dry orgasm does not mean you cannot have children. It means the sperm are going somewhere else, or not moving along the tube. A fertility specialist can usually find out which, and there are several ways forward.
First, a simple urine test
You pass urine straight after orgasm, and the lab looks for sperm in it. If sperm are there, the problem is direction, and that is often the easier situation to work with.
Medicines that tighten the bladder neck
Some men are offered a medicine that helps close the bladder neck, such as pseudoephedrine or imipramine. They do not work for everyone, and they are not suitable with some heart conditions or other medicines. Only the fertility specialist should decide this. Do not start one on your own.
Collecting sperm directly
Sperm can be recovered from urine that has been made less acidic first. If that fails, a small procedure can take sperm straight from the testicle, called TESE. The sperm are then used in IVF with a single sperm injected into each egg, known as ICSI.
Ask your team when it is reasonable to test. Nerves sometimes recover over the first months, so an early result is not always the final one.Commonly believed
What do families get wrong about fertility after RPLND?
"He has had cancer surgery, so he cannot be a father."
Many men father children naturally after RPLND, and many more do so with help. The operation affects the route semen takes. Sperm production depends on the remaining testicle and on any chemotherapy, and neither is decided by the surgery.
"No fluid means no sex life."
Erections and the feeling of orgasm usually stay the same. What changes, when it changes, is the fluid. Couples often find it matters less than they feared once they know what to expect.
"Sperm banking is only for rich families or big cities."
Fertility laboratories that freeze sperm exist in Hyderabad and in other Telangana towns. The first visit is a test and a freeze. Ask for the storage charges in writing, so the family can plan.
"We will think about children after treatment is over."
By then the chance to store sperm from before treatment has passed. Banking takes a short time and can usually be fitted in before surgery. Deciding later about using the samples is fine.
Honest limits
What can this page not tell you?
It cannot tell you your own chances. Those depend on your semen report, your chemotherapy, the template your surgeon plans and whether nerve-sparing is possible in your case. Your treating team and a fertility specialist can give you an answer that fits you.
Who this page does not cover well
Men who have had both testicles affected, men with very low counts before treatment, and men who also need radiotherapy to the pelvis face different questions. So do men with low testosterone, which causes tiredness and low sex drive and is treated separately.
What to ask your surgical team
Ask whether nerve-sparing is planned, and on one side or both. Ask whether you can bank sperm before the date. Ask who to contact if ejaculation changes afterwards, and when a semen test makes sense. Take your partner or a family member you trust, so you do not have to remember it all alone.
Questions we are asked
Common questions about fertility after RPLND
Will RPLND make me infertile?
Not usually on its own. The operation does not stop your body making sperm. What it can change is ejaculation, if the nerves are affected. Many men keep normal ejaculation, especially when nerve-sparing is possible. If you do not, sperm can often still be collected and used for fertility treatment.
Should I bank sperm even if nerve-sparing is planned?
Most teams suggest it. A plan for nerve-sparing is an intention, and what the surgeon finds on the day can change it. Chemotherapy can also lower your count. Stored sperm keeps your options open whatever happens, and you can decide later whether you ever need to use it.
How do I know if I have retrograde ejaculation?
You reach orgasm but little or no fluid comes out, and your urine afterwards may look cloudy. It is not harmful to your health. A simple urine test after orgasm can confirm it. Tell your surgical team or a fertility specialist, especially if you are hoping to have children soon.
Can my wife still get pregnant naturally?
If ejaculation is normal after the operation and your semen report is healthy, natural conception is possible. If ejaculation is dry, natural pregnancy is unlikely, but not the end of the road. A fertility specialist will usually test both of you and explain which option fits your situation.
Does chemotherapy damage sperm more than surgery?
They affect fertility in different ways. Chemotherapy can lower the number of sperm made, sometimes for a long time. Surgery can affect how semen leaves the body. Some men have both. That is why a semen test after treatment, at a time your team suggests, is more useful than guessing.
Can ejaculation come back after RPLND?
Sometimes. Nerves that were stretched rather than cut can recover over the following months. Nerves that were removed with the disease do not grow back. Your surgeon can tell you what was done on each side, which gives you a better idea of what to expect.
Is it safe to try for a baby soon after chemotherapy?
Ask your oncologist before trying. Teams usually advise waiting for a period after chemotherapy, because sperm made during treatment may be affected. The right gap depends on the drugs you had. Use contraception until your team says it is reasonable to stop.
Does stored sperm lose quality over time?
Frozen sperm can stay usable for many years when it is stored properly. Some sperm do not survive thawing, which is why labs prefer more than one sample. Keep the storage paperwork safe, and keep the bank informed if your phone number or address changes.
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- Cancer Research UK — Testicular cancer: treatment
- American Cancer Society — Surgery for Testicular Cancer
- National Cancer Institute — Testicular Cancer Treatment (PDQ) - Patient Version
- Macmillan Cancer Support — Testicular cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Nerve-sparing RPLND and ejaculationHow the surgeon protects the nerves that matter hereRetrograde ejaculation after RPLNDWhat a dry orgasm is like, and what helpsTemplates: full bilateral vs modifiedWhy the extent of the operation changes the nerve riskThe emotional side of cancer surgeryTalking about this with a partner
Talk to us
Want to talk about fertility before your operation?
Call the helpline or send us your reports. A surgical oncologist will explain what the plan may mean for fertility and help you put the right questions to your team. One helpline serves every CION centre.