Dr. Ajay Nangia - Fertility & Sexual Health

Welcome to Episode 30 of It Takes Balls

In this episode of It Takes Balls, Dr. Ajay Nangia, professor and vice chair of urology at the University of Kansas Medical Center, speaks about fertility and sexual health, particularly for testicular cancer survivors.

Fertility: Understanding Sperm and Treatment Impacts

Sperm Basics: Sperm production spans ~90 days, making it vulnerable to damage from factors like fever, alcohol, chemotherapy, and radiation.
Cancer Link: Germ cells, which produce sperm, can also develop into testicular cancer, often impairing sperm quality even in the unaffected testicle.
Treatment Effects:
- Surgery (orchiectomy) can lower sperm counts; 90% of men retain some production.
- Chemotherapy, especially cisplatin, is highly damaging to sperm quantity and DNA integrity.
- Radiation poses risks from scattered exposure.

Dr. Nangia emphasizes sperm banking before treatment to preserve fertility, with options like home freezing kits making it more accessible.

Sexual Health After Treatment

Physical Changes: RPLND or radiation can cause retrograde ejaculation (semen enters the bladder). Options include electroejaculation or testicular sperm extraction for fertility preservation.
Libido and Hormones: Low testosterone from treatment affects libido, mood, and energy. Hormone therapies (e.g., Clomid, HCG) may help, while psychological factors like PTSD and cancer-related anxiety often require attention.

Survivor Guidance

Prioritize Sperm Banking: Early preservation improves fatherhood chances post-treatment.
Seek Specialist Care: Follow-up for hormone levels, fertility, and mental health is crucial.
Mental Well-Being: Survivors should address anxiety, fear of recurrence, and body image concerns with support networks and professionals.

Dr. Nangia closes with encouragement, urging survivors to channel their resilience into advocacy, kindness, and renewed purpose.