I spent last week on the Cape with some great friends from Italy, their three sons, and Netsai, whom some of you know about from earlier posts one and two on dating post-cancer. While the kids—aged 3, 5, and 7—drove me crazy on more than one occasion, I did think about how much I’d like to have children of my own. The question for me, after more than a year-and-a-half of chemo, is whether it’s even possible.

Given that I was 15 years-old when I started chemo and my brain cancer diagnosis gave little hope for survival, no one was thinking about banking my sperm. (God knows I was producing plenty of it, but none of it was being put to its intended use . As an adult survivor, I’ve never had my sperm tested. The only indicator of male fertility for which I have been tested is my testosterone level. My doctor at Memorial Sloan-Kettering told me that the fact that it is and has been normal is a good indicator of male fertility. Beyond that, I don’t know, and I’m not sure I want to just yet.

A word on male fertility. In order to fertilize a female egg during sex, sperm has to be of the right shape and in proper concentration. It also has to move quickly and accurately. Chemotherapy can be a deal breaker in any of these areas, whether by reducing sperm count, impeding mobility, or impairing the ability to fertilize the egg. The kind of chemotherapy received is a factor; alkylating chemo drugs, including Cytoxan, Dusulfan, and Mustargen, are the most harmful to male fertility. Other factors include the dosage level and age at the time of treatment (men who undergo chemotherapy over the age of 35 are more likely to have problems than those receiving chemotherapy when they are younger). Higher rates of male infertility are associated with certain types of cancer, among them testicular cancer (most testicular cancer patients have one testicle free of cancer, but it’s often not entirely healthy), lymphoma, leukemia, and Hodgkin’s disease. The effects of chemo in terms of infertility can be temporary—if there is going to be improvement, semen analysis will generally show healthy results in one to three years—or permanent. Chemotherapy can also have no effect at all.

If you receive a cancer diagnosis and you think you might want to have children in the future, your safest bet is to bank your sperm. It’s one of the last things you’ll be thinking about after you learn you’ve got cancer, but it’s something you may deeply regret later in life—like when you’ve beaten the disease. Ask your doctor about sperm banking. In some cases, particularly with very aggressive cancers, your doctor may want you to start chemotherapy immediately, and you should listen. But if taking a few weeks to bank some sperm receives your doctor’s OK, then seriously consider doing it.

If you’ve had chemotherapy in the past, currently want children, and are having trouble getting your partner pregnant, make an appointment to see a doctor who specializes in male fertility, and ideally one who works either exclusively or extensively with cancer survivors. Another option, and one I’ll happily jump at if I find out I’m infertile, is adoption. While I’d love to see a little of myself in my kid, I’m sure I’ll be able to find it in the love, nurturing, and life-long support I know I’ll provide my child.

A final note. There’s a fantastic resource out there for cancer patients and survivors who are dealing with fertility issues as a result of medical treatment. Fertile Hope, an initiative of LIVESTRONG,provides tremendously helpful information and support, including a comprehensive, nation-wide directory of fertility specialists, adoption agencies, sperm banking services, and much more.