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Fertility Preservation For Males Before Cancer Treatment

Adolescent males and men requiring treatment for cancer such as chemotherapy or radiation be sure to learn about their options for fertility preservation before treatment.

ASCO (American Society of Clinical Oncology) has patient handouts and guidelines for healthcare providers regarding fertility preservation (cryopreservation of sperm).  ASRM (American Society of Reproductive Medicine) has also written guidelines for sperm cryopreservation in cancer patients.  These are absolutely critical reading for both patients and practitioners because low rates of sperm cryopreservation continue.

The optimal window for fertility preservation (cryopreservation, microdissection testicular sperm extraction [microTESE], electroejaculation) is prior to any cancer treatments (chemotherapy, radiation) which are frequently toxic to the testes.  Additionally, for pre-pubertal boys undergoing cancer treatment,  investigational testicular tissue cryopreservation to obtain spermatogonial stem cells which could possibly be utilized with new techniques in the future.

There are several possible factors leading to low rates of sperm/testicular tissue cryopreservation before treatment including: lack of understanding of treatment effects on fertility, sperm bank cost, urgency to begin chemotherapy, azoospermia (no sperm in ejaculate) pre-treatment .  In some studies only 50% of male patients were offered sperm cryopreservation prior to cancer treatment.

Patients should be encouraged to ask questions and have a thorough discussion with their physicians regarding options as part of a comprehensive fertility preservation program before undergoing treatment.  Spermatogenesis can also be impaired in male patients with cancer before oncological treatment due to physiological and psychological stress-related factors.

When men have no sperm after cancer treatment, only 20 to 50% of these men may have some recovery.  If no sperm are identified, patients may be candidates for microsurgical sperm retrieval (microdissection testicular sperm extraction) with IVF/ICSI (in vitro fertilization, intracytoplasmic sperm injection).  When there is recovery of sperm, men may have DNA damage (following chemotherapy/radiation) requiring a waiting period before trying to have children.  There is no consensus on this time period, but the European Society of Medical Oncology (ESMO) recommend at least 1 year, while other groups recommend 18-24 months post-treatment.  However, more study is needed to determine the length of time to wait following treatment.

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