Sperm banking prior to cancer treatment

In recent years, the survival rate in young men suffering from cancer has improved significantly. The overall 5 year survival rate for cancer has risen to 60%; the rates being much higher for Hodgkin’s disease (82%) and testicular cancer (95%), two of the most common tumours in men in the reproductive age. The majority of cancer survivors are interested in having children but infertility is a well-documented consequence of cancer treatment that involves chemotherapy, radiotherapy, surgery, or a combination of these treatments. Further, men with newly diagnosed cancer often have poor semen quality that is associated with limited success in achieving pregnancy after cryobanking and subsequent intrauterine insemination. In addition, the process of cryopreservation results in further reduction in semen quality. Fortunately, recent advances in assisted reproductive techniques, particularly intracytoplasmic sperm infection (ICSI), in which a single sperm is injected into an oocyte to achieve fertilization, have made sperm cryopreservation an important service for men with cancer. It is now possible to offer realistic options of preserving fertility potential in men diagnosed with cancer before they embark on adjuvant chemotherapy and radiotherapy.

The following papers highlight some of the recent evidence in the literature on cryopreservation and semen quality in men with cancer and oncologists’ attitudes and practices regarding sperm banking.
 

1. Cryopreservation of semen from pubertal boys with cancer
Muller J, et al. Med Paed Oncol 2000; 34:191-194

In this study, 21 boys, aged 13-18 years and diagnosed with cancer, provided semen samples for cryopreservation. Only boys in Tanner Stage 3 or higher were considered because those who were less sexually mature were considered unable to produce a sperm sample. In most cases, semen was produced by masturbation but in a few cases, other methods were required including penile vibration (performed by the boy after careful instruction) and electroejaculation (under general anaesthesia provided in connection with other necessary procedures for cancer evaluation and/or treatment).

In 19 boys, it was possible to recover spermatozoa for cryopreservation; the median percentage of motile sperm was 50% (range 9-86%) and the total number of spermatozoa ranged from 0-210 million.

This study demonstrated that in boys diagnosed with cancer, sperm banking in those who are sexually mature and capable of producing a sperm sample is a realistic possibility that should be discussed with the patient and his parents.
 

2. Poor semen quality from patients with malignancies does not rule out sperm banking. Hallak J, et al. Urol Res 2000; 28:281-284

Records of nine patients with cancer who had been referred for sperm cryopreservation were reviewed and the results were compared with those of 50 normal healthy donors. The total motile sperm count was significantly lower in patients with cancer compared with donors for both prefreeze and post thaw specimens. The percent motility was also significantly lower in patients compared to donors. The percentage change in motility after thawing was also greater for patient samples compared to donor samples. Despite these observations, the sperm quality was sufficiently good to offer ICSI to achieve pregnancy. The authors reported that in their patients with cancer, assisted reproduction utilizing cryopreserved sperm was able to achieve very acceptable overall rates of fertilization (63.1%), pregnancy (31.6%) and live birth (21.1%).

Thus, despite some of the limitations of this study, the results demonstrate that cryopreserved spermatozoa from patients with cancer, irrespective of the type of tumour, are able to fertilize and initiate pregnancy with assisted reproductive techniques. Consequently, semen cryopreservation should be offered to all men of reproductive age with cancer.
 

3. Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. Shover LR et al J. Clin Oncol 2002; 20: 1880-1889

The objective of this study was to conduct a survey among men aged 14 – 40 years diagnosed and treated for cancer to determine their knowledge, attitudes, and experiences regarding cancer-related infertility and sperm banking. Overall, only 201 out of 904 men (27%) participated in the survey; the responders did not differ significantly from the non-responders in terms of age, ethnicity and site of cancer. Over half of the men wanted children in the future, including three fourths of men who were childless at cancer diagnosis. However, only 60% of men recalled being informed about infertility as a side effect of cancer treatment, and only 51% had been offered sperm banking. Lack of information was the most common reason for the men failing to bank sperm.

This survey confirmed the importance of fatherhood to younger men treated for cancer. These men worried a fair amount about their fertility, the anxiety being more marked for childless men. The results of this study indicate that health care providers in the field of oncology are not adequately meeting the needs for men diagnosed with cancer awaiting treatment.
 

4. Oncologists’ attitudes and practices regarding banking sperm before cancer treatment. Schover LR et al. J Clin Oncol 2002; 20:1890-1897

The objective of this study was to conduct a survey of oncologists to ascertain their knowledge, attitudes and practices regarding sperm banking. The response among the 718 oncology staff physicians and fellows who received the survey forms was poor with a return rate of only 24%. Nevertheless, the majority of respondents agreed that sperm banking should be offered to all men at risk of being rendered infertile as a result of the cancer treatment, but only 10% of the physicians attained this standard in their practices. Regretably, 48% of the respondents indicated that they either never bring up the topic or mention it to less than a quarter of eligible men. The likelihood of discussing the option of sperm baking was not influenced by physicians having greater knowledge about sperm banking or seeing larger numbers of eligible men annually, factors that one would have thought would have had a positive effect. The barriers to effective dissemination of information included lack of time for discussion and the lack of convenient facilities. Further, oncologists perceiving overestimated that the costs of sperm banking and the number of samples required to make cryopreservation worthwhile.

Despite the low response rate, the results of this study are disturbing because they highlight a pattern of practice that is sub/optimal. The results point to the importance of informing oncologists of the value of offering sperm banking to all teenagers and adult men about to undergo cancer treatment that my damage their fertility.

 
Conclusion

The availability of cryopreservation services to store sperm and the improvement in assisted reproductive techniques have made it possible for men with cancer desirous of having children to realize their goal. Although the quality of semen may be sub/optimal because of their illness, and the cryopreservation process may further reduce the quality, there will still be sufficient numbers of viable spermatozoa to enable fertilization of oocytes with intracytoplasmic sperm injection so that pregnancy can be achieved. It is important that this option be offered to men with cancer prior to commencing any treatment that may render them sterile.

Recent Research Notebook Entries: (Go to Notebook Index)

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• Sperm banking prior to cancer treatment