By Dr. Joe Massey, Reproductive Endocrinologist, Batzofin Fertility Services, New York, NY

The treatments available for treatment of cancer in young men are highly successful. Leukemias, lymphomas, and malignant tumors often are treated with chemotherapy which is toxic to the testicle and sperm production. One of the most devastating consequences of anticancer therapy is the loss of fertility. Semen cryopreservation prior to therapy has been a strategy utilized for over 20 years in these situations.  After early attempts at IUI had low success rates, the advent of IVF, especially with ICSI, raised the level of successful outcomes.

In the Netherlands a large series of patients over 600 collected semen since 1983. Among the subjects, 14% of the population died, most of them very early. In 9% of the men there were no motile sperm at the time of collection of the sample. In follow-up, some of the men regained sperm function and achieved pregnacies. Many still have sperm waiting for usage.

Of those who did not recover, and wished to conceive at the reporting center, there were only 37 men.

In the cases in which  IVF was performed with ICSI usually, success rates for achieving parenthood, including multiple attempts, was 54% (Van Casteren,  2008). The age of the females was an adverse factor in some of the cases in this study.

Another report involved over 100 cases of men who had sperm thawed and their wives underwent IVF treatment. The average age of the women was 35 suggesting again that the circumstances did not induce these men to push initiation of their family forward aggressively. Pregnancy rates were in the30% range per cycle and enough patients repeated therapy to reach cumulative results of nearly two thirds of couples  succeeding (Hourvitz 2008). Other research has found success rates from 33-73%.

It must be remembered that, though offering hope, there are limits to the success of this method. Sperm quality from men who are ill may be poor. Preserving multiple samples prior to therapy is a good concept to keep in mind.  There is always some urgency to begin chemotherapy and the referral for semen cryopreservation should not be a last minute recommendation. This study points out the need for awareness of the option among all men facing cancer treatment who may wish to preserve their reproductive options.

Increasingly, the same availability of the option to preserve fertility is being offered to young women thanks to the advent of successful egg cryopreservation.

References:

Hourvitz A et al. ICSI with cryopreserved sperm from men with malignant neoplasm.  Fertil Steril 2008; 90:  557-563.

Van Casternen NJ et al.  Use rate and assisted reproduction technologies; outcome of cryopreserved semen from 629 cancer patients. Fertil Steril 2008;90:2245-50.