Male Fertility After Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Fertility;  Prostate / Prostate Cancer
Article Date: 19 Jan 2009 - 3:00 PDT

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UroToday.com - This current abstract and related review article describe the effects of cancer and treatment on subsequent male fertility. The diagnosis of malignancy in men during their reproductive years has been increasing worldwide over the past 25 years, with significant increases in testicular cancer in particular.1 While cancer survival rates have dramatically improved for a number of the cancers which affect reproductive-aged males, the direct gonadotoxic effects of both the cancer and therapy render significant numbers of survivors with long-term subfertility.

Preservation of fertility remains a principal concern for cancer survivors, an issue potentially underappreciated by medical providers. In our review of seminoma patients, 48% reported that having children was an important issue to them after completing their treatment.2 Similar results were reported by Schover et al. noting that over half of male cancer survivors in the reproductive age group desire to preserve their future fertility climbing to a rate of 77% in men who are childless at the time of cancer diagnosis.3 These findings are especially concerning given the apparent reticence of treating physicians to be fully aware and discuss patients' reproductive options. In our multi-center survey, only 46% of men were offered pretreatment sperm cryopreservation, in a time when sperm banking had become a widely available practice (post 1993). A more recent review of fertility counseling in peripubertal cancer patients in Britain noted that 83% of post-pubertal boys assessed as medium to high risk for future infertility were offered sperm cryopreservation although this was only offered to 39% of boys in early puberty.4

Cancer and subsequent treatments can have significant detrimental effects on fertility through a variety of mechanisms inducing direct impact on sperm production, quality and genetic integrity. Efforts are underway to mitigate these through advances in our understanding of the gonadotoxicity of various chemotherapeutic regimens, promising studies on stem cell preservation in animal models5 as well as alterations in surgical techniques such as parenchymal-sparing surgery for certain testicular neoplasms. However, until our therapies have been relieved of their fertility impact, all patients must be offered the opportunity to cryopreserve semen specimens in advance of treatment.

Bibliography

1. Bray, F., Richiardi, L, Ekbom, A., Pukkala, E., Cuninkova, M., and Moller, H. Trends in testicular cancer incidence and mortality in 22 European countries: continuing increases in incidence and declines in mortality. Int J Cancer 2006; 118: 3099-111.

2. Nalesnik,J., Sabanegh, E., Eng, T., and Buchholtz, T. Fertility in men after treatment for stage 1 and 2A seminoma. Am J Clin Oncol 2004; 27:584-8.

3. Schover,L., Brey, K., Lichtin, A., Lipshultz, L. and Jeha, S. Knowledge and experience regarding cancer, infertility and sperm banking in younger male survivors. J Clin Oncol 2002; 20:1880-9.

4. Anderson, R., Weddell, A., Spoudeas, H., Douglas, C., Shalet, S., Levit, G., and Wallace, W. Do doctors discuss fertility issues before they treat young patients with cancer. Hum Reprod 2008; 23(10):2246-51.

5. Wyns, C., Curaba, M., Martinez-Madrid, B., Van Langendonckt, A., Francois-Xavier, W., and Donnez, J. Spermatogonial survival after cryopreservation and short-term orthotopic immature human cryptorchid testicular tissue grafting to immunodeficient mice. Hum Reprod 2007; 22(6):1603-11.

Written by: Edmund Sabanegh, Jr. as part of Beyond the Abstract on UroToday.com.

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