FERTILITY PRESERVATION FOR MALE CANCER PATIENTS: OPTIONS BEFORE TREATMENT

For men diagnosed with cancer, fertility preservation is an urgent consideration before beginning life-saving treatments such as chemotherapy, radiation, or surgery. While these treatments can be effective at curing cancer, they often come with the unintended consequence of damaging or even permanently impairing fertility. Sperm banking, also known as sperm freezing or cryopreservation, offers a reliable way for cancer patients to safeguard their ability to have biological children in the future.

This blog will provide valuable insights for both patients and healthcare providers, outlining the importance of fertility preservation, available options, and recent research on the success of sperm freezing before cancer treatment.

How Cancer Treatment Affects Male Fertility

Cancer treatments like chemotherapy and radiation are highly effective at targeting cancer cells, but they also harm healthy cells, including the sperm-producing cells in the testes. The impact of cancer treatment on male fertility can vary based on the type, dose, and duration of the treatment, but in many cases, fertility may be significantly diminished or lost altogether.

Chemotherapy: Chemotherapy drugs, especially alkylating agents, can damage the DNA within sperm cells and reduce the number of healthy sperm produced. The extent of damage depends on the drug and dosage, but many men experience reduced sperm counts or permanent sterility following treatment.
Radiation Therapy: Radiation directed at or near the testes can damage sperm production by harming the delicate tissues within the testes. Depending on the location of the cancer, radiation can also indirectly affect fertility by damaging hormone production or affecting other reproductive organs.
Surgery: Some cancers, such as testicular or prostate cancer, may require surgeries that remove or damage reproductive organs. Testicular cancer treatments, for example, often involve removing one or both testicles, which can severely impact sperm production.

The Importance of Sperm Banking Before Treatment

For men diagnosed with cancer, time is often of the essence. Sperm banking offers a safe and effective way to preserve fertility before cancer treatment begins. Sperm cryopreservation is the most common and reliable fertility preservation option for men facing cancer. By freezing sperm before treatment, men can ensure they have healthy, viable sperm available for use in future reproductive treatments.

Why is it important to act before treatment?

Permanent Damage to Fertility: Once cancer treatment begins, sperm production can be irreversibly damaged. By freezing sperm ahead of time, patients can avoid the risk of permanent infertility.
No Guarantees of Recovery: While some men may regain fertility after cancer treatment, this is not guaranteed. In many cases, sperm counts remain low or absent even years after treatment is completed.
Sperm is Easier to Preserve Before Treatment: Before chemotherapy or radiation, sperm quality is typically better than after treatment. The earlier a sample is banked, the better the chances of success in future fertility treatments.

Steps in the Sperm Banking Process

Sperm banking for cancer patients follows the same procedure as for other patients, but it often requires quick action. Here's a breakdown of the key steps involved:

Consultation with a Fertility Specialist: The first step involves meeting with a fertility specialist who can guide the patient through the process. This consultation typically includes a discussion of the patient’s treatment plan and fertility goals.
Semen Analysis: Before the sperm is frozen, a semen analysis is conducted to assess the quality of the sperm, including count, motility, and morphology. This information is crucial for determining the potential for successful future use.
Sperm Collection: Sperm is collected through masturbation, and patients may need to provide several samples over a few days to maximize the number of viable sperm available for freezing.
Cryopreservation: After collection, the sperm is mixed with a cryoprotectant, a substance that protects the sperm cells during freezing. The sample is then frozen in liquid nitrogen at -196°C, where it can be stored for years.
Long-Term Storage: The frozen sperm is stored in a cryogenic facility or sperm bank, where it remains viable until it is needed for fertility treatments like in vitro fertilization (IVF) or intrauterine insemination (IUI). Sperm can be stored almost indefinitely, with successful pregnancies reported even after decades of storage.

Success Rates of Using Frozen Sperm

One of the most common concerns for cancer patients considering sperm banking is whether frozen sperm will be as effective as fresh sperm when trying to conceive. Recent research has shown that the success rates of using frozen sperm in assisted reproductive technologies (ART) are comparable to fresh sperm.

Sperm Viability: Studies have demonstrated that over 50% of sperm survive the freeze-thaw process, and the ability to fertilize an egg remains high .
Pregnancy Rates: Pregnancy rates using frozen sperm are similar to those using fresh sperm, particularly when used with advanced fertility treatments like ICSI (intracytoplasmic sperm injection), where a single sperm is injected directly into an egg .
Long-Term Success: Frozen sperm can remain viable for many years without losing its fertility potential. In fact, healthy pregnancies have been achieved using sperm stored for over 20 years .

Alternatives to Sperm Banking for Cancer Patients

While sperm banking is the most common and successful method of fertility preservation for male cancer patients, other options are available for those who may not be able to produce a sperm sample before treatment.

Testicular Sperm Extraction (TESE): In cases where sperm cannot be collected through masturbation, testicular sperm extraction can be performed. This surgical procedure involves extracting sperm directly from the testes. TESE is often used in men with low or no sperm in their ejaculate.
Testicular Tissue Cryopreservation: Although testis tissue cryopreservation is a standard proactice in adult males, this is an experimental option for pre-pubertal boys who have not yet begun producing sperm. Testicular tissue is removed and frozen, with the hope that future advances in reproductive technology will allow sperm to be harvested from the stem cells in the tissue that is cryopreserved.

Special Considerations for Pediatric and Adolescent Cancer Patients

For boys who have not yet reached puberty, traditional sperm banking is not an option, as they do not yet produce mature sperm. However, fertility preservation is still an important consideration for this group.

Pre-pubertal Boys: For younger boys, experimental techniques like testicular tissue cryopreservation are being explored. While this option is not yet widely available, it holds promise for preserving fertility in children who are not yet producing sperm.
Post-pubertal Adolescents: Teenage boys who have started producing sperm can follow the same sperm banking procedures as adult men. However, there may be psychological and emotional challenges involved in discussing fertility preservation with younger patients, so sensitive counseling is crucial.

The Role of Healthcare Providers: Counseling Cancer Patients on Fertility Preservation

Healthcare providers play a critical role in ensuring that cancer patients are aware of their fertility preservation options. Research has shown that many cancer patients are not informed about the risk of infertility or the availability of sperm banking before treatment begins.

A 2023 study highlighted that only half of male cancer patients were offered sperm banking as an option before starting treatment. This is a significant gap in care, as early counseling can empower patients to make informed decisions about their reproductive future.

Providers should initiate conversations about fertility preservation early in the cancer treatment process. This is particularly important for younger patients and those with high-risk cancers that require aggressive treatment. Fertility preservation should be discussed as part of a comprehensive care plan that addresses both survival and quality of life after cancer treatment.

Conclusion

For men diagnosed with cancer, preserving fertility is an important consideration before beginning treatment. Sperm banking offers a safe, effective, and widely available option to ensure that cancer patients retain the ability to have biological children in the future. Whether you are a patient navigating a cancer diagnosis or a provider guiding a patient through treatment decisions, fertility preservation is a vital part of the conversation.

With advancements in sperm cryopreservation and reproductive technologies, men can confidently bank sperm and preserve their fertility for years to come. By acting before treatment begins, patients can take control of their reproductive future—ensuring that they have the opportunity to start or grow a family when the time is right.