Optimizing Fertility Preservation for Pre- and Postpubertal Males with Cancer

Abstract

Advances in diagnostic techniques and therapies have drastically improved cancer survival rates. However, the testes are highly susceptible to chemotherapy and radiation therapy, and spermatogenesis and semen parameters can be negatively impacted either permanently or transiently. Fertility preservation is an important issue to patients, and sperm banking has a positive psychological effect that helps patients cope emotionally with cancer. Innovations in sperm freezing and assisted reproductive technologies are improving the fecundity of males regardless of sperm parameters, and now even allow for fertility potential after gonadotoxic therapy. Experimental options also exist for prepubertal males, and hold promise for use in the future. At present, sperm cryopreservation is underutilized in the setting of a cancer diagnosis, and pretreatment referrals to fertility specialists are inconsistently offered. A multidisciplinary team approach is critical to educate families on the available options and help accomplish fertility preservation in a timely manner.

NextGen® Home Sperm Banking Kit: Outcomes of Offsite vs Onsite Collection—Preliminary Findings

“…27 Previous studies have suggested that specimens with high sperm concentration, motility, and intact sperm DNA can be stored in relatively large aliquots suitable for intrauterine insemination. 3 On the other hand, specimens with poor sperm motility and higher DNA damage may be stored in multiple small aliquots suitable for further fertility treatment.…”

“…28,29 Timely cryopreservation is critical because in some cases, >1 visit will be required to cryopreserve sufficient numbers of sperm, or there may be urgent need to start therapy. 27 We have optimized our protocol for the best recovery of healthy sperm and investigated several strategies to further enhance post-thaw recovery of spermatozoa. The limitations of the present study include the following: (1) small sample size, (2) heterogeneity of the population, (3) lack of semen analysis before the overnight shipping of the sample using the NextGen kit, (4) inadequate matched control group, and (5) finally, the patients were counseled over the phone and then asked to review and mail the "Semen Collection and Storage Agreement" by mail.…”

Sperm Banking: Fertility Preservation for Male Patients With Cancer

“…Although penile vibratory stimulation may be effective in some cases, electroejaculation is another option that involves the emission of a mild electrical current from a rectal probe to stimulate ejaculation (Katz et al, 2013;Wang, Muller, & Lin, 2013).…”

“…This impairment is most common in men with testicular cancer, lymphoma, or leukemia (Agarwal & Allamaneni, 2005). Testicular sperm extraction involves the removal of a small amount of testicular tissue by biopsy or aspiration; any sperm found in the tissue are extracted and frozen (Katz et al, 2013;Wang et al, 2013). Reproductive urologists perform these procedures while patients are under anesthesia.…”

“…He or she will determine the optimal technique for using the thawed sperm based on the number of stored vials and the sperm count and motility (Wang et al, 2013). In the instance of multiple vials and a high sperm count and motility, intrauterine insemination, which involves the instillation of thawed semen into the uterus, may be an option.…”