Gonadal dysfunction in male cancer patients before cytotoxic treatment

Abstract

Male patients diagnosed with cancer are often referred for semen cryopreservation before gonadotoxic treatment but often have low semen quality. The aim of this study was to evaluate which type of cancer affects gonadal function and proposes a risk factor for low pre-treatment semen quality. Between January 1983 and August 2006, 764 male cancer patients were referred for semen cryopreservation prior to chemotherapy and radiotherapy. We compared semen characteristics and reproductive hormones between different groups of cancer patients. In addition, we evaluated the role of tumour markers in patients with testicular germ-cell tumours (TGCT) on fertility. Abnormal semen parameters were found in 489 men (64%) before cancer treatment. Patients with TGCT and extragonadal germ-cell tumours had significantly lower sperm concentrations and inhibin B levels than all other patient groups. No semen could be banked in 93 patients (12.2%). Eight hundred and thirty-nine of 927 (90%) produced semen samples were adequate for cryopreservation. Inhibin B in all groups showed to be the best predictor of semen quality. Although pre-treatment raised tumour markers were associated with a decrease in inhibin B and increased follicle stimulating hormone, both predictive for low semen quality; no direct linear association could be found between raised beta-HCG, alfa-fetoprotein and semen quality. Only 1/3 of cancer patients had normal semen parameters prior to cancer treatment. Patients with TGCT and extragonadal GCT have the highest risk for impaired semen quality and gonadal dysfunction at the time of semen cryopreservation.

Ovarian response to controlled ovarian hyperstimulation in women with cancer is as expected according to an age-specific nomogram

“…Whereas several studies have shown that malignancies, especially testicular cancer and lymphoma, in male patients adversely affect fertility before the initiation of the oncologic treatment [9], in women data are conflicting. An adverse influence of malignancy on oocyte biology was first reported by Pal et al [10].…”

Effect of Cancer on Ovarian Function in Patients Undergoing In Vitro Fertilization for Fertility Preservation: A Reappraisal

“…Interest in the effect of cancer on ovarian function has probably been fueled by reports of decreased sperm quality and count in patients with cancer 4,5 . Those observations sparked an interest in reports describing baseline ovarian function and outcomes of ovarian stimulation in patients needing fertility preservation because of background malignancies.…”

“…Recent evidence demonstrated a negative effect of cancer on spermatogenesis, with a decrease in sperm quality and indices in patients diagnosed with hematologic and testicular cancers 4,5 . Likewise, the effect of cancer on baseline ovarian function and ovarian response to stimulation for in vitro fertilization (ivf) has been studied with mixed results.…”

Effects of cancer on ovarian response in controlled ovarian stimulation for fertility preservation

“…Women diagnosed with cancer have different options for fertility preservation, but embryo freezing after in vitro fertilization (IVF) seems the best option available today. Concerns over ovarian response in cancer patients during IVF treatment are now being brought up in conjunction with studies of men with cancer who demonstrate reductions in sperm count and quality even before treatment (1,2). However, the data regarding this subject with women are conflicting.…”