Impact of cancer and cancer treatment on male fertility

Abstract

While cancer, and especially testicular cancer and Hodgkin's disease, affects male fertility in many ways, the current increase of survival of male cancer patients of reproductive age or earlier has emerged as a new challenge to their subsequent ability to father children. Cancer treatments, including surgery, radiotherapy and chemotherapy, can have a transitory as well as a permanent detrimental impact on male fertility. Gonadotoxic effects and the length of time for sperm recovery after radiotherapy depends not only on initial semen quality, but also on gonadal dosage and the delivery method after chemotherapy, on the type of regimens and dosages and on the spermatogenesis phase that each drug impacts. Combination treatment with radiotherapy and chemotherapy will induce more gonadotoxicity than either modality alone. Although efforts to prevent gonadal toxicity in cancer treatment are routinely applied, sperm cryopreservation remains the gold standard to maintain male fertility after cancer survival. Fertility preservation for prepubertal boys presents the greatest problem due to the absence of mature sperm in their gonads. In this area, research efforts are concentrated on cryopreservation of immature gametes and, in particular, techniques for their maturation and proliferation after thawing.

Sperm DNA Fragmentation Index and Hyaluronan Binding Ability in Men from Infertile Couples and Men with Testicular Germ Cell Tumor

“…Therefore, it is unclear whether to use semen cryopreserved before chemotherapy or fresh semen taken immediately after irradiation or chemotherapy, if present, for further fertility treatment [30]. Irradiation is a particularly dangerous factor inducing chromatin fragmentation [36], and exposure at a dose higher than 4 Gy may irreversibly affect spermatogenesis [37]. Paoli et al (2015) report that chemotherapy and radiotherapy increased sperm DFI three to six months after the end of the treatment, improving after 12 to 24 months.…”

Fertility preservation and pregnancy outcomes in adolescent and young adult male patients with cancer

“…This highlights the importance of using fertility preservation measures prior to cancer treatments, such as chemotherapy or radiotherapy. As previously mentioned, sperm cryopreservation is a well‐established method and is the current gold standard for fertility preservation, with reports of a successful delivery in 50% of patients with cancer following ICSI with cryopreserved sperm . As such, it should be the first fertility preservation choice for men of reproductive age.…”

Control of Germline Stem Cell Lineages by Diet and Physiology

“…While our understanding of the effect of cachexia on mammalian GSC lineages is limited, cachetic patients are often insulin resistant (Honors and Kinzig 2012), and chronic inflammation, found in many cancers (Crusz and Balkwill 2015), can lead to Interleukin-6 mediated hyperactivation of the hypothalamic-gonadal-pituitary axis (Raber et al 1997). Therefore, although it is clear that many cancer treatments can impair fertility (Suhag et al 2015; Vakalopoulos et al 2015), it is also possible that the physiological changes caused by the tumors themselves may also have effects on the germ line of patients.…”