COSA:AYA cancer fertility preservation/Options for fertility preservation/Cryopreservation of ejaculated semen

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Fertility preservation for AYAs diagnosed with cancer: Guidance for health professionals. > COSA:AYA cancer fertility preservation/Options for fertility preservation/Cryopreservation of ejaculated semen

Cryopreservation of semen

Recommendation Grade
Sperm cryopreservation is the only well-established method of preserving fertility in post-pubertal adolescent and adult males. It must be offered to all adolescent and young adult males prior to chemotherapy or radiotherapy that may damage the testes.
B
The procedure of epididymal or testicular aspiration or biopsy attempting to obtain sperm for cryopreservation should be offered to post-pubertal males who have an azoospermic ejaculate or who are unable to ejaculate.
PP

An estimated 15% to 30% of adult survivors of childhood and adolescent cancers will have a zero sperm count (‘azoospermia’) as a result of cancer treatments.[1] An individual patient’s fertility outcome is highly dependent on the type and extent of the tumour as well as the chemo- and/or radio- therapeutic regimen.[2] Semen cryopreservation before treatment starts is the only well-established method to preserve fertility potential in post-pubertal adolescents and adult men.

The most widely available standard procedure for post-pubertal males able to ejaculate is cryopreservation of ejaculated sperm. The opportunity for a future pregnancy may be increased if more than one sample is stored. Long term follow up studies have demonstrated successful pregnancies with sperm stored for up to 28 years.[3] Freeze-thawing of semen results in a decrease in the number of motile sperm recovered from the sample, which means that many cryostored samples are not suitable for simple insemination and may only be used to achieve a pregnancy in conjunction with assisted reproductive technology.

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Which patients should cryo-store sperm?

Post-treatment sterility cannot always be predicted [4] hence all men at risk of permanent sterility must be offered cryo-storage. It is important to recognise that semen quality is commonly decreased in young males with cancer even before treatment starts.[5] For example, fever, catabolism and tumour burden in Hodgkin disease is associated with poor sperm quality and increased sperm DNA damage prior to cancer therapy.[6] Also males with testicular cancer are more likely to have impaired sperm production and/or a history of undescended testes; the clustering of these problems suggests an underlying disturbance in testis development, perhaps during early life.[7] An AYA patient should be advised of the possibility of impaired sperm production and that it may not be appropriate for cryostorage.

Freezing of several samples is advocated, however freezing of one sample may be sufficient. Current assisted reproduction techniques permit fertility even with very poor semen quality, especially the ICSI (intracytoplasmic sperm injection) technique that requires only a single viable sperm per oocyte. Therefore any sample containing viable sperm, even if extremely few in number, should be cryopreserved.

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When to cryo-store

Cryo-storage is recommended before cancer treatment starts to avoid increased sperm aneuploidy rates and increased sperm DNA damage which may result from chemotherapy or radiotherapy. These abnormalities have also been found in association with testicular cancer and Hodgkin disease prior to any treatment.[8][9]

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Risks and side effects

While no excess chromosomal abnormalities have been reported in the offspring of men who received chemotherapy and radiotherapy in childhood or adolescence, there is insufficient data to exclude the possibility of adverse genetic outcomes in children conceived with semen collected during and shortly after chemotherapy.[10]

Therefore if semen samples are cryostored after starting treatment the patient must receive genetic counselling about the potentially increased risk of aneuploidy in offspring prior to the later use of such samples in fertility treatments.[11]

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References

  1. Schrader M, Heicappell R, Müller M, Straub B, Miller K. Impact of chemotherapy on male fertility. Onkologie 2001 Aug;24(4):326-30 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11574759.
  2. Meistrich ML, Vassilopoulou-Sellin R, Lipshultz LI. Gonadal Dysfunction. In: DeVita VT, Hellman S, Rosenberg SA editors. Cancer: Principles and Practice of Oncology. Vol. 7. 2005;Philadelphia: Lippincott Williams & Wilkins. p. 2560-2574.
  3. Feldschuh J, Brassel J, Durso N, Levine A. Successful sperm storage for 28 years. Fertil Steril 2005 Oct;84(4):1017 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16213859.
  4. Gandini L, Sgro P, Lombardo F, Paoli D, Culasso F, Toselli L, et al. Effect of chemo- or radiotherapy on sperm parameters of testicular cancer patients. Human Reproduction 2006;21;(11):2882-2889.
  5. Agarwal A, Allamaneni SS. Disruption of spermatogenesis by the cancer disease process. J Natl Cancer Inst Monogr 2005;(34):9-12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15784813.
  6. O'Flaherty C, Vaisheva F, Hales BF, Chan P, Robaire B. Characterization of sperm chromatin quality in testicular cancer and Hodgkin's lymphoma patients prior to chemotherapy. Hum Reprod 2008 May;23(5):1044-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18346994.
  7. Skakkebaek NE, Rajpert-De Meyts E, Main KM. Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects. Hum Reprod 2001 May;16(5):972-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11331648.
  8. Fait G, Yogev L, Botchan A, Paz G, Lessing JB, Yavetz H. Sex chromosome aneuploidy in sperm cells obtained from Hodgkin's lymphoma patients before therapy. Fertil Steril 2001 Apr;75(4):828-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11287046.
  9. Kobayashi H, Larson K, Sharma RK, Nelson DR, Evenson DP, Toma H, et al. DNA damage in patients with untreated cancer as measured by the sperm chromatin structure assay. Fertil Steril 2001 Mar;75(3):469-75 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11239525.
  10. Meistrich ML. Effects of chemotherapy and radiotherapy on spermatogenesis. Eur Urol 1993;23(1):136-41; discussion 142 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8477773.
  11. Tempest HG, Ko E, Chan P, Robaire B, Rademaker A, Martin RH. Sperm aneuploidy frequencies analysed before and after chemotherapy in testicular cancer and Hodgkin's lymphoma patients. Hum Reprod 2008 Feb;23(2):251-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18083744.

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