Cryopreservation of semen
|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. 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. 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. 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.
Which patients should cryo-store sperm?
Post-treatment sterility cannot always be predicted  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. 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. 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. 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.
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.
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.
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.
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