Does the use of cryopreserved sperm from men with cancer result in pregnancy and live birth? Is there any evidence of complications?
It is well established that in men and boys with cancer the use of chemotherapeutic agents and irradiation to the pelvis has the potential to damage spermatogenesis. An estimated 15% to 30% of men with a history of cancer during childhood and adolescence 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 type of chemotherapy or radiotherapy regimen.
Semen quality is commonly decreased in young men with cancer, even before treatment starts. Hodgkin disease is associated with poor sperm quality and increased sperm DNA damage prior to cancer therapy, and men with testicular cancer are more likely to have impaired sperm production and a history of undescended testes.
The most widely available procedure for post-pubertal men able to ejaculate is cryopreservation of ejaculated sperm. Current assisted reproduction techniques permit fertility even with very poor semen quality, especially the 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.
Cryopreservation of sperm is recommended before cancer treatment starts to avoid increased sperm aneuploidy rates and sperm DNA damage which may result from chemotherapy or radiotherapy. Despite the likelihood of decreased sperm quality in cancer patients there is some evidence to suggest that the live birth rate from using cryopreserved sperm and assisted reproductive technologies is at least comparable to that of the non-cancer population.
|Cryopreservation of semen (or testicular sperm) prior to cancer therapy is associated with a high chance of successful conception in the partners of men living with a history of cancer.||III-2, IV||, |
Good practice point
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