Sperm cryopreservation for male patients with cancer: an epidemiological analysis at the University of Pennsylvania

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Abstract

Many cancers strike young males who have not yet started or completed families. Since cancer treatments such as chemotherapy and radiation can irreversibly affect spermatogenesis, sperm cryopreservation is an important option for storing male reproductive potential. In this report, we review our database of 10 years of experience with cryostorage for male cancer patients. We assess types of cancer, timing of collection, sperm quality, and utilization for reproductive purposes. We also report specimen disposal and rates of patient death.

There were a total of 164 oncology patients electing to freeze sperm at our institution during the study period. Types of cancer were varied, with testicular cancer, Hodgkin’s lymphoma, leukemia, and gastrointestinal cancers comprising the largest groups. Evaluation of semen parameters for these groups revealed that oligospermia, even prior to initiation of cancer therapy, was common. Sperm counts, motility, and morphology did not differ by type of cancer.

Interestingly, less than 5% of patients utilized their specimens for reproductive purposes. Seven insemination cycles yielded no pregnancies, while one of two IVF attempts and the single ICSI case were successful.

In conclusion, the epidemiological review of our database suggests that sperm cryostorage for fertility preservation in male cancer patients is under-utilized. Additionally, there is minimal use of cryopreserved specimens for reproductive purposes. We speculate that this under-utilization may be due to the paucity of reports regarding reproductive outcome after freezing. It is our objective to provide a compilation of data that will prove useful to both physicians and patients who are considering sperm cryopreservation.

Introduction

There are many cancers that strike young males who have not yet started or completed families. Studies have shown that a significant number of male cancer patients have the desire to have children and that anxiety about the potential for infertility exists [1]. Chemotherapy and radiation are the mainstays of successful cancer treatment, but often lead to diminished fertility and, in some cases, irreversible impairment of spermatogenesis. For instance, chemotherapeutic agents are known to damage germinal epithelial cells and cause Leydig cell dysfunction. Likewise, radiation treatments at doses >1–2 Gy are mutagenic and destructive to germ cells [2], [3]. Due to the effectiveness of these cancer treatments, the overall 5 year survival rates for the two most common tumors affecting males have greatly improved, and were recently reported as 95% for testicular cancer and 82% for Hodgkin’s disease [4]. Although efforts have been made to modify protocols in order to minimize effects on fertility, the chances of fathering children after treatment remain difficult to predict. Depending on the chemotherapeutic agent and the duration of treatment, 45–80% of patients will have permanent gonadal dysfunction resulting in azoospermia [5].

Cryopreservation of sperm has provided hope for fertility preservation in cancer patients. Ideally, it should be offered prior to initiation of cancer therapy, but it can also be done for patients already undergoing treatment. Sperm cryopreservation prior to the initiation of chemo- or radiotherapy is advantageous because the quality of the sample may be compromised even after a single treatment session. However, depending on the type of cancer and the overall condition of the patient, sperm quality may be poor even in patients who have not yet started therapy [6]. The precise mechanisms of abnormalities in sperm production prior to cancer therapy are not clear, but may be related to type of cancer, emotional stress, fever, and immune-mediated factors.

Reports suggest that most young male patients diagnosed with cancer do not utilize cryopreservation. The most commonly cited reason among cancer patients for not banking sperm has been that they were never adequately informed of their options [7]. There appears to be a lack of awareness among both patients and physicians, which may be due to the fact that the service of sperm cryostorage for cancer patients is not widely publicized. There is a paucity of reports on the demographics of oncology patients who do freeze their sperm, the timing of collection relative to cancer therapy, and the potential use of the samples for reproduction. This epidemiologic information, which we aim to present in this paper, is essential to physicians in counseling their patients. We conducted a review of all male cancer patients who have elected to freeze their sperm at our institution over the past 10 years. We assessed types of cancer, patient age, timing of collection, and duration of storage. We evaluated and compared pre-therapy semen properties of patients from different cancer groups to determine whether certain cancer types rendered patients more susceptible to poor semen quality. We also report specimen disposal, sperm beneficiaries and utilization rates for reproductive purposes. For those patients who discontinued storage, we looked at reasons for discontinuation including death.

Section snippets

Materials and methods

We performed a review of our cryopreservation database, including all oncologic patients who had submitted specimens between June 1993 and March 2003. All patients were referred by their primary oncologists. Each patient’s initial visit consisted of an interview and consultation with an attending physician, during which a complete medical, surgical and social history was gathered, as well as information regarding prior fertility. Additionally, a detailed consent form was issued, which described

Results

There were a total of 164 cancer patients who cryopreserved sperm during the study period. Patient characteristics are listed in Table 1. The mean age at first freeze was 29.5±7.1 years, ranging from 13 to 58 years of age. The number of samples collected was determined by the patient and his treatment plan, and ranged between one and nine samples. The types of cancer were diverse (see Table 2). Testicular cancer, Hodgkin’s lymphoma, and leukemia comprised the majority.

Thirty three patients

Discussion

Given the estimated frequency of cancers diagnosed in young males, the epidemiological review of our database suggests that sperm cryostorage for fertility preservation in cancer patients is clearly under-utilized. An estimate of 2% of all males between the ages of 18 and 44 will be diagnosed with cancer per year in the United States [8]. Unfortunately, this accumulation of new cancer cases has not been reflected in the number of patients seeking cryopreservation services. Over a 10-year

Condensation

To preserve future fertility in male patients with cancer cryopreservation of sperm is recommended before chemo- or radiotherapy.

To compile data useful to physicians in counseling patients, we reviewed semen parameters according to the type of cancer, reproductive usage and choice of sperm disposition from our database.

Acknowledgements

Debbie Schafer, L.P.N., for her continuous commitment to patient care. Clarisa Gracia, M.D., for her help and support.

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