Article
Sperm cryopreservation before cancer treatment: a 15-year monocentric experience

https://doi.org/10.1016/j.rbmo.2011.11.015Get rights and content

Abstract

Sperm banking is an important procedure to preserve fertility before cancer therapy. The aim of this study was to comprehensively analyse cryopreservation activity retrospectively for 1080 patients referred to the sperm bank for sperm cryopreservation before cancer treatment. This study included 1007 patients diagnosed with testicular cancer (TC) (41.7%), lymphoma (26%), other haematological cancers (9.4%) or other types of cancer (22.8%); of these, 29 patients did not produce any semen sample and cryopreservation was impossible for 67 patients. Semen characteristics before treatment were within normal ranges, except moderate asthenospermia. Sperm concentration was significantly lower in TC than in non-TC. Straws from 57 patients (6.3%) were used in assisted reproductive technologies, which led to a 46.8% cumulative birth rate. Straws were destroyed for 170 patients (18.7%) and 140 patients performed semen analyses after cancer therapy. After an average delay of 22.5 months after the end of therapy, 43 patients (30.7%) exhibited azoospermia. This study of a large population of cancer patients revealed a high level of successful sperm storage. Utilization of cryopreserved spermatozoa led to good chances of fatherhood. Nevertheless, sperm banks should be aware of the low rates of straw use and straw destruction by cancer patients.

Sperm banking is an important procedure to preserve fertility before cancer therapy. The aim of this study was to analyse comprehensive cryopreservation activity. We retrospectively studied 1080 patients referred to the sperm bank for sperm cryopreservation before cancer treatment. We included 1007 patients diagnosed with testicular cancer (TC) (41.7%), lymphoma (26.0%), other haematological cancers (9.4%) or other types of cancer (22.8%). Of these, 29 patients did not produce any semen sample and cryopreservation was impossible for 67 patients. Semen characteristics before treatment were within normal ranges, except moderate decrease in sperm motility. Sperm concentration was significantly lower in TC than in non-TC. Frozen spermatozoa from 57 patients (6.3%) were used in assisted reproductive treatment, which led to a 46.8% cumulative birth rate. Frozen spermatozoa were destroyed for 170 patients (18.7%). A total of 140 patients performed semen analyses after cancer therapy. After an average delay after the end of therapy of 22.5 months, 43 patients (30.7%) exhibited an absence of spermatozoa in the semen. This study of a large population of cancer patients revealed a high level of successful sperm storage. Utilization of cryopreserved spermatozoa in assisted reproduction led to good chances of fatherhood. Nevertheless, sperm banks should be aware of the low rates of frozen sperm use and frozen sperm destruction by cancer patients.

Introduction

Cancer therapies have significantly improved survival rates for patients with cancer, particularly in men between 15 and 44 years old. In Europe, the 5-year survival rate is above 90% for testicular cancer (TC) and Hodgkin lymphoma (HL) (Sant et al., 2009). These cancers represent 19% and 5.1%, respectively, of all cancers in this age category, and haematological cancers as a group represent 16.9% of the cancers in this age category. Moreover, TC is the most frequent cancer in men between 15 and 39 years old (Belot et al., 2008). However, chemotherapy and radiotherapy often damage spermatogenesis (Colpi et al., 2004, Dohle, 2010); these therapies can cause transient or permanent infertility (Magelssen et al., 2006). The effects of chemotherapy on spermatogenesis depend on the cytostatic agents used, their dosage and the treatment length. Between 15% and 30% of men remain permanently infertile after chemotherapy (Schrader et al., 2001). Infradiaphragmatic radiotherapy exposes patients to a high risk of impaired spermatogenesis (Magelssen et al., 2006). Moreover, cancer surgery (such as prostatectomy or retroperitoneal lymphadenectomy) can have harmful consequences on erectile function and/or ejaculation (Magelssen et al., 2006, Maltaris et al., 2006, Montorsi et al., 2004).

These harmful effects on spermatogenesis are particularly serious in young men without offspring. It is very difficult to predict which patients will have permanent infertility and which will regain fertility (Naysmith et al., 1998). Therefore, sperm cryopreservation before treatment is strongly recommended for cancer patients of reproductive age (Ethics Committee of American Society for Reproductive Medicine, 2005).

Sperm banks have been developed partly to help with fertility preservation before cancer therapies. Several studies on this function have been published, but few of them have included a large population of cancer patients. Moreover, little is known about the result of fertility preservation according to cancer type.

This is a 15-year retrospective study in a population of patients referred for sperm cryopreservation before cancer therapy. The aims were to examine: (i) pre-freeze semen parameters and sperm banking feasibility according to cancer type; (ii) straw utilization and destruction; and (iii) changes in semen parameters after treatment.

Section snippets

Patients

This study retrospectively assessed the database of the Marseille University Hospital sperm bank (Centre d’Etude et de Conservation des Œufs et du Sperme humains, CECOS), searching for all male cancer patients who were referred to the unit to cryopreserve ejaculated spermatozoa between January 1995 and December 2009. Exclusion criteria were previous cancer therapy (except for TC: patients were referred either before or after orchiectomy) and an absence of histological diagnosis of cancer.

Patients and distribution of cancer types

The sperm cryopreservation database contained 2516 attempts of sperm cryopreservation from 1080 cancer patients between 1995 and 2009. Of these 1080 men, 1007 met the inclusion criteria, made 2317 cryopreservation attempts and banked 2250 samples. Details are shown in Figure 1.

TC (41.7%, n = 420) and haematological cancers (35.5%, n = 357) accounted for the majority of cancers (Table 1). The mean age was 29.3 ± 8.8 years (range 12.7–64.8). The mean age of patients was significantly lower in HL (25 ± 

Discussion

As far as is known, this study is the largest ever published about pre-treatment semen parameters and post-treatment straw utilization in men with cancer. Pre-freeze semen parameters in a series of 1386 patients with TC were previously studied by Auger et al. (2000), but post-treatment straw utilization was not assessed.

Conclusion

This study of a large population of cancer patients showed a high level of successful sperm storage before cancer therapy. Utilization of cryopreserved spermatozoa in assisted reproduction treatment led to good chances of pregnancy. In this 15-year experience, straw destruction was more frequent than straw utilization. Most living patients did not use their cryopreserved spermatozoa and did not produce samples for control semen parameters after cancer therapy, which resulted in long-term

Acknowledgements

The authors thank the CECOS laboratory personnel for their assistance and the clinical personnel for their involvement.

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    Dr Pascale Bizet is a young embryologist. She graduated from Air–Marseille University Faculty of Medicine, Marseilles, France with a Medical Doctorate in 2011. She received her Master of Science in Biology of Reproduction from Paris Descartes University in 2010. During her residency, she participated in research focusing on male fertility preservation techniques and on the effect of occupational exposures on semen parameters.

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