Do men undergoing sterilizing cancer treatments have a fertile future? |
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Authors: | Naysmith TE; Blake DA; Harvey VJ; Johnson NP |
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Institution: | fertilityPLUS, National Women's Hospital, Auckland, New Zealand. |
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Abstract: | This study was designed to assess the effect of cancer treatments on the
natural and assisted reproductive potential of men. A cohort of men with
cancer, in whom radiotherapy and/or chemotherapy was planned, were invited
to participate. Twenty-two pre- and post-treatment semen samples were
analysed. The reproductive potential of participants was assessed with
respect to the current range of fertility treatment options available.
Abnormal sperm concentrations were found in 27% of patients pre-treatment
compared to 68% post-treatment following a mean latency of 20 months from
treatment. Fifty-nine percent of patients experienced a clinically
significant decrease in sperm, concentration following radiotherapy and/or
chemotherapy; 23% developed azoospermia following treatment. Eighty-two
percent of patients with testicular malignancy had oligo- or azoospermia
post-treatment. Only one patient had a clinically significant reduction in
the percentage of motile spermatozoa post-treatment. Cryopreservation of
semen prior to treatment improved the fertility prospects of 55% of
patients. Intracytoplasmic sperm injection (ICSI) enhanced the fertility
prospects of a further 14%. In the absence of, or after depletion of,
cryopreserved semen, ICSI could enhance the fertility prospects of 45% of
patients. Fertilization has been achieved by ICSI using spermatozoa
retrieved by testicular biopsy from an azoospermic testicular cancer
survivor 8 years after chemotherapy. It was concluded that chemotherapy
and/or radiotherapy may depress semen concentration to the extent of
rendering a man infertile. The severity of the reduction in sperm
concentration following treatment is unpredictable but likely to be most
severe in those with testicular malignancy and those treated with
radiotherapy or alkylating chemotherapy agents. Not all men are keen to
undergo an appraisal of their post-treatment fertility potential, for
reasons which are unclear. Improving awareness and education of patients
concerning the effects of both cancer and cancer treatments on reproductive
potential is essential. With the advent of ICSI, it is possible to offer a
very reasonable chance of conception in all men with cancer who present for
cryopreservation of semen prior to treatment in whom spermatozoa (even in
very low concentrations) are present in the ejaculate.
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