Do men undergoing sterilizing cancer treatments have a fertile future?

This study was designed to assess the effect of cancer treatments on thenatural and assisted reproductive potential of men. A cohort of men withcancer, in whom radiotherapy and/or chemotherapy was planned, were invitedto participate. Twenty-two pre- and post-treatment semen samples wereanalysed. The reproductive potential of participants was assessed withrespect to the current range of fertility treatment options available.Abnormal sperm concentrations were found in 27% of patients pre-treatmentcompared to 68% post-treatment following a mean latency of 20 months fromtreatment. Fifty-nine percent of patients experienced a clinicallysignificant decrease in sperm, concentration following radiotherapy and/orchemotherapy; 23% developed azoospermia following treatment. Eighty-twopercent of patients with testicular malignancy had oligo- or azoospermiapost-treatment. Only one patient had a clinically significant reduction inthe percentage of motile spermatozoa post-treatment. Cryopreservation ofsemen prior to treatment improved the fertility prospects of 55% ofpatients. Intracytoplasmic sperm injection (ICSI) enhanced the fertilityprospects of a further 14%. In the absence of, or after depletion of,cryopreserved semen, ICSI could enhance the fertility prospects of 45% ofpatients. Fertilization has been achieved by ICSI using spermatozoaretrieved by testicular biopsy from an azoospermic testicular cancersurvivor 8 years after chemotherapy. It was concluded that chemotherapyand/or radiotherapy may depress semen concentration to the extent ofrendering a man infertile. The severity of the reduction in spermconcentration following treatment is unpredictable but likely to be mostsevere in those with testicular malignancy and those treated withradiotherapy or alkylating chemotherapy agents. Not all men are keen toundergo an appraisal of their post-treatment fertility potential, forreasons which are unclear. Improving awareness and education of patientsconcerning the effects of both cancer and cancer treatments on reproductivepotential is essential. With the advent of ICSI, it is possible to offer avery reasonable chance of conception in all men with cancer who present forcryopreservation of semen prior to treatment in whom spermatozoa (even invery low concentrations) are present in the ejaculate.