With the significant improvement in cancer survival rates over the last few decades, there has been a surge in the number of young cancer survivors. Consequently, cancer treatments now focus on both survival and quality of life after treatment. However, all cancer treatments—chemotherapy, radiation, medication, and surgery—can adversely affect fertility in both men and women. Male infertility due to cancer treatments can range from mild to severe and be either temporary or permanent. As it’s impossible to predict whether or not a male patient will recover spermatogenesis after treatment, sperm cryopreservation is extremely important to ensure fertility preservation. Sperm banking is presently the only pretreatment strategy to preserve fertility for male cancer patients. Yet surprisingly, less than a quarter of cancer patients opt for sperm banking. The most common cause for not taking this measure is the lack of information and awareness. Only two-thirds of male cancer patients awaiting treatment know about sperm banking.
Causes of infertility in men taking cancer therapy
Poor semen quality in male cancer patients is a result of multiple factors and the reasons not clearly understood yet. Some of the possible causes are endocrine problems, preexisting defects in germ cells, local tumour effects, and autoimmune and systemic effects of cancer.
Cancer treatments can destroy or eliminate all the stem cells in the testicles that generate new, mature sperm cells. During treatment, both testicles may need to be removed or they might be exposed to a very high dosage of alkylating chemotherapy drugs or high doses of radiation. Chemotherapy damages spermatogenesis too, either temporarily or permanently. Patients with testicular cancer, who are usually young, are likely to be infertile before they are diagnosed with cancer but may recover fertility after treatment.
Chemotherapy drugs and radiotherapy to the pelvis can lead to genetic changes in sperms and eggs. There are possibilities of early miscarriage in pregnancy or birth defects in case of embryos with genetic damage. Since very few babies have been conceived during cancer therapy, there are no conclusive statistics on the possibility of birth defects. If a man is undergoing chemotherapy while his wife is pregnant, he should use a condom to prevent the drugs from reaching the fetus through sexual intercourse.
Preserving Fertility in Male Cancer Patients
The majority of oncologists recommend sperm banking for all men before cancer treatment. Sperm cryopreservation is easier, cheaper and more effective than fertility preservation for women. Sperm banking includes the collection of a semen sample before any chemotherapy or pelvic radiation therapy begins, to prevent the storage of damaged sperms, and then freezing it. The sperms can be thawed in future and the healthiest sperm captured and utilized for intrauterine insemination or in vitro fertilization.
While semen samples are usually provided through masturbation, some patients may face difficulties and they can collect the sample with a condom instead. However, the condom needs to be approved by the medical laboratory. Multiple collections are recommended by doctors at times, depending on the patient’s number of motile sperm observed, the time elapsed since the last ejaculation, and individual variability. Thus, sperm banking prior to beginning life-saving cancer therapy offers young survivors and their families the safest and best chances to father biological children in their future and it must be offered to all male cancer patients.