Preserving Fertility in Men with Cancer

Preserving fertility in men diagnosed with cancer may be possible in some cases. Whether fertility can be maintained during treatment depends upon the location of the cancer in the body, the type of cancer and of course therapy. Unfortunately, the preservation of fertility cannot be guaranteed. 

Preservation of Fertility and Radiation

The effect of radiation on fertility may be minimized if the testes can be shielded during treatment. In some cases, it may be possible to cover the testes with a lead shield. Patients will have a better chance of preserving fertility if the radiation can be directed in a small region. 

Some types of cancer require more radiation exposure than other types. Radiation directed at the entire body, such as that used during bone marrow transplantation treatment, has a high incidence of leaving patients permanently infertile. Shielding of the testes provides little protection for patients undergoing entire body radiation treatment. 

In addition, the external radiation used to treat prostate cancer may affect fertility. The effect of radiation on spermatozoa is unpredictable. Therefore, patients are advised against impregnating their partners during and shortly after treatment. Sperm retrieval and cryopreservation is an option for patients who may become infertile during treatment. 

Chemotherapy and Fertility

Numerous agents are used in chemotherapy treatment. How chemotherapy affects fertility depends upon the agent used during the course of treatment. Some of the chemicals severely affect sperm production, which may lead to permanent infertility or years of recovery. Other agents have only a minimal to moderate affect on sperm production, whereas a patient may regain fertility in as little as six months to a year after treatment. 

Patients should not attempt to impregnate their partners during chemotherapy and for up to six months after cessation of treatment. Chromosomal abnormalities have been detected in the sperm of men undergoing chemotherapy. Although studies indicate that the rate of birth defects are not higher, most health providers caution it is best to wait until spermatogenesis (sperm cell development) returns to normal levels. 

Sperm Retrieval and Cryopreservation

Patients who are unable or to ill to produce a semen sample, may be candidates for sperm retrieval procedures. Testicular sperm extraction (TESE) and Microsurgical Epididymal sperm aspiration (MESA) are 2 options for men wanting to retrieve and preserve sperm for future in vitro fertilization procedures. 

During TESE, a biopsy is performed in order to remove small sections of tissue from the testes. The tissue is examined for the presence of spermatozoa. If sperm are found, they are isolated and preserved cytogenetically. In a MESA procedure, a small needle is inserted into the epididymis and the sperm are extracted with a syringe, tested and preserved.

Sperm Bank

Depositing sperm in a sperm bank is an option for patients who are able to provide a semen sample without medical intervention. Men either provide semen samples in the facility or at home if they can be transported to the facility within one hour. 

The sperm bank will evaluate the sample for sperm count, motility and morphology (development) before putting it into storage. Clients pay a storage fee and if not used, the specimen can be donated for research or destroyed. Patients who are concerned about preserving their fertility should consult with their oncologist.

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