This abstract assesses effect of cancer treatments on mens’ fertility in young cancer survivor. Fertility chalenges may be major concern for Hodgkin lymphoma or seminoma patients, with 5-year survival rate 85-100%. However, for them, fertility recovery is least likely. Data is lacking in metastatic prostate cancer patients, but conception is still feasible. Highest sterility risks pose: radiotherapy doses> 40 Gy, alkylating agents, surgery, TKIs and hormonal therapy. 10-15% of these males suffer from azoospermia, absence of spermatozoon in ejaculate. It is impossible to predict which will recover and which will be irreversibly sterile. Interestingly, mean recovery latency is 19 months, minimum 3 months, maximum 5-8 years.
Cryopreservation is considered standard of care in young oncology patients. Firstly, spermogram is obtained. Semen with reduced spermcount is called oligospermic, with low motility asthenospermic, and one with morphologic changes is teratospermic. Oligostenoteratospermic, when disorders are combined. Total absence of spermia is called azospermia.
One European study analysed 21 semen samples. Abnormal spermcount was found in 30% of patients, pretreatment, compared to 70% posttreatment. About 2/3 of patients experienced decrease in sperm concentration after radiochemotherapy; ¼ developed azoospermia, 1/5 of patients with testicular malignancy had oligospermia or azoospermia, posttreatment. Reproductive potential of participants was assessed based on their sperm concentrations: if > 20x106/ml-indication for natural conception (NC); 5x106/ml-in vitro fertilization (IVF);
This study demonstrates that it is possible to offer conception in all cancer survivor by semen cryopreservation, improving fertility prospects of 55%. Intracytoplasmic sperm injection (ICSI) adds another 14%. Testicular sperm aspiration (TESA) or testicular biopsy should be attempted in azospermic patients, before offering donor insemination. Another option is sperm transplantation. Now, that the future of cancer survivors holds more possibility for fertility preservation, the counselling role of the oncologist is even more crucial.
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All authors have declared no conflicts of interest.