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Current Gaps in Fertility Preservation for Men: How Can We do Better?

More than eight million male cancer survivors were living in the United States in 2019, a figure that will certainly increase as cancer diagnostics, treatments, and prognoses continue to improve.1 For men diagnosed with cancer between age 15 and 39 years, the survival rate exceeds 80%,2 and for certain malignancies, the overall 5-year survival approximates 95%.3 Unfortunately, however, nearly a quarter of these survivors suffer from long-term sterility caused by gonadotoxic or surgical treatment.4

With increased survivorship comes an increased need to address post-treatment health concerns at the time of diagnosis. As care providers, given what we have learned from long-term survivors, collection of sperm pretreatment will improve long-term outcomes.5,6 Permanent azoospermia is a significant concern for men planning pelvic radiation and/or exposure to high-dose alkylating agents. Although sperm counts may recover after a period of time for some men, others will remain azoospermic for life.7

Luwam Ghidei, MD1; John Sullivan, MD2; Rair Jose Valero Carrion, MD2; Joshua Schammel, MD2; Larry Lipshultz, MD2; and Laurie J. McKenzie, MD1,3

  1. Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, One Baylor Plaza, Houston, TX
  2. Department of Urology, Baylor College of Medicine, One Baylor Plaza, Houston, TX
  3. Department of Gynecology Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
References:

  1. American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the North American Association of Central Cancer Registries (NAACCR), and the National Cancer Institute (NCI): Annual Report to the Nation on the Status of Cancer. https://seer.cancer.gov/report_to_nation/ Google Scholar
  2. Brannigan RE, Fantus RJ, Halpern JA: Fertility preservation in men: A contemporary overview and a look toward emerging technologies. Fertil Steril 115:1126-1139, 2021 Crossref, Medline, Google Scholar
  3. American Society of Clinical Oncology: Testicular Cancer: Statistics, 2021. https://www.cancer.net/cancer-types/testicular-cancer/statistics Google Scholar
  4. Dar S, Orvieto R, Levron J, et al: IVF outcome in azoospermic cancer survivors. Eur J Obstet Gynecol Reprod Biol 220:84-87, 2018 Crossref, Medline, Google Scholar
  5. Zebrack BJ, Casillas J, Nohr L, et al: Fertility issues for young adult survivors of childhood cancer. Psychooncology 13:689-699, 2004 Crossref, Medline, Google Scholar
  6. Oosterhuis BE, Goodwin T, Kiernan M, et al: Concerns about infertility risks among pediatric oncology patients and their parents. Pediatr Blood Cancer 50:85-89, 2008 Crossref, Medline, Google Scholar
  7. Bahadur G, Ozturk O, Muneer A, et al: Semen quality before and after gonadotoxic treatment. Hum Reprod 20:774-781, 2005 Crossref, Medline, Google Scholar

Source: Ghidei L., Sullivan J., Carrion R. et al. "Current Gaps in Fertility Preservation for Men: How Can We do Better?" Journal of Clinical Oncology. 2022. 40, no. 23 2524-2529.