Fertility Preservation for Men
Fertility Preservation Options for Men
Cancer treatments can affect a man’s ability to father a child. All men should be offered information about how cancer treatment could affect their fertility. If they are interested in having a child in the future, they should discuss their options for fertility preservation. Preserving a man’s fertility does not take a lot of time. In rare cases, cancer treatment may be emergent, limiting options. It is important to have an open and honest discussion with your care team regarding your wishes and options. For many men, sperm banking is a great option for preserving fertility. Let's review the options available to men:
Cryopreservation (freezing & storage) of sperm is the only proven method of fertility preservation in men. This frozen sperm is later used to fertilize a woman’s egg using in-vitro fertilization (IVF). It can also be injected directly into the woman’s uterus, known as intracytoplasmic sperm injection (ICSI). For many men with cancer, sperm quality is poor even before starting therapy. In the past, this was thought of as a reason to not freeze sperm. IVF and ICSI technologies have improved and even a sample with few sperm can result in a successful pregnancy.
It is best to collect samples before starting therapy for cancer, but they can still be collected after therapy has started. If collection happens after therapy has started, men should be aware of the chance of the sperm having genetic damage. This damage and risk to the fetus has not been well studied, so there are no statistics on the chance of problems.
If a man is interested in freezing sperm, he will be sent to a fertility clinic to have the sperm collected in person. In some cases, a collection kit can be given to the man to be done at home and mailed to the storage facility. Semen samples are best collected through masturbation after refraining from sexual activity for 2-5 days. More samples can be collected, with at least 48 hours between samples. This will provide an optimal number of sperm. Men without enough sperm in their semen can have sperm removed from the testicle with a needle (called aspiration).
The samples are mixed with a substance to protect them from the freezing and thawing process. They are slowly frozen to the right temperature and stored. When the samples are needed, they are slowly thawed to protect the sperm from damage. It is not known exactly how long sperm can survive the freezing process, but it is thought to be many years.
The cost of collection, freezing, and storage varies greatly, and it may be worth a few phone calls to find the best pricing. There are fees to store the samples, which can be charged monthly, yearly, or for a period of 1-5 years paid in advance. In some cases, insurance may cover these fees, so check with your insurance company. There are also costs tied to future IVF to consider.
Other Preservation Techniques Being Studied
While sperm banking is a good choice for many, there are men who cannot put off treatment by a few days to bank sperm. In addition, boys treated before puberty do not yet produce sperm and cannot bank. The techniques below are being studied, but are still in the research stage.
Testicular Tissue Freezing
In this procedure, testicular tissue is removed and frozen, before cancer therapy starts. This tissue would be thawed for use at a later date. There are a few ways this tissue may be used:
- Sperm stem cells are collected from the tissue and implanted back into the man’s testicles. The hope is that these cells begin to produce sperm and a man can impregnate a female normally.
- The tissue can be implanted in the man - either in the testicle or elsewhere. After the tissue begins making sperm, it is collected using a needle. This sperm is then used through IVF procedures to result in pregnancy.
This technique has been successful in animals, but there have been no live human births yet. Many fertility clinics use this technique, but men should know that this is purely experimental at this time.
One other method that has been tested is called gonadoprotection. This works on the theory that germ cells are harmed by chemotherapy because they are quickly dividing and reproducing. By giving medication to stunt the reproduction of these cells, perhaps they would be safe from the damage of chemotherapy. This did not prove true when tested in humans and sperm production did not get better after therapy in the men studied.
Fertility-preserving techniques for men can come at a major cost. Many patients will not have coverage for fertility-sparing procedures through their health insurance. The National Infertility Association has a website that includes up-to-date information on each state's laws. Men should talk to their insurance companies or human resource representatives to explore what is covered.
We have a long way to go in helping men facing cancer therapy to preserve their fertility. While sperm cryopreservation is a good choice for many men, it leaves out the many childhood cancer survivors with a dream of starting a biologic family. Future research will hopefully find methods to preserve fertility in these young men. Testicular tissue cryopreservation holds great hope and will be a focus in the years to come.
A first step is making sure men know the options available to them. Have an open conversation with your providers regarding your wishes concerning your fertility. You can also learn more about how your treatments can affect your fertility and find links to resources for more information.
Devita Jr, V. T., Lawrence, T. S., & Rosenberg, S. A. (2015). DeVita, Hellman, and Rosenberg's cancer: principles & practice of oncology. Lippincott Williams & Wilkins.
Lee SJ, Schover LR, Partridge AH, et al: American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. Journal of Clinical Oncology 24:2917-31, 2006
Meistrich, ML. The Effects of Chemotherapy and Radiotherapy on Spermatogenesis in Human. Fertility and Sterility. Nov 1, 2014.
Nieman CL, Kazer R, Brannigan RE, et al: Cancer survivors and infertility: a review of a new problem and novel answers. Journal of Supportive Oncology 4:171-8, 2006
The Oncofertility Consortium. Found at: http://oncofertility.northwestern.edu/for-patients
Save My Fertility. Found at: http://www.savemyfertility.org/pocket-guides/providers/fertility-preservation-men-diagnosed-cancer
Simon B, Lee SJ, Partridge AH, et al: Preserving fertility after cancer. CA: A Cancer Journal for Clinicians 55:211-28; quiz 263-4, 2005