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COSA guidelines for fertility preservation for people with cancer
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Sperm cryopreservation

Sperm cryopreservation

Sperm cryopreservation

Clinical Question

Does the use of cryopreserved sperm from men with cancer result in pregnancy and live birth? Is there any evidence of complications?

It is well established that in men and boys with cancer the use of chemotherapeutic agents and irradiation to the pelvis has the potential to damage spermatogenesis.[1] An estimated 15% to 30% of men with a history of cancer during childhood and adolescence will have a zero sperm count (azoospermia) as a result of cancer treatments.[2] An individual patient’s fertility outcome is highly dependent on the type and extent of the tumour as well as the type of chemotherapy or radiotherapy regimen.[3]

Semen quality is commonly decreased in young men with cancer, even before treatment starts.[4] Hodgkin disease is associated with poor sperm quality and increased sperm DNA damage prior to cancer therapy,[5] and men with testicular cancer are more likely to have impaired sperm production and a history of undescended testes.[6]

The most widely available procedure for post-pubertal men able to ejaculate is cryopreservation of ejaculated sperm. Current assisted reproduction techniques permit fertility even with very poor semen quality, especially the intracytoplasmic sperm injection technique that requires only a single viable sperm per oocyte.[7][8][9] Therefore, any sample containing viable sperm, even if extremely few in number, should be cryopreserved.

Cryopreservation of sperm is recommended before cancer treatment starts to avoid increased sperm aneuploidy rates and sperm DNA damage which may result from chemotherapy or radiotherapy.[10] Despite the likelihood of decreased sperm quality in cancer patients there is some evidence to suggest that the live birth rate from using cryopreserved sperm and assisted reproductive technologies is at least comparable to that of the non-cancer population.[11][12]

Evidence summary

Evidence summaryLevelReferences
Cryopreservation of semen (or testicular sperm) prior to cancer therapy is associated with a high chance of successful conception in the partners of men living with a history of cancer.III-2, IV[11], [12]

Recommendation

Evidence-based recommendationGrade
It is essential to counsel post-pubertal adolescents and adult men about the potential impact of their cancer treatment on their future fertility, and to provide an opportunity to freeze semen samples (ideally multiple) before cancer treatment.C

Good practice point

Practice point
Screening of patients with cancer for infectious diseases concurrently with sperm cryopreservation is encouraged. Suggested blood tests: HIV 1&2 Abs, Hep B sAg, Hep B cAb, Hep C Ab, Syphilis Ab, CMV IgM & IgG Ab, HTLV 1&2 Abs. Suggested urine PCR tests: Chlamydia, Gonorrhoea, Mycoplasma genitalium​.

References

  1. Hart R. Preservation of fertility in adults and children diagnosed with cancer. BMJ 2008 Oct 27;337:a2045 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18955375.
  2. Schrader M, Heicappell R, Müller M, Straub B, Miller K. Impact of chemotherapy on male fertility. Onkologie 2001 Aug;24(4):326-30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11574759.
  3. Meistrich ML, Vassilopoulou-Sellin R, Lipshultz LI. Gonadal Dysfunction. In: DeVita VT, Hellman S, Rosenberg SA editors. Cancer: Principles and Practice of Oncology. Vol. 7. 2005;Philadelphia: Lippincott Williams & Wilkins. p. 2560-2574.
  4. Agarwal MM, Khandelwal N, Mandal AK, Rana SV, Gupta V, Chandra Mohan V, et al. Factors affecting bone mineral density in patients with prostate carcinoma before and after orchidectomy. Cancer 2005 May 15;103(10):2042-52 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15830347.
  5. O'Flaherty C, Vaisheva F, Hales BF, Chan P, Robaire B. Characterization of sperm chromatin quality in testicular cancer and Hodgkin's lymphoma patients prior to chemotherapy. Hum Reprod 2008 May;23(5):1044-52 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18346994.
  6. Skakkebaek NE, Rajpert-De Meyts E, Main KM. Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects. Hum Reprod 2001 May;16(5):972-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11331648.
  7. Botchan A, Karpol S, Lehavi O, Paz G, Kleiman SE, Yogev L, et al. Preservation of sperm of cancer patients: extent of use and pregnancy outcome in a tertiary infertility center. Asian J Androl 2013 May;15(3):382-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23524529.
  8. Kelleher S, Wishart SM, Liu PY, Turner L, Di Pierro I, Conway AJ, et al. Long-term outcomes of elective human sperm cryostorage. Hum Reprod 2001 Dec;16(12):2632-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11726587.
  9. Muller I, Oude Ophuis RJ, Broekmans FJ, Lock TM. Semen cryopreservation and usage rate for assisted reproductive technology in 898 men with cancer. Reprod Biomed Online 2016 Feb;32(2):147-53 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26687904.
  10. Chung JP, Haines CJ, Kong GW. Sperm cryopreservation for Chinese male cancer patients: a 17-year retrospective analysis in an assisted reproductive unit in Hong Kong. Hong Kong Med J 2013 Dec;19(6):525-30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24141859.
  11. García A, Herrero MB, Holzer H, Tulandi T, Chan P. Assisted reproductive outcomes of male cancer survivors. J Cancer Surviv 2015 Jun;9(2):208-14 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25272983.
  12. Meseguer M, Molina N, García-Velasco JA, Remohí J, Pellicer A, Garrido N. Sperm cryopreservation in oncological patients: a 14-year follow-up study. Fertil Steril 2006 Mar;85(3):640-5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16500332.

Body of evidence

In male cancer patients does the use of cryopreserved sperm result in pregnancy and live birth? Is there any evidence of complications? Is it better to cryopreserve sperm before cancer treatment?

CitationLevel of EvidenceQuality of EvidenceSize of EffectNumber of PatientsRelevance of Evidence
Botchan A, Karpol S, Lehavi O, Paz G, Kleiman SE, Yogev L, et al. Preservation of sperm of cancer patients: extent of use and pregnancy outcome in a tertiary infertility center. Asian J Androl 2013 May;15(3):382-6 Available from:http://www.ncbi.nlm.nih.gov/pubmed/23524529IVLow56826
Chung JP, Haines CJ, Kong GW. Sperm cryopreservation for Chinese male cancer patients: a 17-year retrospective analysis in an assisted reproductive unit in Hong Kong. Hong Kong Med J 2013 Dec;19(6):525-30 Available from:http://www.ncbi.nlm.nih.gov/pubmed/24141859IVLowN/A1306
Crha I, Ventruba P, Zakova J, Huser M, Kubesova B, Hudecek R, et al. Survival and infertility treatment in male cancer patients after sperm banking. Fertil Steril 2009 Jun;91(6):2344-8 Available from:http://www.ncbi.nlm.nih.gov/pubmed/18554588IVLow56191
Freour T, Mirallie S, Jean M, Barriere P. Sperm banking and assisted reproductive outcome in men with cancer: a 10 years' experience. Int J Clin Oncol 2012 Dec;17(6):598-603 Available from:http://www.ncbi.nlm.nih.gov/pubmed/21979750IVLow5822
García A, Herrero MB, Holzer H, Tulandi T, Chan P. Assisted reproductive outcomes of male cancer survivors. J Cancer Surviv 2015 Jun;9(2):208-14 Available from:http://www.ncbi.nlm.nih.gov/pubmed/25272983III-2Low32722
Gilbert K, Nangia AK, Dupree JM, Smith JF, Mehta A. Fertility preservation for men with testicular cancer: Is sperm cryopreservation cost effective in the era of assisted reproductive technology? Urol Oncol 2018 Mar;36(3):92.e1-92.e9 Available from:http://www.ncbi.nlm.nih.gov/pubmed/29169844III-2MediumN/A1,0391
Hourvitz A, Goldschlag DE, Davis OK, Gosden LV, Palermo GD, Rosenwaks Z. Intracytoplasmic sperm injection (ICSI) using cryopreserved sperm from men with malignant neoplasm yields high pregnancy rates. Fertil Steril 2008 Sep;90(3):557-63 Available from:http://www.ncbi.nlm.nih.gov/pubmed/18692822IVLow51182
Kelleher S, Wishart SM, Liu PY, Turner L, Di Pierro I, Conway AJ, et al. Long-term outcomes of elective human sperm cryostorage. Hum Reprod 2001 Dec;16(12):2632-9 Available from:http://www.ncbi.nlm.nih.gov/pubmed/11726587IVLow58332
Lass A, Akagbosu F, Abusheikha N, Hassouneh M, Blayney M, Avery S, et al. A programme of semen cryopreservation for patients with malignant disease in a tertiary infertility centre: lessons from 8 years' experience. Hum Reprod 1998 Nov;13(11):3256-61 Available from:http://www.ncbi.nlm.nih.gov/pubmed/9853891IVLow52312
Meseguer M, Molina N, García-Velasco JA, Remohí J, Pellicer A, Garrido N. Sperm cryopreservation in oncological patients: a 14-year follow-up study. Fertil Steril 2006 Mar;85(3):640-5 Available from:http://www.ncbi.nlm.nih.gov/pubmed/16500332IVLow51862
Muller I, Oude Ophuis RJ, Broekmans FJ, Lock TM. Semen cryopreservation and usage rate for assisted reproductive technology in 898 men with cancer. Reprod Biomed Online 2016 Feb;32(2):147-53 Available from:http://www.ncbi.nlm.nih.gov/pubmed/26687904IVLow1898N/A
Neal MS, Nagel K, Duckworth J, Bissessar H, Fischer MA, Portwine C, et al. Effectiveness of sperm banking in adolescents and young adults with cancer: a regional experience. Cancer 2007 Sep 1;110(5):1125-9 Available from:http://www.ncbi.nlm.nih.gov/pubmed/17647219IVLow58211
Sanger WG, Olson JH, Sherman JK. Semen cryobanking for men with cancer--criteria change. Fertil Steril 1992 Nov;58(5):1024-7 Available from:http://www.ncbi.nlm.nih.gov/pubmed/1426353IVLow51171
Záková J, Lousová E, Ventruba P, Crha I, Pochopová H, Vinklárková J, et al. Sperm cryopreservation before testicular cancer treatment and its subsequent utilization for the treatment of infertility. ScientificWorldJournal 2014;2014:575978 Available from:http://www.ncbi.nlm.nih.gov/pubmed/24587730IVLow55572