What Fertility Preservation Options do Men Have before Starting Cancer Treatment?

The cancer survival rates nowadays are much better as compared to a decade ago. The survival rates even for childhood cancers are increasing. It is important that patients are aware of their fertility preservation options.

If you have not completed your family, then you should be offered an opportunity to discuss fertility preservation options. In men, the fertility preservation is much simpler compared to women. But, it can be challenging in the case of pre-pubertal boys.

In this post, I am discussing the various aspects around male fertility preservation for recently diagnosed cancer patients who are yet to complete their family.

How does cancer treatments affect male fertility?

There is a toxic effect of the chemotherapy drugs on the testes. The cells in the testes divide fast so they are at a particular risk of being affected by cancer treatments. These drugs try and stop the cancer cells from dividing and hence can affect the other cells in the body such as the germ cells that develop into sperms.

The effect depends on the type of the chemo drugs. It also depends on whether only one or many agents have been used. This is dependent on the kind and extent of cancer; and sensitivity of the cancer cells. Small amounts of radiation can lead to low sperm count.

High doses of radiation can result in testicular failure and permanent male infertility. If both the chemo drugs and radiation are used for cancer treatment, then the effect may be much more than what it would be if only one mode of treatment were used.

What is the process for fertility preservation for men?

Your oncologist or the specialist nurse in the cancer services may offer you an option of freezing your sperms. If you have not been offered an opportunity, and you have not completed your family, then you should not hesitate in discussing this with your cancer specialist.

Once you have agreed to see a fertility specialist, the NHS will fund the freezing of the sample for an initial period. All men diagnosed with cancer and at risk of being infertile in the long term can freeze sperms for a total of 55 years. While the NHS may fund the first storage, it may not continue to do so for prolonged periods of storage.

On the day of your appointment to a fertility clinic, you may be seen by a fertility specialist or an embryologist. You will be given all the relevant information before you consent to freeze and store your sperms. The sample is produced by masturbation. If this is not acceptable, then please discuss with the staff at the fertility clinic.

You may have to visit the fertility clinic more than once depending on your semen analysis. You will also have to do the mandatory infection screening for HIV, Hepatitis B and hepatitis C before producing any sample. Also, there may be other tests that will depend on your assessment.

What options do adolescent and pre-pubertal boys have for fertility preservation?

Most teenage boys can produce the sample by masturbation. If you can’t provide the sample, you may consider freezing some part of the testicular tissue as part of fertility preservation. This is still experimental. There are many challenges yet to be overcome in restoring male fertility from frozen testicular tissue in pre-pubertal boys.

Once the cancer is cured and you are ready to start a family, then you can see your fertility specialist. This may be all too much to take when you are still trying to come to terms with the new cancer diagnosis. In this case, you can decide against fertility preservation. Upon completion of the cancer treatment, you may do the male fertility tests.

The group where the options are limited is the pre-pubertal boys. They cannot produce semen for freezing. So, their only option would be to freeze testicular tissue for the eventual restoration of the sperm production.

Many years later after the cancer treatment has been completed and you are thinking of starting a family, an attempt will be made to transplant the spermatogonial stem cells to the testis.

As mentioned earlier, it is still experimental. There are challenges to overcome in using these few extracted spermatogonial stem cells (SSC) to restore natural sperm production upon transplantation. The other challenge when transplanting the spermatogonial stem cells back is to ensure that these cells are free of the cancer cells.

What other consideration I should bear in mind?

When considering fertility preservation before your cancer treatment, you are taking a lot of complex information in a short period. It is also an emotionally difficult time. So, you may not be able to take on board all that has been discussed.

When preserving fertility, the sperms or testicular tissue can be stored for a total of fifty-five years according to the HFEA. The storage period is extended every ten years and has to be certified by the fertility specialist or the lead consultant. When the storage period is coming to an end, your fertility clinic will contact you.

You will have to complete the relevant consent forms to extend the storage of the sperms or testicular tissue. You may have to pay for the continued sperm storage if the NHS funding does not exist.

The NHS funding for continued sperm storage differs much from postcode to postcode. Therefore, it is important that you keep your contact details up to date. This will ensure the continued storage of the sperms or testicular tissue.

If you do not respond to the repeated attempts by your fertility clinic to contact you, then your fertility clinic will not be able to maintain the ongoing storage of the frozen sperms or testicular tissue once the current consent has expired or the payment for the storage has not been received.

What if I have recovered from cancer and wish to start a family?

You recovered from cancer and you wish to start a family. Now is the time to get in touch with the fertility clinic where your samples are stored. If you have moved out of the area, you can think of moving the samples to a nearby clinic which may provide similar facilities.

Otherwise, your fertility specialist will discuss your best available fertility treatment options. This will include assessing restoration of natural male fertility.

If using frozen sperms, then you and your partner may consider insemination, IVF or ICSI, as advised by your fertility specialist. If you have testicular tissue, then your fertility specialist will discuss the latest developments regarding how to use the tissue, if clinically possible.