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Sperm Banking

Created: 7/12/2008


Sperm Banking

Sperm Cryopreservation

• Semen is frozen and stored in liquid nitrogen
• Can be thawed in the future and used in assisted reproduction techniques
• Can help men who may be undergoing chemotherapy or radiotherapy which could result in a reduction or loss of testicular function
• There will often be a local/regional Assisted Reproduction Unit (eg. South West Centre for Reproductive Medicine – Derriford)
• Funded by the PCTs
• Costs may vary

Practical points

• Patients diagnosed with testicular cancer are counselled by doctor/uro-oncology nurse specialist about sperm banking
• Semen collection can be performed before or after radical orchidectomy (before any other therapy)
• All patients need to sign a written consent form
• Abstain for 2-4 days
• Multiple samples are preferred (if possible)
• Initial sperm analysis performed
• Semen is cryopreserved if suitable

Cryopreservation and testicular cancer

Infertility is a major issue for testicular cancer survivors:

  • Patients are often young at diagnosis
  • High cure rate
  • Good prognosis following treatment

Abnormal semen analyses in more than 50% at the time of diagnosis

Possible causes include:

  • Common risk factors such as cryptorchidism
  • Hormone production by tumour
  • Antisperm antibodies
  • Contralateral malignancy or in situ carcinoma
  • Psychological stress associated with the diagnosis

Unilateral orchidectomy does not appear to cause infertility

Factors affecting fertility post therapy

  • Chemotherapy
  • Radiotherapy
  • Retroperitoneal lymph node dissection
    • Retrograde ejaculation
    • Dry ejaculation
  • Nearly 100% of patients become azoospermic during and immediately after cisplatin chemotherapy
    • Approx. 50% of patients regain normal sperm counts within 2 years from treatment
    • This proportion may increase to as high as 80% within 5 years

Brydøy M, Fosså SD, Klepp O, Bremnes RM, Wist EA, Wentzel-Larsen T, Dahl O.
Paternity following treatment for testicular cancer.
J Natl Cancer Inst. 2005 Nov 2;97(21):1580-8

BACKGROUND: Studies of fertility in men treated for testicular cancer have mainly addressed serum follicle-stimulating hormone levels and sperm parameters. We assessed post-treatment paternity among long-term survivors of testicular cancer.

METHODS: Men (n = 1814) who had been treated for unilateral testicular cancer in Norway during 1980 through 1994 were invited to participate in a national multi-center follow-up survey in 1998 through 2002. The participants were allocated to five groups according to the treatment received after orchiectomy, including treatment at relapse (surveillance, retroperitoneal lymph node dissection, radiotherapy, low-dose chemotherapy [i.e., < or = 850 mg cisplatin], and high-dose chemotherapy [i.e., > 850 mg cisplatin]). Cox proportional hazards analysis was used to assess predictive factors for post-treatment paternity. Statistical tests were two-sided.

RESULTS: A total of 1433 men were assessable, of whom 827 were fathers at diagnosis. Post-treatment conception was attempted by 554 men, among whom the overall 15-year actuarial post-treatment paternity rate was 71% (95% confidence interval [CI] = 66% to 75%) without the use of cryopreserved semen. This rate ranged from 48% (95% CI = 30% to 69%) in the high-dose chemotherapy group to 92% (95% CI = 78% to 98%) in the surveillance group (P < .001). The median actuarial time from diagnosis to the birth of the first child after treatment was 6.6 years overall but varied according to treatment. Assisted reproductive technologies were used by 22% of the couples who attempted conception after treatment. Dry ejaculation, treatment group, pretreatment fatherhood, and marital status were statistically significant independent predictors for post-treatment fatherhood, with dry ejaculation as the most important negative factor.

CONCLUSIONS: Although the overall paternity rate after treatment for testicular cancer was high, the ability to conceive and the time to conception reflected the intensity of treatment. These data may help inform patients about their future ability to father biological children.

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