Prof Thinus Kruger shares the fertility options males have when faced with a cancer diagnosis.
The diagnosis of cancer
When the diagnosis of cancer is made, it’s often a frightening experience for patients. It’s foreign territory for the patient but not for the medical staff involved. Sadly, at times the oncologist may overlook the fertility preservation aspect, as the focus at the time is to treat and cure the cancer.
Germ cells sensitive to chemotherapy and radiation
Chemotherapy and radiation with surgery are often involved in the treatment plan of these patients and can cause infertility.
The function of the testes is to produce testosterone and sperm. The Leydig cells that produce testosterone are fairly resistant to damage by cancer treatments1. Measuring morning semen testosterone and luteinizing hormone (LH) levels can assess Leydig cell function.
On the other hand, the germ cells, that produce sperm, are very sensitive to chemotherapy and radiation. Semen analysis is the gold standard for assessing the ability to produce sperm.
In males who are unable to provide semen, high follicle-stimulating hormone (FSH) levels and low inhibin (hormone) are associated with impaired spermatogenesis (development of mature sperm), often leading to the diagnosis of azoospermia (no sperm in semen).
Childhood cancer survivors
Childhood cancer survivors have a lower chance to be fertile than their healthy counterparts. Dependent on what type of chemotherapy or radiation they received, prognosis can be established regarding fertility. However, when they reach adulthood the semen analysis and testing of FSH and testosterone will assist the patient and medical practitioner to establish fertility potential.
No fertility-preserving options are available for pre-pubertal boys who are not yet producing sperm. Thereis great anticipation that new therapies will be available in the future. Many centres in the US have determined that it’s reasonable to preserve testicular tissue for young patients who are at high-risk of infertility and have no other options to preserve their fertility. Utilisation of cryopreserved (freezing) testicular stem cells for future transfer or for in vitro maturation represents exciting alternatives on the horizon2,3.
The option available to adult men is by freezing several sperm samples, in a reputable fertility facility, prior to chemotherapy, radiation or surgery.
With current technology, dependent on the concentration of the sperm in the sample, 1 semen sample can give up to 10 straws with the potential of 10 treatments in future. At our centre, we like at least two to three samples if possible. These can be given daily if the cancer treatment must be done on an emergency basis.
In cases where there is no sperm in the sample, a testicular sperm extraction (TESE) can be offered, and the sperm obtained must also be frozen. This is a very successful method.
Intra cytoplasmic sperm injection (ICSI) – where the selection and injection of a single sperm directly into an egg to fertilise – can be offered in future to these patients4.
Testicular shielding of patients during radiation of a tumour is important, if possible.
How successful is freezing of sperm?
This is a well-established technique and dependent on the quality of semen sample, artificial insemination (IUI) can be offered in future, or ICSI if the sample is not good. ICSI is always offered in cases where TESE had to be used to preserve fertility4.
It’s important to give a patient the option to freeze a semen sample at the time of diagnosing a malignant disease. One call to any fertility centre will bring the necessary help immediately to the patient and oncologist.
- Chemaitilly, W. and C.A. Sklar, Endocrine complications in long-term survivors of childhood cancers.Endocr Relat Cancer, 2010. 17(3): p. R141-59.
- Abram McBride J, Lipshultz LI.Male fertility preservation Curr Urol Rep.2018 May 17;19(7):49. doi: 10.1007/s11934-018-0803-2.
- Martinez F Update on fertility preservation Fertil Steril 2017,108,3, 407-415.
- What is ICSI and IUI ?- www.aevitas.co.za
MEET OUR EXPERT – Prof Thinus Kruger
Prof Thinus Kruger is the founder of Tygerberg Fertility Clinic, Stellenbosch University, the first IVF clinic in South Africa. He is also the co-founder and partner of Aevitas Fertility Clinic.
This article is sponsored by Ferring Pharmaceuticals in collaboration with SASREG. The content and opinions expressed are entirely the medical expert’s own work and not influenced by Ferring in any way. 2019/001a