Safeguarding your sperm
Dr Lizle Oosthuizen expands on the current options of safeguarding sperm before testicular cancer treatment and answers beneficial questions.
All treatment (surgery, chemotherapy and radiation) can affect the ability of the testicle to produce sperm in the future. The options for sperm preservation depend on factors, such as age and current state of health, but time until treatment shouldn’t prevent access to options.
Cryopreservation of ejaculated sperm
The most common method for men and boys who have gone through puberty is to produce a sperm sample by masturbation. Although we recommend a period of 2-5 days between produced samples, they can be produced every day if time doesn’t allow. You should produce the samples before any treatment starts. Many clinics will allow you to produce the sample at home and transport it rapidly to the clinic for freezing.
How much ejaculated sperm should be stored?
Your fertility needs in the future can vary, so we need to be prepared for inseminations as a first-line treatment option, but also consider how many children you would like. Inseminations involve either naturally or medically assisting your partner to produce an egg, programming ovulation and inserting the sperm into the uterus via a small catheter at the time of ovulation. Inseminations aren’t a guarantee of pregnancy, so we recommend having enough sperm stored for multiple attempts.
We usually request 2-3 samples, but you’ll get feedback after each sample to let you know about the quality of the sample and how many straws were frozen. Straws are the devices that are used to store the sperm, and typically two straws will allow for one insemination attempt. We always comment on the quality as you may already have symptoms related to the diagnosis and the quality may be negatively affected.
What if I can’t produce a sperm sample?
There are multiple reasons for being unable to produce a sample. You may be on medication, or have pre-existing medical conditions that make this difficult. You may be suffering from anxiety or depression, or symptoms from cancer itself. Many young men may struggle to produce a sample by masturbation.
Always ensure a safe and comfortable environment to produce the sample. If this fails, there are medical methods to assist. Your doctor may prescribe medication used to treat erectile dysfunction in some cases. You can discuss options like vibratory stimulation and electroejaculation with your doctor to see if they’re possible.
Surgically extracted sperm
A testicular biopsy can be used to extract sperm if ejaculation isn’t possible, if the sperm sample is insufficient to freeze, or if there is no sperm seen in the ejaculate. More tests will be done to understand the chances of retrieving sperm this way, which include a physical examination and blood markers.
If testicular sperm is preserved, this will mean that future fertility attempts will require ICSI (the IVF process where sperm is injected into an egg), and not insemination. This is because the amount of sperm retrieved is less and usually not very motile.
The biopsy can be done under local anaesthetic or sedation, and doesn’t require admission to hospital.
Options for boys before puberty
Currently the only option is to freeze testicular tissue. The laboratory would check the sample to look for any sperm, and if present, they could freeze this like we would for a testicular biopsy in an older patient.
If no sperm is seen then the immature tissue could be frozen. There is currently no accepted and available option to use this tissue, so it would be stored in the anticipation of future technology that could use the tissue/sperm stem cells to produce sperm. Animal data does exist for this, but we haven’t yet advanced to being able to use this tissue in humans.
Important facts to consider
- There should always be a documented HIV, Hepatitis B and C, and syphilis test result when you store sperm.
- The clinic will bill you for the freezing of the sample, as well as an annual fee to store the sperm. Make sure you know what this is upfront.
- A difficult but important consideration is what should happen to the sperm/testicular tissue if anything should happen to you. Your clinic should advise you on planning a directive for what you would like to happen to the stored sample in the future.
- Shielding of the testicles can be requested during radiation. It doesn’t prevent all the radiation exposure, but can reduce the amount of exposure.
What if I already had treatment and didn’t preserve my fertility?
You need to see a fertility specialist and perform a sperm test. This will be the best way to see if you’re producing sperm. If there is no sperm then a physical examination and blood test will be done to see if a testicular biopsy is possible.
Where to start?
Ask your oncologist if there is a reproductive centre they work with to rapidly start the process of storing sperm. If not, find out about clinics in your area, and communicate to them that you’ve been diagnosed with cancer so the process should be expedited. You should be able to be assisted within a day and start the necessary tests and consultation to begin freezing sperm without unnecessary delays.
MEET THE EXPERT – Dr Lizle Oosthuizen
Dr Lizle Oosthuizen is a reproductive medicine specialist. She was part of the fellowship programme in reproductive medicine at UCT. She obtained her certification through the College of Medicine SA, as well as a masters in philosophy from UCT.