As more adolescents and young adults survive an initial cancer diagnosis, fertility preservation has become an important topic of discussion for clinicians and young patients. An estimated 80 percent of teens and young adults diagnosed with cancer today will achieve long-term remission; this improvement in prognoses is often due to chemotherapy, radiation and surgical procedures.
Although cancer treatment can be extremely effective, it can also have a lasting impact on fertility. While many clinicians are aware of the fertility preservation options afforded to their young female cancer patients, providers should also be informed of the options for young men diagnosed with cancer to plan their future families.
The Importance of Male Fertility Counseling
The toxic effects of many cancer treatments on female and male fertility have led the American Society of Clinical Oncology (ASCO) to publish guidelines highlighting the need for counseling on this topic, notes the Journal of Clinical Oncology. Despite these recommendations, a large number of adolescent and young adult men do not receive proper guidance on fertility preservation from health professionals prior to treatment. This leaves many young male survivors of testicular cancer, Hodgkin's lymphoma and other diseases without the knowledge to make informed decisions about their care.
While fertility effects are a major concern for 80 percent of clinicians, only about two-thirds of these providers routinely refer their male patients to a fertility preservation specialist before cancer treatment, according to Acta Biomedica. After treatment, young cancer survivors can face significant distress over being unable to have children. It is critical for clinicians to discuss fertility options sooner rather than later.
Using Sperm Cryopreservation for Male Fertility Preservation
While the fertility preservation options prior to cancer treatment depend on the patient's age, health, and whether or not they have entered puberty, one established method to consider is cryopreservation.
For adolescent males who have already begun puberty, cryopreservation of sperm remains the most effective approach to male fertility preservation. This inexpensive and noninvasive method involves the patient providing ejaculated sperm, which is then cryopreserved. Clinicians can later use this sperm for intrauterine insemination (occasionally aided by ultrasound guidance) or in vitro fertilization in a female partner or gestational carrier.
Tissue Banking and Implantation
For males who haven't entered puberty, the fertility preservation options are limited. However, testicular tissue banking is an experimental method that may be an option for adolescent boys, as well as young men who are unable to provide sperm for cryopreservation.
In testicular tissue banking, clinicians remove tissue containing spermatogonial stem cells through a small incision in the testicles. The tissue is then frozen and stored. After seeing some success in animal studies, researchers believe this tissue can be used to produce sperm once it is thawed and transplanted back into the seminiferous tubules of the patient's testicles using ultrasound guidance. Research published in the journal Human Reproduction suggests tissue banking and ultrasound-guided implantation into the testicles is a viable option for boys who choose to undergo fertility preservation before age 16.
Testicular ultrasound can be a valuable tool in evaluating the prostate and testes before and after any fertility preservation procedures are carried out. Ultrasound can also help clinicians assess whether the testicles are growing normally in the months and years after a biopsy for tissue banking.
When counseling young male cancer patients and their families, physicians should include a discussion of pre-treatment fertility preservation. Both standard and experimental approaches can help preserve male fertility and are enhanced by the use of ultrasound technology.
