Survey of Long-Term Experiences of Sperm Cryopreservation in Oncological and Non-Oncological Patients: Usage and Reproductive Outcomes of a Large Monocentric Cohort.

Ulrich Keller,Ivan Jelas,Philipp Le Coutre,Lars Bullinger,Sebastian Stintzing,Nadine Lackamp,Ina Wilkemeyer

doi:10.3389/fonc.2021.772809

Abstract

Progress in oncological treatment has led to an improved long-term survival of young male cancer patients over the last decades. However, standard cancer treatments frequently implicate fertility-damaging potential. Cryopreservation of sperm is the current standard option to preserve patient’s fertility after treatment, yet long-term data on usage and reproductive experiences is still limited. Natural fertility after treatment and especially in relation to the type of treatment has been poorly analyzed so far. Therefore, we performed a retrospective survey including male patients with an indication for gonadotoxic treatment who cryopreserved reproductive material at our institution between 1994 and 2017. Study questionnaires regarding treatment, material usage, and reproductive outcomes were sent to eligible patients. Additionally, semen analyses of study participants from the time of cryopreservation were evaluated. A total of 99 patients were included in the study. Respondents’ median age was 38.0 years. Most frequent diagnoses were testicular cancer (29.3%) and lymphoma (26.3%). A further 8.1% suffered from autoimmune diseases. Testicular cancer patients had a significantly lower pre-treatment median sperm concentration (18.0 million/ml) compared to non-testicular cancer patients (54.2 million/ml). Until November 2020, the determined sperm usage and cumulative live-birth rate per couple were 17.2% and 58.8%, respectively. Most sperm users received treatments with high (40.0%) or intermediate (33.3%) gonadotoxic potential. 20.7% of all patients reported to had fathered at least one naturally conceived child after treatment, this being the case especially if they had been treated with less or potentially gonadotoxic therapies. In conclusion, our findings emphasize the importance of sperm cryopreservation in the context of male fertility preservation. Furthermore, they indicate that the gonadotoxic potential of patients’ treatments could represent a predictive factor for sperm usage.

Highlights

Due to advances in both oncological diagnosis and treatment, over the last few decades the long-term survival of young male cancer patients has significantly improved
Fertility can be reduced after gonadal surgeries, such as the radical inguinal orchiectomy, which is the mainstay of treatment for testicular cancer patients
A study-specific questionnaire was developed by the researchers including the following questions: sociodemographic characteristics, questions related to diagnosis and treatment, questions concerning the cryopreservation, questions about usage of stored material, and questions regarding family and children [marital status, number of children, characteristics of children]

Summary

Introduction

Due to advances in both oncological diagnosis and treatment, over the last few decades the long-term survival of young male cancer patients has significantly improved. Several studies have shown reduced semen quality in some cancer patients even prior to the initiation of their treatment. This impairment of spermatogenesis, induced by the malignancies themselves, especially applies to patients with testicular cancer, the most frequently diagnosed cancer type in young men [1,2,3]. Various cancer treatments cause damage to spermatogenesis: Firstly, cytotoxic agents frequently compromise spermatogenesis, at least temporarily, and in some cases even induce permanent azoospermia. Fertility can be reduced after gonadal surgeries, such as the radical inguinal orchiectomy, which is the mainstay of treatment for testicular cancer patients. Several studies report adverse effects on semen parameters and hormonal functions after radical inguinal orchiectomies [6]

Objectives

Methods

Results

Conclusion