WS8-3 - Fertility Preservation in Cancer Survivors(From the Male Infertility Clinic)

Abstract

After introduction of multidisciplinary treatments the cure rate of cancer patients of reproductive age improved dramatically. Thus, fertility preservation of these cancer survivors became an urgent issue today.There are two types of problems in those cancer survivors who are referred to the male infertility clinic. One is a male infertility patient due to the sexual dysfunction, and the other is a male infertility patient due to the failure of spermatogenesis.Sexual dysfunction (erectile dysfunction and mainly ejaculatory dysfunction like retrograde ejaculation) can be caused by a radical cystectomy, a retroperitoneal tumor resection, and a retroperitoneal lymph node dissection. In these patients testicular sperm extraction (TESE) combined with intracytoplasmic injection (ICSI) is used to overcome infertility.Failure of spermatogenesis is often encountered after chemotherapy (and/or radiotherapy) in leukemia, lymphoma, and sarcoma. It is ideal to cryopreserve sperm for future ICSI before starting treatment. However, still many patients undergo treatment without this. Although cancer survivors had no frozen sperm and proved azoospermia, they can obtain sperm by a meticulous microdissection TESE (MD-TESE). And these testicular sperm can be used for ICSI.The unsettled problem is fertility preservation in childhood cancer survivors who had been treated before starting spermatogenesis. We have started animal experiments for cryopreservation of juvenile testicular tissue and induction of spermatogenesis in vitro. In this workshop the most recent data of fertilizing ability of these sperm cells and a possible clinical implication are to be mentioned.