EFFECT OF CRYOPRESERVATION ON SEMEN QUALITY IN PATIENTS WITH TESTICULAR CANCER

Objectives. Current techniques in cryopreservation of human semen subs tantially decrease sperm quality. In addition, the pregnancy rate usin g cryopreserved sperm obtained from testicular cancer patients is lowe r than when sperm from normal fertile men is used. However, it is stil l unclear whether cryopreserved sperm from these patients is inherentl y defective or if the sperm loses its motility after thawing. This stu dy was undertaken to assess the effect of cryopreservation on the qual ity and motion characteristics of semen from patients with testicular cancer before definitive therapy compared with semen from normal volun teers. Methods. We compared the sperm quality before and after cryopre servation in samples from 34 patients with testicular cancer and 30 no rmal volunteers who were referred for sperm banking over a 7-year peri od. The effects of cancer stage and histologic type on various semen p arameters were also examined. A computer-assisted semen analysis was p erformed before and after cryopreservation on each specimen. The nitro gen vapor technique using Test yolk buffer with glycerol as a cryoprot ective agent was used for cryopreservation. The motile sperm count and motion characteristics (motility, velocity, linearity, amplitude of t he lateral head movement, motility index) were analyzed before and aft er cryopreservation and compared between the groups. Results. Semen qu ality did not significantly differ among patients with Stage I, II, or III cancer. However, semen duality tended to be poorer at higher canc er stages. In general, semen duality was better among patients with pu re seminomas than with pure embryonal tumors; quality was worst among patients with mixed germ cell tumors. However, 71.4% of patients with mixed tumors presented with Stage III disease, whereas all patients wi th seminomas presented with Stage I disease. Significant differences w ere also seen in prefreeze motility (median, 42% [interquartile range, 24 to 51] versus 60.5% [range, 49 to 73]; P = 0.0004) and motile sper m count (6.7 x 10(6)/ml [range, 3.4 to 14.4] versus 50.0 [range, 24.6 to 72.0]; P = 0.0001) in patients compared with controls, respectively . The motile sperm count and percent motility significantly decreased in both patients and controls after cryopreservation (P = 0.0001). How ever, the percentage decline in motile sperm count and motion characte ristics after cryopreservation did not differ significantly between pa tients and controls (P > 0.01). Conclusions. We conclude that the effe ct of cryopreservation on sperm quality in patients with testicular ca ncer is identical to its effect on sperm from normal fertile men. Diff erences in values after preservation are explained by poor semen chara cteristics before freezing; semen duality declines with more extensive disease. Stage I patients also had poorer quality than control subjec ts. Thus, we recommend that routine sperm banking be encouraged among all patients with testicular cancer before the initiation of specific medical treatment. We also recommend that future efforts be focused on improving the technique of sperm banking.