DO MEN UNDERGOING STERILIZING CANCER TREATMENTS HAVE A FERTILE FUTURE

This study was designed to assess the effect of cancer treatments on t he natural and assisted reproductive potential of men. A cohort of men with cancer, in whom radiotherapy and/or chemotherapy was planned, we re invited to participate, Twenty-two pre- and post-treatment semen sa mples were analysed. The reproductive potential of participants was as sessed with respect to the current range of fertility treatment option s available. Abnormal sperm concentrations were found in 27% of patien ts pretreatment compared to 68% post-treatment following a mean latenc y of 20 months from treatment. Fifty-nine percent of patients experien ced a clinically significant decrease in sperm, concentration followin g radiotherapy and/or chemotherapy; 23% developed azoospermia followin g treatment. Eighty-two percent of patients with testicular malignancy had oligo- or azoospermia post-treatment. Only one patient had a clin ically significant reduction in the percentage of motile spermatozoa p ost-treatment, Cryopreservation of semen prior to treatment improved t he fertility prospects of 55% of patients. Intracytoplasmic sperm inje ction (ICSI) enhanced the fertility prospects of a further 14%. In the absence of, or after depletion of, cryopreserved semen, ICSI could en hance the fertility prospects of 45% of patients, Fertilization has be en achieved by ICSI using spermatozoa retrieved by testicular biopsy f rom an azoospermic testicular cancer survivor 8 years after chemothera py, It was concluded that chemotherapy and/or radiotherapy may depress semen concentration to the extent of rendering a man infertile, The s everity of the reduction in sperm concentration following treatment is unpredictable but likely to be most severe in those with testicular m alignancy and those treated with radiotherapy or alkylating chemothera py agents. Not all men are keen to undergo an appraisal of their post- treatment fertility potential, for reasons which are unclear. Improvin g awareness and education of patients concerning the effects of both c ancer and cancer treatments on reproductive potential is essential. Wi th the advent of ICSI, it is possible to offer a very reasonable chanc e of conception in all men with cancer who present for cryopreservatio n of semen prior to treatment in whom spermatozoa (even in very low co ncentrations) are present in the ejaculate.