A PROGRAM OF SEMEN CRYOPRESERVATION FOR PATIENTS WITH MALIGNANT DISEASE IN A TERTIARY INFERTILITY CENTER - LESSONS FROM 8 YEARS EXPERIENCE

The improved survival in recent years of young males suffering from ca ncer, and an understanding of the gonadotoxic effects of chemotherapy treatment, have motivated patients and clinicians to preserve fertilit y potential before embarking on adjuvant therapy. Among 231 men (mean age 28.0; range 15-56 years) diagnosed with malignant disease and refe rred to our unit for semen cryopreservation, 112 patients (49.8%) had reduced sperm quality of <10 x 10(6) motile spermatozoa per ejaculate; however, most had sufficient suitable spermatozoa for freezing. In 40 patients (17.3%) the semen samples were not frozen because of complet e azoospermia (n = 32) or only immotile sperm in the ejaculate (n = 2) , while six men were unable to produce a single sample. Some 79 men ha d testicular tumours (group I), 121 suffered from haematological malig nancy (leukaemia or lymphoma; group II), and 27 had cancer of differen t causes (group III), Men in group I had significantly lower (P < 0.00 1) sperm quality compared with groups II and III. There was no differe nce between patients with seminoma and non-seminoma tumours, In the ha ematological malignancy group there was no difference in sperm paramet ers between leukaemia (n = 12) and lymphoma (n = 77) patients, but pat ients with Hodgkin's lymphoma had significantly lower sperm quality co mpared with non-Hodgkin's lymphoma. Following chemotherapy, six couple s attended the clinic for assisted conception treatment using the froz en semen. Two had successful intrauterine Insemination cycles which ea ch resulted in delivery of a healthy girl; one couple had conceived in their first in-vitro fertilization (IVF) attempt, followed by deliver y of healthy twins. Two women conceived after intracytoplasmic sperm i njection treatment and the sixth woman achieved only biochemical pregn ancy after numerous IVF and frozen embryo replacement cycles. We recom mend that a properly designed programme for semen cryopreservation for cancer patients should be developed in leading tertiary assisted conc eption centres, which have adequate facilities and experience for cryo preservation and can offer the whole range of appropriate assisted rep roductive treatment and counselling.