Fertility preservation in men with oncological diseases
Will I be a man again after cancer treatment?
We don't like to start our articles by asking a question, but this is a different case. This question is on the mind of every man and boy with newly diagnosed cancer. It's time to give them an answer. Yes, it is possible, BUT you have to distinguish between sperm production and sexual function.
Regarding the spermatozoids
Sperm cells are delicate and sensitive cells that are very likely to be affected by your treatment. Moreover, many men with active cancer, wherever it is, already have deterioration in some of the markers in the spermogram.
Radiation or chemotherapy can severely reduce sperm count and damage sperm morphology so that they become unfit for fertilization, even with the help of our in-vitro procedures.
Spermatogenesis (the formation of mature sperm) is a slow process that takes place in the seminiferous tubules of the testis. Before the functional spermatozoa are formed completed with head and tail like you have seen in the video, they are immobile round cells and go through various stages of development. Sperms at an earlier stage of development are easily damaged by ionizing radiation and cytostatics, such as chemotherapeutics. The resulting mature sperm, if any, are very oddly and irregularly shaped.
Yes, in rare cases there is a chance that the spermogram markers will return to normal after a while, but we recommend that you do not rely on this alone. Act with foresight, contact us immediately.
Not only will we freeze your still healthy sperm, but our biologists will advise you on how many frozen samples are needed to ensure your reproduction.
The procedure will be completely free of charge to you, and we will carry it out quickly, with no risk of delaying your treatment.
If you have any more questions, read on and give us a call.
Sexual function depends on testosterone levels, not sperm count. Testosterone is produced in other cells of the testicle called Leydig cells. These are more resistant and therefore less likely to be affected by therapy. However, it is still possible to have transient sexual disorders.
Radiotherapy to the head area can cause a sharp drop in male sex hormone levels. Ionizing radiation applied on the testicular area, as well as some chemotherapy drugs, can permanently damage Leydig cells, or cause them to produce a very small amount of testosterone. This is where we step in and give hormone therapy that will quickly and easily restore your sexual functions.
Oncological diseases in men
Treatment is determined by the stage of the disease. The surgery for removal of the tumor carries no risk to sperm and testosterone production. The most commonly used medicines during chemotherapy are 5-FU, capecitabine, and oxaliplatin. The first two medications are drugs with low gonadotoxic effects, but oxaliplatin poses a higher risk for damaging the sperm.
We recommend fertility preservation by freezing sperm prior to the start of therapy, before, or even after the surgery. This will keep your reproductive function for the future.
Operative treatment involves orchiectomy (removal of the testicle). Oncologists often recommend chemotherapy with cisplatin. This medication has a high toxicity to sperm, so we recommend that you preserve your fertility by freezing reproductive cells before or after testicular removal. Even in cases where chemotherapy is not part of comprehensive cancer treatment, removing one testicle reduces the amount of sperm produced by half and puts fertility at risk.
Treatment for prostate cancer depends on your age and the stage of the disease and can cause temporary or permanent loss of your reproductive abilities. Surgical treatment includes removal of the prostate gland and two small glands next to it – the seminal vesicles. After their removal, you will not be able to ejaculate (release semen). For these reasons, you should freeze sperm before therapy and before surgery.
Radiotherapy is used to destroy cancer cells in and around the prostate, and may be combined with surgical treatment, or carried out alone. With this treatment, it is possible to disrupt sperm and testosterone production.
Hormone therapy for this type of cancer is also one of the treatment options, whereby the production of testosterone is suppressed through medication. Prostate cancer cells growth is stimulated by testosterone, but suppressing it blocks sperm production. Therefore, it is necessary to take care in advance to preserve your reproductive ability and freeze sperm.
Urinary bladder cancer
In cases with cancer of the urinary bladder, surgical intervention is often associated with the removal of the prostate gland as well. The consequences of surgery and local radiotherapy and the risks to your sperm are the same as for prostate cancer.
Chemotherapy and immunotherapy regimens are different for the different types of this disease. However, we will say that they will damage or stop sperm production more or less. Medicines, such as cisplatin, permanently damage spermatogenesis. Our advice is to seek us out before you have started therapy.
Treatment involves surgical removal of one lobe, or the entire thyroid gland. The most common forms of the disease (papillary and follicular carcinoma) are often treated with radioactive iodine therapy. With this method, you will be treated with radioactive iodine (most commonly iodine-131), aimed at the complete destruction of residual cancer cells in the body. Usually the dose is small and causes transient negative effects on spermatogenesis. However, we recommend preserving fertility by freezing sperm before starting therapy. It is believed that prolonged administration of radioactive iodine may have a lasting negative effect on reproductive abilities.
Treatment of this type of solid malignancy involves chemotherapy with alkylating agents – the drugs with the highest gonadotoxic effect. Radiotherapy is also part of the treatment, but its damaging effects depend on the total radiation dose and the site under exposure. We recommend fertility sparing by freezing sperm before starting therapy.
Treatment is by surgery for the removal of the tumor formation and by medicines represented by BRAF and MEK inhibitors (dabrafenib/trametinib and vemurafenib/cobimetinib) as well as immunotherapy such as checkpoint inhibitors (pembrolizumab, nivolumab, ipilimumab). In medical literature, their gonadotoxic risk is defined as unknown. Although these therapies are considered to be relatively safe in terms of male fertility, preservation of reproductive ability by sperm freezing is an option that should not be excluded from a comprehensive treatment approach.
Hematological diseases (leukemia and lymphoma)
The treatment of these diseases includes various combinations of chemo-, radiation-, target therapy and in some cases high-dose chemotherapy with hematopoietic stem cell transplantation. These methods have different gonadotoxic risks, ranging from relatively low with targeted therapy to extremely high with high-dose chemotherapy. Fertility sparing through sperm freezing prior to therapy is recommended.
Frequently asked questions and common situations you may run into
I had an abnormal spermogram before being diagnosed with cancer. Can I preserve sperm?
Problems with the spermogram are another indication to seek fertility sparing even with treatment that is low or medium gonadotoxic risk. Our specialists will process the sperm and freeze them. If they judge that their quantity or quality is not satisfactory, they will advise you to ejaculate more material. Our biologists are very experienced and can preserve sperm in extremely poor spermogram parameters. Do not give up! Get in touch with us!
After diagnosed with the disease, I have had issues with the release of ejaculate. Can I preserve my fertility?
The easiest way to preserve fertility is to freeze semen obtained through masturbation. In cases where spontaneous ejaculate release is not possible, we switch to electrostimulation, microsurgical testicular sperm extraction (micro TESE) or microsurgical epididymal sperm aspiration (MESA).
Is there anything more I can do to preserve my fertility during treatment?
Our specialists will advise you and suggest supplement formulas to take during treatment. It is possible for sexual-function-related complaints to occur during the course of therapy. We also have a solution to these problems. Get in touch with us! We will help you!
How can I preserve my fertility?
It is enough to just call and share your problem with us. You will get a consultation the very next day. Cancer patients are examined on a priority basis, without the risk of delaying their treatment. If any questions arise regarding your therapy, we will seek the opinion of your treating physician or arrange a consultation with our oncologist/hematologist.
I already have children; I am only interested in the sexual function.
The two things are related, though separate. Let's just say, one never knows what will happen, and we will make sure that neither function suffers.
In conclusion, you guys have a tough road ahead of you, but we shall make it together, because the options offered by oncology science are growing every day, and we implement all new medical achievements in our practice.
We are the ones who will not only preserve your sperm, but also will take care of your quality of life – make sure that you are complete and have an easier road to your recovery. We believe in that!
What do you need to know?
Testosterone is needed for both sperm production and sexual function.
Freeze sperm cells before starting therapy, as their production is the first to drop down when you start treatment.
Usually testosterone restores its levels after therapy, but if it does not, there is another option – testosterone replacement therapy.
Surgical treatment with removal of one testicle in the case of malignancy or brain surgery near the hypothalamus/pituitary decreases a man's chances of producing enough sperm.
Radiotherapy in a man can affect Sertoli cells (the cells "helpers" in sperm production), and Leydig cells. The damage is manifested by azoospermia (lack of sperm in the ejaculate). A radiation dose > 20 Gy carries a high risk for damaging germinative cells (precursors of sperm), and a dose > 30 Gy has a negative impact on them and testosterone-producing cells as well.
The adverse effects of chemotherapy depend on the type of drug, its total dose, and the duration of drug treatment. The so-called alkylating medications, such as cyclophosphamide, ifosfamide, cisplatin, and others, carry the highest risk for sperm damage.
In the last few years, immunotherapy has significantly changed the course of some cancers. Its exact gonadotoxic effect for both women and men is still unknown. Although they are considered relatively safe in terms of fertility, there are studies showing that some medications could lead to reduced testosterone levels and deterioration of spermogram markers.
Fertility preservation options
In current practice, the following treatments are used to preserve fertility in men with cancer – sperm freezing, micro TESE and hormonal protection.
|Fertility preservation options|| |
Frequency of application and success rate of the approach
|Microsurgical testicular sperm extraction (micro TESE)||★★|
★★★ - most commonly used approach, highest success rate ★★ - less frequently used approach, lower success rate ★ - rarely used approach