Fertility Preservation – Why Is It Needed In Young Adult Males?
According to latest statistics reported by US Surveillance, Epidemiology, and End Results Program (SEER) – a project of NIH, investigators suggested that more than 180,890 American men will be diagnosed with prostate cancer and more than 8,720 males will develop testicular malignancy in the year 2016. Fortunately, with advancements in science and technology, more cancers are detected and treated at an earlier stage. For example, based on latest available data, 2.9 million Americans are currently living a heathy life after undergoing therapy for prostate malignancy.
However, it is a no brainer than malignancy of prostate and testicles (as well as antineoplastic therapies for other cancers) are very strongly linked to a higher risk of developing infertility in men.
How Does A Malignant Process Affect Fertility In Men?
Research and clinical data indicates that an active malignant process involving a genital tissue (or cancer treatment) can affect future male fertility in a number of ways. For example:
- In some cases, malignant process itself damages/ destroys the viable tissue that is actively involved in the production of sperms.
- Most cancer treatments (such as resection of tumor, radiotherapy, chemotherapy, freezing techniques) etc. can compromise the potential of genital tissues to produce healthy and viable sperms. For example, almost all cancer treatment therapies exert their action by killing actively growing cells (mostly cancer cells). In this process, sometimes normal cells (that lines testicular tubules) may also get affected; thereby causing infertility.
Infertility, secondary to a malignant process or treatment can be transient (lasting for a period of up to 5 years after the completion of treatment) or permanent (lifelong infertility).
Although it is likely that preservation of fertility may not be a major concern at the time of diagnosis (or during treatment process), but healthcare professionals can take measures to alleviate the risk of fertility related complications. It is imperative to mention that some males are still capable of fathering their children despite poor/ low quality sperms.
What Are Some Risk Factors That Are Negatively Associated With Fertility In Cancer Survivors?
Following risk factors are suggestive of poor fertility (transient or permanent) in men suffering from cancer:
- Advanced testicular or prostate malignancy
- Complete removal of testicles (orchidectomy)
- Combination therapy (local radiotherapy in addition to chemotherapy/ surgery)
- Pelvic surgery (for the malignancy of testicles, prostate colon or bladder) is associated with worse prognosis as surgical process may cause irreversible damage to vital nerves that are responsible for erection or ejaculation.
- Other malignancies near testicular tissue
- Full body radiation therapy (especially for the management of cancers of head & neck region) is also associated with fertility issues due to damage to vital glands that are responsible for secreting vital hormones. Experts recommend strict birth control for at least 6-12 months post-radiation therapy as ionizing radiations can aggravate the risk of mutations in sperm cells.
What Are Some Factors That Are Positively Associated With Fertility In Cancer Survivors?
The capacity to produce viable sperms are high if:
- The malignant process is localized (tumor is small in size or diagnosed at an early stage)
- Cancer involving one testicles only (as the normal testicles can function in an orderly manner to secrete testosterone for the maintenance of fertility).
Fertility Preservation – What Are Some Techniques?
The decision to preserve fertility should be taken before initiating the therapy. There are several benefits of this approach, regardless of the nature of surgery/ treatment. For example, if after therapy, your sperm count/ quality deteriorate, you can always rely on the stored samples to have children of your own.
Here are most recommended and promising fertility preservation techniques:
- Sperm storage
- Semen storage
Several samples of semen are collected from the patient (prior to chemo/ radiation therapy) via masturbation. These sperm samples are then stored at a freezing temperature (-196˚C in liquid nitrogen) for months or even years. Once needed, the sample can be used for specialized assistive reproductive techniques like IVF (in-vitro fertilization).
In a small group of males, collection of sample via masturbation is not possible for a number of reasons. All such individuals are an ideal candidate for small testicular biopsy (a microinvasive procedure that aims to collect a sample of tissue with sperms).
Speak to your healthcare professional if you have any questions or concerns regarding the procedure.
References:
1. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics
2. Loren, A. W., Mangu, P. B., Beck, L. N., Brennan, L., Magdalinski, A. J., Partridge, A. H., … & Oktay, K. (2013). Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology, 31(19), 2500-2510.
3. Tran, S., Boissier, R., Perrin, J., Karsenty, G., & Lechevallier, E. (2015). Review of the Different Treatments and Management for Prostate Cancer and Fertility. Urology, 86(5), 936-941.