Sperm cryopreservation for male patients with cancer: an epidemiological analysis at the University of Pennsylvania

Many cancers strike young males who have not yet started or completed families. Since cancer treatments such as chemotherapy and radiation can irreversibly affect spermatogenesis, sperm cryopreservation is an important option for storing male reproductive potential. In this report, we review our database of 10 years of experience with cryostorage for male cancer patients. We assess types of cancer, timing of collection, sperm quality, and utilization for reproductive purposes. We also report specimen disposal and rates of patient death. There were a total of 164 oncology patients electing to freeze sperm at our institution during the study period. Types of cancer were varied, with testicular cancer, Hodgkin's lymphoma, leukemia, and gastrointestinal cancers comprising the largest groups. Evaluation of semen parameters for these groups revealed that oligospermia, even prior to initiation of cancer therapy, was common. Sperm counts, motility, and morphology did not differ by type of cancer. Interestingly, less than 5% of patients utilized their specimens for reproductive purposes. Seven insemination cycles yielded no pregnancies, while one of two IVF attempts and the single ICSI case were successful. In conclusion, the epidemiological review of our database suggests that sperm cryostorage for fertility preservation in male cancer patients is under-utilized. Additionally, there is minimal use of cryopreserved specimens for reproductive purposes. We speculate that this underutilization may be due to the paucity of reports regarding reproductive outcome after freezing. It is our objective to provide a compilation of data that will prove useful to both physicians and patients who are considering sperm cryopreservation. (C) 2003 Elsevier Ireland Ltd. All rights reserved.