Male Fertility Preservation
If you have found this article, most likely you or your loved one has been faced with the diagnosis of cancer. From the moment these words are uttered, everyone is focused on the plan to treat as rapidly as possible. You may have been the patient, too overwhelmed to think about your future fertility. You may have been a parent, more anxious about what the future holds to even consider the prospect of grandchildren one day. You may be their partner, focused on how you will survive the months to come and not your future family. With the hope for cure comes the hope for a future, and the ability to have children can be a part of this.
The treatment options you or your loved one may face can include surgery, radiation and/or chemotherapy. All of these options can affect the ability of the testicle to produce sperm in the future. The options for preserving your fertility will depend on multiple factors, such as age and current state of health, but time until treatment should not prevent access to options.
Cryopreservation of Ejaculated Sperm
The most common method for fertility preservation for men and boys who have gone through puberty is to produce a sperm sample by masturbation. Although we recommend a period of 2-5 days between produced samples, they can be produced everyday if time does not allow. You should produce the samples before any treatment starts. Our clinic will allow you to produce the sample at home and transport it rapidly to the clinic for freezing. We make sure you have containers and instructions on how to do this.
How much ejaculated sperm should be stored?
Your fertility needs in the future can vary, so we need to be prepared for inseminations as a first line treatment option, but also consider how many children you would like. Inseminations involve either naturally or medically assisting you partner to produce an egg, programming ovulation and inserting the sperm into the uterus via a small catheter at the time of ovulation. Inseminations are not a guarantee of pregnancy, so we recommend having enough sperm stored for multiple attempts.
We usually request 2-3 samples for storage, but you will get feedback after each sample to let you know about the quality of the sperm sample and how many straws were frozen. Straws are the devices that are used to store the sperm, and typically 2 straws will allow for one insemination attempt. We always comment on the quality of the sample as you may already have symptoms related to the cancer diagnosis, and the sperm quality may be negatively affected.
What if I can’t produce a sperm sample?
There are multiple reasons for being unable to produce a sample. You may be on medication, or have pre-existing medical conditions that make this difficult. You may be suffering from anxiety or depression, or symptoms from the underlying cancer itself. Many young men may struggle to produce a sample by masturbation. The first step is always to be sure there is a safe and comfortable environment to produce the sample. If this fails, there are medical methods to assist. Your doctor may prescribe medication used to treat erectile dysfunction in some cases. You can discuss options like vibratory stimulation and electroejaculation with your doctor to see if they are possible or necessary for you.
Surgically extracted sperm
A testicular biopsy can be used to extract sperm if ejaculation is not possible, if the sperm sample is insufficient to freeze, or if there is no sperm seen in the ejaculate. Your doctor will do more tests to understand the chances of retrieving sperm this way, which should include a physical examination and some blood markers. If testicular sperm is preserved, this will mean that future fertility attempts will require ICSI (the IVF process where sperm is injected into an egg), and not insemination. This is because the amount of sperm retrieved is less and usually not very motile. The biopsy is done in our clinic under sedation and does not require admission to hospital. You should only spend about 2 hours from arrival to leaving the clinic.
What are the options for boys before puberty?
Currently the only option for young boys who have not gone through puberty yet is to freeze testicular tissue. The laboratory would check the sample to look for any sperm, and if present, they could freeze this like we would for a testicular biopsy in an older patient. If no sperm is seen then the immature tissue could be frozen. There is currently no accepted and available option to use this tissue, so it would be stored in the anticipation of future technology that could use the tissue/sperm stem cells to produce sperm – in other words, this is still experimental. Animal data does exist for this, but we have not yet advanced to being able to use this tissue in humans.
What are the other important facts to consider?
There should always be a documented HIV, Hepatitis B and C, and syphilis test result when you store sperm. We will send you for these at one of our lab conveniently situated in the same building as the clinic.
The clinic will bill you for the freezing of the sample, as well as an annual fee to store the sperm. You can get a quote for this by chatting to your doctor or their receptionist.
A difficult but important consideration is what should happen to the sperm/ testicular tissue if anything should happen to you. We can advise you on the process to clearly plan a directive for what you would like to happen to the stored sample in the future.
You are able to ask your oncologist to arrange for what is called “shielding” of the testicles during radiation. It does not prevent all the radiation exposure to the testicles, but it can reduce the amount of exposure.
What is I have previously had treatment for cancer?
If you have previously had treatment then you should see one of our doctors who will perform a sperm test. This will be the best way to see if you are producing sperm. If there is no sperm on the sperm test, then your doctor will do a physical examination and some blood tests to see if a testicular biopsy is possible for you.
Where do I start?
Tell your oncologist you would like to know more about freezing sperm. You can contact our doctors directly on our emails, or call the clinic to make an urgent booking. You should be be assisted within a day and start the necessary tests and consultation to begin freezing sperm without unnecessary delays.