Fertility preservation in males

Infertility in males with cancer may be caused by the primary malignancy itself or occur secondary to surgery, radiation, and/or chemotherapy. Recognition of the potential causes of infertility in cancer patients can inform cancer treatment planning to reduce the impact on future fertility. The optimal time for discussion with patients about their fertility preservation options is at the initial cancer diagnosis. The ability to preserve fertility in males is dependent upon the age at presentation. Sperm cryopreservation prior to the start of cancer treatment is the most common technique utilized for fertility preservation in pubertal and postpubertal males. In the absence of any anatomic or neurologic impairment, sperm are retrieved via ejaculation following a period of abstinence of 48 h. Successful sperm collection can be challenging in certain populations, including adolescents and patients with anterograde ejaculation, neurologic compromise, or anatomic obstruction. For prepubertal males, no mature sperm is available for cryopreservation, and testicular tissue harvesting and cryopreservation of cell suspension or whole tissue can be performed, though only in the context of experimental, IRB-approved protocols. At the present time, the risk of reseeding malignant cells with reintroduction of cryopreserved testicular tissue has limited the utility of this approach for restoring fertility after cancer treatment. In addition, there are no data demonstrating the ability to transform immature germ cells in cryopreserved tissue into mature, functional sperm, though this is an area under active investigation.