Background: Gonadotoxic treatment for cancer or non-cancer diseases damages spermatogenesis and impairs male fertility whereas pre-treatment sperm cryopreservation can preserve future male fertility. Sperm cryopreservation is an established technique to preserve male fertility prior to gonadotoxic treatment.
Methods: Clinical, anthropometric, semen analysis and hormonal data were analysed from 1978-2017 involving 2717 men comprising 2085 men with cancer, 234 non-cancer disease and 398 healthy controls to define sperm output by diseases, the feasibility of sperm cryostorage notably for adolescents, regional access to an urban cryostorage facility, the determinants of sperm output and time-dependent disposal of cryostored sperm. Semen samples were assessed by contemporaneous WHO methods.
Findings: Of 2085 men with cancer, 904 (43%) had haematological malignancies, 680 (33%) testicular cancers and 136 (6.5%) were adolescents. Most men (89%) and adolescents (80%) could collect sperm. Sperm output for all cancers and non-cancer diseases was lower than controls. Sperm output correlated positively with total testicular volume (r=0.44, p<0.0001) and negatively with serum FSH and LH (r=-0.24, -0.12 respectively, both p<0.0001) but not testosterone. For all stored samples, the median time in cryostorage was 8.5 years, 7% were transferred for use to induce pregnancy (median time 2.5 years) and 62.2% were discarded as no longer needed (return of fertility, 35.9% median 3.5 years; death, 26.3%, median 6.5 years), the high disposal rate reflecting regular annual follow-up to establish ongoing need for continued cryostorage. Cryostorage facilities are not available in remote and rural areas of the State and the proportion of outer regional and remote area residents cryostoring sperm was only about half that compared with urban residents.
Conclusion: Sperm cryostorage is feasible for virtually all men, including sufficiently mature adolescents, who can collect semen to insure future paternity as well as making positive psychological preparation for the patient’s survival. Disposal is efficient with regular follow-up. Sperm cryopreservation should be an integral part of comprehensive treatment plan in men receiving gonadotoxic treatment but remains underutilised.