Male Fertility Preservation
The impact of cancer on male fertility may precede chemotherapy, or radiation treatment. While the reasons are not clearly understood, male sperm count may be reduced by the cancer itself. This makes male fertility for all cancer patients a matter of concern at the time of diagnosis.
Post-Pubertal
For post-pubertal boys, the most common form of fertility preservation is cryo-preservation of sperm. Even patients with low sperm count can take advantage of cryo-preservation to bank sperm indefinitely. Additionally, surgical procedures can be used to extract sperm from the mature testes for cryo-preservation. Of all the protocols in place for the preservation of fertility, those available to the post-pubertal boys are the most widely used and have the longest success record. While the discussion of sensitive matters is always difficult for adolescent boys and their parents, the confidence that comes with years of successful sperm preservation should make the conversation hopeful.
Pre-Pubertal
It is unclear at what stage of maturation a young boy is able to produce sperm. However, sperm production in young boys is not possible. Researchers are currently using a surgical technique to remove immature testicular tissue for cryo-preservation. Because of the power of immature cells to form new cells, researchers hold hope for creating sperm from immature tissue. The cryo-preservation of undeveloped testes is currently available in a limited number of hospitals in the United States. At this time the following physicians are accepting patients for this research study:
Ann & Robert H. Lurie Children’s Hospital of Chicago
Contact: Laura Erickson, MSN, APN, CPNP–lerickson@luriechildrens.org – (312) 227-5535
Children’s Hospital of Pittsburgh
Children’s National Medical Center, DC
Contact:
Kelsey Hilton — KelseyKHilton@childrensnational.org
Amanda Mahoney — AMahoney@childrensnational.org
Children’s Hospital of Orange County and UC-Irvine
Contact:
Julie Messina — jmessina@uci.edu
The cryo-preservation of testicular cells and their future development into fertility enabling tissue is experimental. However, it may well be a reality within the lifetime of the young cancer survivor.
More Information
- Film 1: “Gravity of Cancer” – for all parents
- Film 2: “Post Pubertal Fertility Preservation” – for adolescent patients and their parents
- Film 3: “Sperm Extraction” – for adolescent patients and their parents
- Film 4: “Testicular Tissue Freezing” — for pre-pubertal patient’s parents
- Film 5: “Handling the Conversation” – primarily for medical providers
- Film 6: “Path to Parenthood” – for all viewers
More Information
The cryopreservation of testicular tissue remains experimental for pediatric cancer patients.. For this reason, parents who choose to have their child’s tissue preserved must enroll him in a research study. This study holds great hope for the use of cryo-preserved tissue for normal hormone health, as well as eventual pregnancy. The following hospitals are part of the Oncofertility Research Consortium and are fully prepared to enroll children in this study. The contact person at each hospital can be contacted by the treating oncologist, or directly by parents.
PORF encourages parents to learn more about fertility preservation before making a final decision. The RESEARCH section of the website gives an overview of current research relevant to pediatric patients. The PREPARE section suggests questions that parents may pose to medical care providers and to each other. The CONNECT section shows parents how to best connect to the closest medical facility that participates in Pediatric Oncofertility Research. This section also connects parents with others who have made fertility preservation decisions before them.
Next Steps
PORF encourages parents to learn more about fertility preservation before making a final decision.
Parent to Medical Provider
The first set of questions is intended for parents to get fundamental information from their medical provider. PORF uses the term “medical provider,” because medical practices vary in how they interface with parents and patients. Sometimes the nurse practitioner, or physician assistant is a more comfortable source of information than the primary physician. Some practices have a special representative who addresses issues of fertility preservation. It is most important that parents speak to someone who is knowledgeable and a good listener.
Post-pubertal Questions:
- Do you have evidence that our son’s fertility has been compromised by the cancer itself?
- If so, do you believe there will be enough sperm for successful cryo-preservation?
- How will the sperm be collected?
- Will one sperm collection be sufficient for cryo-preservation?
- How difficult is it to make use of the preserved sperm?
- In the event of a pregnancy, is there any reason to believe the cancer, or the cancer treatment could endanger the fetus?
Pre-pubertal Questions:
- Do you have evidence that our son’s fertility has been compromised by the cancer itself?
- If so, is he a candidate for testicular tissue harvesting?
- Will a tissue harvest cause our son more pain, or delay the start of chemotherapy?
- Medical research is notoriously slow, do you believe our son will personally benefit from this procedure in his lifetime?
- In the event of a pregnancy, is there any reason to believe the cancer, or the cancer treatment could endanger the fetus?
Parent to Parent
Answers to the questions above will give parents a good basis for their own discussion. Parents will be able to assess the value of the procedure for their own son. The age of their son and the promise of research bearing fruit are two important considerations for parents to discuss.
Post-pubertal Questions:
- Are we comfortable having a discussion about sperm harvesting with our son?
- If not, do we know of someone who would be comfortable having such a conversation?
- Does our religion or our culture take issue with sperm harvesting and preservation?
- If so, should we consult with a religious consultant before we talk with our son?
- Will we be able to afford the cost of storing the sperm?
Pre-pubertal Questions:
- Since this research is very new, are we certain that it will not make our son more uncomfortable, or delay his treatment?
- Will our insurance pay for the research procedure?
- Will we be able to afford the cost of storing the tissue?
- Should we discuss this research with a religious consultant?
Parent to Religious Consultant
Post-pubertal Questions:
- How does our religion view sperm harvest under our circumstances?
Pre-pubertal Questions:
- How does our religion view cryo-preservation of testicular tissue?
To be hopeful in a time of tremendous stress is a demonstration of strength. Parents need support, encouragement, and courage to address the issue of fertility preservation. However, by its very nature, this is a discussion of hope for the future. We would not have this hope without the miracle of modern medicine. Since the vast majority of children with cancer live vibrant, productive lives, a parent’s gift of fertility may be well worth the struggle.