Cryopreservation of sperm is recommended before cancer treatment starts to avoid increased sperm aneuploidy rates and sperm DNA damage which may result from chemotherapy or radiotherapy.

For cancer patients

it important to preserve their sperm for future use. After chemo treatment, sperm production slows down or might stop altogether. Some sperm production might return, but can take many years, and sometimes does not return at all.

Semen cryopreservation is the oldest and the most successful option for fertility preservation in male cancer survivors, where the sperms are frozen before initiating cancer treatments like chemotherapy or radiotherapy.

modality is the cryopreservation of testicular tissue, where the tissue from testis is frozen. This tissue can later be thawed and sperm extracted for usage with eggs to create embryos. Timely consultation and initiation of the procedure is the key to preserve the fertility of cancer patients.

Sperm freezing becomes important as men age, their sperm quality tends to decrease including sperm concentration, sperm motility, sperm morphology and sperm DNA fragmentation that will affect the likelihood of future fertility.

Higher doses of these drugs are more likely to cause permanent fertility changes, and combinations of drugs can have greater effects. The risks of permanent infertility are even higher when males are treated with both chemo and radiation therapy to the abdomen (belly) or pelvis.

SHOULD I CONSIDER SPERM BANKING?

Sperm banking is used in a variety of different situations. Most commonly, men bank sperm because they are about to undergo treatments or take medications which may affect their sperm production.

You may want to consider cryobanking if:

• You are undergoing a treatment for cancer, which may impair your sperm production or quality (e.g. chemotherapy, radiation)
• You will be taking any ongoing medications which may impair your sperm production or quality (e.g. sulfasalazine, methotrexate)
• You will undergo any procedure which could affect your testis, prostate, or your ability to ejaculate (e.g. prostate resection, colon surgery or retroperitoneal lymph node dissection).
• You have a medical condition which is beginning to affect your ability to ejaculate (e.g. multiple sclerosis, diabetes)
• You are having a vasectomy
• You are entering a line of work where you may be introduced to reproductive toxins
• As part of your infertility treatment, you will be undergoing a procedure where sperm may be easily harvested (e.g. vas reconstruction, testicular biopsy). These sperm can then be stored and used later in conjunction with advanced reproductive techniques if alternative infertility treatments do not prove successful.

Below mentioned are some of the cancer treatments that could impact fertility in patients:

1. Chemotherapy

   Chemotherapy is a medicine-based treatment of cancer wherein the chemicals are used to stop the development of fast-growing cells. The use of these medications often damage the sperm as well as germ cells (sperm forming cells).

2. Hormone Therapy

   Some cancers are dependent on hormones for growth. In such cases, hormone therapy is done, which involves procedures. One involves obstruction or blocking of hormones so that cancer growth stops or declines. On the other hand, the second procedure interferes with the human body’s interaction with hormones, and therefore, there are chances of cancer growth getting hindered. To sum it up, if a certain cancer type requires endocrine (hormonal) therapy, then there are chances sperm production depleting.

3. Radiation Therapy

   This therapy uses high intensity radiation to either terminate cancer cells or decrease the size of tumor. If radiation therapy is targeted on reproductive organs or even around the abdomen (at pelvis, spine, etc.), it can decrease the sperm count. Moreover, it may also cause testosterone levels to decline, leading to infertility.1

4. Surgery

   This treatment requires surgical removal of the cancerous tumor from the patient’s body. Although not all surgeries are high risk, but those done near or around reproductive organs and pelvic area (from where colon, bladder or prostate cancer may be removed) could possibly damage sex organs, nerves or lymph nodes.

Can sperm come back after chemo?

If chemotherapy has made you infertile, it can be difficult to tell whether this is permanent or not. Some men stay infertile but others find their sperm returns to normal and their fertility comes back. It can take a few months or sometimes years for fertility to return to normal.

During puberty the testicles start making sperm, and they normally will keep doing so for the rest of a man's life. Certain chemotherapy drugs given during childhood, however, can damage testicles and affect their ability to produce sperm. Certain types of chemotherapy later in life can also affect sperm production

Cells start out as offspring of other cells that have divided. When cells are new, they are immature and not functioning fully. Chemotherapy (chemo) works by killing cells in the body that are dividing quickly. Since sperm cells divide quickly, they are an easy target for damage by chemo. Permanent infertility can result if all the immature cells in the testicles that divide to make new sperm (spermatogonial stem cells) are damaged to the point that they can no longer produce maturing sperm cells.