Infertility and Cancer in Men
Julian A. Sanchez, MD
Cancer treatments have become increasingly sophisticated leading to improved outcomes and increased survival. An unintended consequence of these advanced treatments is diminished fertility among the cancer survivors. Young men are especially at risk and deserving of individualized attention.
Radiation therapy is a focused beam of intense energy used to kill cancer cells and decrease tumor burden. This can be as a primary treatment or as an adjunct to surgery and is used to treat many cancers including lymphoma, gastrointestinal, neuroendocrine, breast, prostate, head and neck and others. Radiation therapy focused in the groin can also kill healthy spermatozoa and damage testis leading to infertility.
Chemotherapy also attacks rapidly dividing cells via multiple mechanisms. Such drugs are toxic to sperm and can lead to mutations. These mutations not only decrease fertility in the cancer patient but also increase the chances of birth defects.
Surgery can also alter fertility in cases where the testicles are removed or if sexual function is compromised by nerve damage leading to impotence or retrograde ejaculation, making natural insemination and subsequent fertilization difficult.
Cryopreservation of sperm prior to initiating therapy can overcome these barriers by collecting sperm before the treatment side effect occurs. Timely collection allows the patient to chose reproduction after his treatment has completed. Patients are encouraged to discuss fertility and potential side effects of any treatment with their doctor to determine if cryopreservation is indicated.
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