The number of men surviving
cancer at a young age has increased dramatically in the past 20 years as a result of early detection and improved
cancer treatment protocols; more than 75% of young
cancer patients nowadays are long-term survivors. Quality of life has become an important issue in childhood and adult
cancer patients. The commonest
cancers in patients of reproductive age are leukaemia, Hodgkin's
lymphomas and testicular
germ cell tumors. Fertility is often impaired after
chemotherapy and
radiation therapy. Cryopreservation of semen before
cancer treatment starts is currently the only method to preserve future male fertility. In some
malignancies, especially in
germ cell tumors, sperm quality is already abnormal at the time of diagnosis. In approximately 12% of men, no viable spermatozoa are present for cryopreservation before the start of
chemotherapy. Cytotoxic
therapy influences spermatogenesis at least temporarily and in some cases permanently. The amount of damage inflicted by
chemotherapy on spermatogenesis depends on the combination of drugs used and on the cumulative dose given for
cancer treatment.
Alkylating agents, such as
cyclophosphamide and
procarbazine, are most detrimental to germ cells.
Radiation therapy, especially whole-body irradiation, is also associated with the risk of permanent
sterility. Besides the
cancer treatment,
tumor type and pretreatment fertility are of prognostic value for future fertility in male cancer survivors. After
cancer treatment, many men need artificial reproductive techniques to achieve fatherhood; usually in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is indicated for successful treatment. About 15% of men will use their cryopreserved semen because of persistent
azoospermia after
cancer treatment. Treatment results with cryopreserved semen are generally good and comparable to general IVF and ICSI results. So far, no studies have reported an increased rate of
congenital abnormalities or
malignancies in children born from fathers who had
cancer treatment is the past, but close follow up is warranted, especially in children born after IVF/ICSI.