There’s new hope for adult male childhood cancer survivors previously considered sterile due to chemotherapy. Doctors at Weill Cornell Medical College have developed a new surgical technique that allows some of these men to father children with the help of in vitro fertilization.
Microdissection testicular sperm extraction (TESE) can effectively locate and extract viable sperm in more than one-third of adult male childhood cancer survivors previously considered sterile due to chemotherapy treatment.
Most adult men who received certain types of chemotherapy in childhood or adolescence have traditionally been considered infertile. Although some will regain their fertility up to several years after treatment, as many as two-thirds will be permanently left with a condition known as azoospermia (very low sperm counts).
"It was previously assumed that most male survivors of childhood cancer whose semen contained little to no viable sperm were incapable of fathering children. This study demonstrates that some of these men do in fact still produce healthy sperm, and that this technique can help men experience parenthood," said senior author Peter Schlegel, MD, chairman of the Department of Urology at Weill Cornell Medical College and urologist-in-chief at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York.
Microdissection TESE enables doctors to identify small areas in the testicles where sperm are made and then carefully extract these healthy sperm cells, even in men whose testicles have been severely damaged by chemotherapy. In this study, 1,072 TESE procedures were performed between 1995 and 2009 on 892 patients with azoospermia. This group included a subgroup of 73 former cancer patients an average of 19 years after receiving chemotherapy, Schlegel said.
Investigators found that the type of chemotherapy male childhood cancer survivors received matters. Men who received platinum drugs, such as those who were treated for testicular cancer, had the highest rate (85 percent) of sperm retrieval. Men treated with alkylating agents such as cyclophosphamide, had lower sperm retrieval rates ranging from 26 percent to 36 percent; this group mainly consisted of men treated for lymphoma. Men treated for sarcoma had the lowest retrieval rate, at only 14 percent.
“When we started this study, we thought sperm retrieval rates would be close to zero among the group of cancer survivors, but we were surprised to discover that in many cases small areas of testicular tissue survived and resumed sperm production over a period of several years,” Schlegel said. “Even in this situation where we thought sperm production had ceased, there still may be an opportunity for fertility with the use of assisted reproductive techniques like this one.”
Schlegel noted that freezing and preserving sperm prior to chemotherapy for later use, known as sperm banking, is an important and frequently possible option for males diagnosed with cancer. However, it remains under used due to patients’ young age and poor sperm quality, cost and a desire to promptly start chemotherapy treatment.
LiveStrong has more information on male infertility due to chemotherapy at http://www.livestrong.org/Get-Help/Learn-About-Cancer/Cancer-Support-Topics/Physical-Effects-of-Cancer/Male-Infertility
Lynette Summerill is an award-winning writer who lives in Scottsdale, Arizona. In addition to writing about cancer-related issues for EmpowHER, she pens Nonsmoking Nation, a blog following global tobacco news and events.