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Why Men with Cancer Should Consider Sperm Banking

Date: August 13, 2015      Publication: Daily Health News      Source: Pasquale Patrizio      Print:

Cancer is no reason for a man to give up plans to father a baby.

If you’ve been given a diagnosis of cancer and there’s even a slight possibility that you will want to father a child in the future, have a discussion with your doctor about sperm banking. Technological advances now make it a feasible option for nearly any man who wants to pursue it.

Here’s why you should discuss this before cancer treatment starts—chemotherapy, radiation and some surgeries can result in infertility by making you azoospermic (no measurable sperm count), by causing ejaculatory dysfunction or by removing reproductive organs. There’s also some evidence that cancer itself can negatively affect sperm production, although not all studies show this.

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What’s stopping more men from doing this? Simple ignorance plays a part—one-third of men awaiting cancer therapy don’t even know sperm banking is an option. But there are many misconceptions as well. To clear them up, we spoke with Pasquale Patrizio, MD, director of the Fertilization and Preservation Center at the Yale School of Medicine.

SIX MYTHS ABOUT SPERM BANKING

MYTH 1: It’s too expensive.

Truth: It’s probably far cheaper than you think. Collecting and initially freezing (technically called “cryopreserving”) sperm costs only a few hundred dollars, and storage fees are about $50 per month. Some insurers will cover a portion of the cost of freezing if it’s for a cancer patient.

MYTH 2: My sperm count is already too low, so banking sperm won’t help.

Truth: Even if you haven’t started treatment yet, your illness might have already taken a toll on your sperm count. This would be revealed during a semen analysis before cryopreservation. But the science has come a long way, and these days more sperm survive the freezing process. That’s true even if there are only a few “units” of sperm—a unit is the contents of one ejaculate. “With the technology that’s now available in the laboratory, that can be sufficient to have a pregnancy,” says Dr. Patrizio. As long as you have some sperm, you’re a candidate for sperm banking, he says, “so freeze no matter what.”

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MYTH 3: I don’t have time. I need to start cancer treatment ASAP.

Truth: Sperm banking is not time-consuming, and your treatment can wait a few hours or a day. A desire to get your cancer treatment started ASAP may be one reason why your primary care doctor or oncologist doesn’t bring up sperm banking to you. (One study found that only 10% of oncologists offered sperm banking to all eligible men.) You have every right to start the conversation yourself if you’re at all interested in fathering a child in the future. Even if you’re too weak from your illness to ejaculate, surgical sperm retrieval is a possibility.

MYTH 4: It’s too late—I already started cancer treatment.

Truth: Although it’s highly recommended and ideal that men freeze their sperm before they start treatment, it’s not absolutely a contraindication to freeze after cancer treatment has started. Have a conversation with a fertility specialist, who can educate you (and your partner if you already have one) about the risks of using sperm that have been exposed to chemotherapy or radiation, which include possible genetic abnormalities and an increased risk for miscarriage. But here again, technology is on your side—if you decide to use this sperm down the line, pre-implantation genetic screening can identify many chromosomal abnormalities in embryos before they are used to create a pregnancy.

MYTH 5: It’s really too late. I never banked sperm, went through all my treatments, and now I don’t have any sperm…but we still want to have a baby.  

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Truth: Don’t despair! Many men begin sperm production again after a period of months or longer. After around a year, if you’re still azoospermic, a specialist can perform a biopsy to see if any sperm can be extracted from your testicles. “In about 25% to 30% of cases, there is some very minute amount of sperm that can be detected in the testicle but is not enough to spill over into the ejaculate,” Dr. Patrizio says. This sperm can be inserted into a partner’s or donor’s egg. Dr. Patrizio says he waits 18 months before diagnosing an azoospermic patient infertile.

MYTH 6: I’m too old.

Truth: Men can father children throughout their life spans. The real concern related to aging has nothing to do with cancer, actually. There’s growing evidence that men of “advanced paternal age”—over age 50—“may have a slightly higher risk of fathering children with chromosomal disorders or diseases due to gene mutations, such as autism, Down syndrome or dwarfism,” says Dr. Patrizio. That risk is worth discussing with a fertility specialist if you’re considering fathering more children. But it has nothing to do with sperm banking.

Source: Pasquale Patrizio, MD, MBE, HCLD, professor of obstetrics, gynecology and reproductive sciences, director of the Yale In Vitro Fertilization and Preservation Program at the Yale School of Medicine in New Haven.