Options for Fertility Preservation in Men and Boys with Cancer

Abstract

Fertility is a critical quality of life issue in young men faced with a new diagnosis of malignancy. Fortunately, many options are available for the acquisition and storage of sperm, and fertility preservation is possible in the majority of cases. In this chapter we review the reproductive toxicities of cancer and cancer therapy, and the clinical management of young men whose fertility is threatened by cancer. The optimal utilization of sperm banking and strategies for fertility preservation in men with ejaculatory dysfunction and azoospermia are discussed. Lastly, emerging options for fertility preservation in pre-pubertal boys are reviewed.

I was diagnosed with Hodgkin’s Lymphoma when I was 15. I guess I was a late bloomer because I’d never really thought about kids or a family. The doctors told my parents there was a good chance I’d never be able to father a child after my treatment. I was only concerned about living, and I didn’t want to talk about sperm banking or think about the future. My mom kept bringing it up though – she wouldn’t drop it – she kept saying “you’ll feel differently one day,” or “you’ll be sorry when you’re older that you didn’t think more about it.” Truthfully, at the time it was so embarrassing, and the last thing I wanted to do was talk to my mom about sperm banking. I felt lousy I was scared of dying and scared of what the treatments were going to be like, and the biggest thing on my mind was all the baseball practices and games I was going to miss. I yelled at my mom and told her not mention it again – I’d made up my mind I was not going to do the sperm banking.

Now I’m 25 years old and haven’t stopped kicking myself. I met the love of my life in college and we married right after graduation. We wanted to start a family right away, and I guess I just forgot that it may be an issue for me. When we couldn’t get pregnant, we went to fertility testing and learned that my fertility was very compromised. My wife wondered why I’d never mentioned this possibility to her – she knew I had cancer, but it just didn’t sink in to me what my mom and the doctor had been trying to tell me. I regret not listening and not doing the sperm banking. We’re going to have to use donor sperm now, and I’m not even sure how I feel about that.

Maybe my mom wasn’t the best person to talk to me about it. I might have listened more if the doctor had talked to me alone or maybe if I had talked to some guy a little older than me who’d gone through the same thing. I have no one to blame but myself, and I’m grateful to be alive, but if I had to do it over again, I would have definitely done the sperm banking.

Lionel, Adult Cancer Survivor