Fertility Preservation Options for Men

Michael L.

Hodgkin's Lymphoma Survivor

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Annually, more than 150,000 Americans are diagnosed with cancer during their reproductive years (younger than age 45). Cancer treatments such as surgery, radiation, chemotherapy and targeted and hormonal therapies can directly or indirectly cause infertility.

However, studies show that the majority of oncologists do not discuss fertility routinely with their at-risk patients. If you're facing cancer, ask your health care team for fertility preservation information as soon as you can so that you will have access to the full range of preservation options.

Questions to Ask Yourself

  • Have I always wanted children?
  • Would I prefer adoption to other parenthood options?
  • Does it matter to me if my children are biologically related to me?
  • Am I open to using donor sperm or donor embryos?
  • How many children do I want to have?
  • How does my partner/spouse feel about all of these issues?
  • Do I have ethical or religious concerns about assisted reproductive technologies?

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If you learn that you are at risk for infertility from cancer treatment, it's important to take the time to think about the significance of parenting to you. Consider whether you want to be a parent some day. If so, think about whether having a child genetically related to you is important. Understanding how you feel about parenthood will help you decide whether to pursue preservation options presented in this article.

Here are several fertility preservation options that men can consider before, during and after cancer treatment.

Sperm Banking

Sperm banking is a simple, well-established way to preserve your fertility. The actions involved in sperm banking may go against some men’s religious beliefs and practices. If you are concerned about this, please contact a trusted leader in your place of worship.

Sperm banks are accessible across the country by appointment. At the sperm bank, you will be escorted to a private room to produce a semen specimen that will be analyzed, frozen and stored for future use. You may find it distracting or embarrassing to bring family or friends with you to the sperm bank. Do what feels right to you—go alone or invite someone with whom you are comfortable.

There are also cryobanks that operate sperm banking by mail programs. These programs allow you to produce the specimen at home or at the hospital and ship it overnight back to the cryobank.

Donations can be made every 24–48 hours, and it is suggested you wait at least 24 hours between donations and any sexual activity. If you are unable to donate through sexual stimulation, sperm cells can be obtained through minor surgery or alternative stimulation methods such as electroejaculation.

Multiple specimen donations are usually recommended, but even one sperm may be enough for conception using Intracytoplasmic Sperm Injection (ICSI). During ICSI, one sperm is injected into a woman’s egg to create an embryo. In the past, millions of sperm were required to make sperm banking worthwhile. Thanks to ICSI, the embryologist can select the best sperm—the best shaped and fastest—and inject it with a needle into the egg with a higher pregnancy rate.

Sperm can be frozen indefinitely. Damage occurs to the sperm during freezing and thawing, not while it is frozen. The success rates of using stored sperm vary and depend on several factors. Approximately 50 percent of the sperm frozen will survive the freezing and thawing process. Success rates will depend on your female partner’s age and fertility status, the method of assisted reproduction and the quality of your sperm.

The average cost of sperm banking is $1,000 for analysis and freezing, plus $300–$500 per year for storage. However, costs vary greatly from center to center, so it is important to compare costs at clinics in your area. Insurance coverage for sperm banking is variable, with some private companies covering the cost of sperm banking. However, they may require a letter from your physician. Through LIVESTRONG Fertility, qualified individuals can access discounted rates for sperm banking.

Testicular Sperm Extraction

Testicular sperm extraction (TESE) is possible for men before or after cancer treatments who have reached puberty and who do not have mature sperm in their semen. If you did not bank your sperm prior to starting cancer treatments and currently have no sperm in your ejaculate, there may still be sperm in your testicular tissue that can be used with in vitro fertilization (IVF) to try to have a child.

Testicular tissue is usually obtained by open biopsy and examined for sperm cells. If sperm cells are found, they are removed and used immediately or frozen for future use with IVF and ICSI.

Success rates vary depending on the exact technique of the biopsy used, but range from 30–70 percent. Studies have shown the presence of live sperm up to 45 percent of the time in men who had no sperm in their ejaculate after cancer treatment. This is an experimental procedure in prepubescent boys but a common procedure for adult men.

The average cost of testicular sperm extraction is $6,000–$16,000. Some insurance companies pay for the procedure if it is performed in conjunction with other treatments. There is such a wide range in cost because many factors are involved: hospital fees, anesthesia, staff time and equipment. If TESE is done at the same time as IVF to achieve pregnancy, there are additional costs.

Radiation Shielding

With radiation shielding, special shields are placed over one or both of the testicles during radiation treatments, which helps reduce the risk of damage to your fertility. Generally the cost is included in the cost of radiation treatments. Success rates vary based on radiation fields and anatomy. Radiation shielding does not protect against chemotherapy.

Testicular Tissue Freezing

Testicular tissue freezing is an outpatient surgical procedure that can be done before treatment for men either before or after puberty. In many cases it is the only option for prepubescent boys. Testicular tissue, including the cells that produce sperm, is surgically removed, frozen, analyzed and stored. The procedure is experimental with no live births to date but shows promise for the future.

The average cost of testicular tissue freezing is approximately $2,500 for surgery, plus $300–$500 per year for storage. The costs may be reduced or waived due to the experimental nature of the procedure, and the technique is offered under IRB protocol at only at a few locations across the country.

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