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Fertility Preservation for Testicular Cancer Patients

InScience,  April 1, 2009

MADISON - Men facing a diagnosis of testicular cancer should take a few days to consider how to preserve their fertility before launching into chemotherapy or radiation.

That's the view of Daniel Williams, M.D., an assistant professor of urology with the University of Wisconsin School of Medicine and Public Health. Williams led a recent study that showed testicular cancer affects sperm quality.

"Because of advances in treatment, young men of reproductive age who get testicular cancer have excellent survival rates," says Williams, an urologist and male fertility specialist at UW Hospital and Clinics. "Because of this, it's very important for us to also focus on quality of life after treatment."

For Williams, that discussion begins by offering sperm cryopreservation before treatment begins.

Williams' own research shows there's good reason to do so.

Cancer Treatments Can Compromise Fertility

Leading a team of researchers in California and Texas, Williams examined semen analyses from more than 400 men with several different types of cancer. All chose to bank their sperm before undergoing treatment.

The results showed that men with non-testicular cancer generally had normal sperm counts and motility. The samples of men with testicular cancer, however, showed something quite different.

"What we found was that young men with testicular cancer are still making sperm, but their sperm counts were significantly lower than men with other types of cancers," says Williams.

On top of having lower sperm counts to begin with, cancer treatments can make fertility matters worse.

According to Williams, about 10-15 percent of men who undergo chemotherapy and/or radiation treatment will have their ability to make sperm wiped out completely—and it's impossible to predict which patients will have their sperm permanently damaged by treatment.

There's also the question of the quality of sperm after chemotherapy and radiation.

"Are the sperm normal, or have they been damaged?" asks Williams. "Are there any increased risks of birth abnormalities after cancer treatments? There's no research that measures this, particularly in the era of advanced reproductive techniques."

Only a few sperm are required to fertilize an egg. Sperm banking options have expanded so that even men with low sperm counts can bank their sperm, although most options involve a fee of several hundred dollars plus a monthly storage fee.

Fertility Preservation Critical Component of Cancer Care

Williams believes that a discussion of fertility preservation should be a critical component of cancer care. In some situations, he says, oncologists are often and understandably focused on beginning cancer treatment immediately.

"While patients are obviously overwhelmed by a cancer diagnosis and many are quite ill at the time of diagnosis, I encourage them to let the information about fertility preservation sink in," says Williams, who notes that two to three days are usually enough time to obtain good samples for banking. "Once patients are able to focus on their long-term treatment strategies, they're really appreciative that we’ve discussed this."

Daniel Mulkerin, MD, a medical oncologist with the UW Paul P. Carbone Comprehensive Cancer Center, believes Williams' approach is a good one.

"If we're truly going to be comprehensive about cancer treatment, it's important that all doctors and oncologists talk to their patients and each other about this issue," he says.

The results of Williams' study appear in the February 2009 issue of the Journal of Urology.


Source: University of Wisconsin Hospitals and Clinics


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