Cryopreservation of Sperm From Adolescents and Adults With Malignancies
AXEL KAMISCHKE*, HERBERT JüRGENS, LOTHAR HERTLE, WOLFGANG E. BERDEL AND EBERHARD NIESCHLAG*
From the * Institute of Reproductive Medicine, the Children's Hospital, the Urologic Clinic, and the Department of Medicine/Hematology and Oncology of the University, D-48129 Münster, Germany.
Correspondence to: Dr Eberhard Nieschlag, Institute of Reproductive Medicine of the University, Domagkstr. 11, D-48129 Münster, Germany (e-mail: [email protected] ).
Although cryopreservation of sperm is performed routinely in adults, only a small amount of information is available on its feasibility in adolescent patients with malignancies. Of 936 patients who were candidates for sperm cryopreservation, 851 (111 adolescents and 740 adults) were eligible for this retrospective analysis after excluding patients with relapses of the original or secondary cancers, known bitesticular lesions, or an unknown diagnosis. In general, patients were seen before initiation of treatment for malignancies. However, unilateral ablation of the testis was performed in 61% of patients with testicular cancer before cryopreservation of samples. Patients were grouped according to primary diagnosis and age. Measurements included testicular volume, semen analysis, and serum hormones (luteinizing hormone [LH], follicle-stimulating hormone [FSH], and testosterone). The youngest patient with an ejaculate containing sperm was 13.5 years old. No significant differences in any investigated parameter could be detected for any diagnosis among the 111 adolescents (age, patients with testicular cancer showed higher FSH values and lower sperm concentrations than adult patients with lymphomas, leukemias, and bone cancers. Patients younger than 16 years had lower ejaculate volumes than men older than 25 years, and testosterone levels were higher in patients aged 20–29 years than in the youngest patient group. Cryopreservation of sperm can be performed in adolescent patients with overall success rates (defined as the observation of at least a single motile sperm after the thawing procedure) similar to those observed in adults and should be recommended even to oncological patients younger than 15 years, provided that these patients can produce a semen sample.
Key words: Cancer, reproduction, fertility, childhood, male
Today, some of the most common malignancies in adolescents and young adults, such as testicular tumors, acute leukemias, lymphomas, and osteosarcomas, can be cured by a combination of surgery, chemotherapy, and radiotherapy, and a considerable fraction of these patients survive long term. It is estimated that 1 in 1000 young adults survive a childhood malignancy (Relander et al, 2000; Howell and Shalet, 2001). However, with increasing long-term survival rates, the long-term toxicity that follows therapeutic intervention and the resulting quality-of-life issues become increasingly important (Kliesch et al, 2000).
Depending on the substances and dosages used, most chemotherapy or radiotherapy treatments affect gonadal function independently of the patient's pubertal status (Howell and Shalet, 2001). Theoretically, hormonal gonadal protection (Meistrich et al, 2000) and retransplantation of germ cell stem cells (Schlatt et al, 1999; Hovatta, 2001) preserved prior to chemotherapy offer the option of preserving spermatogenesis and fertility. However, to date, hormonal gonadal protection has not produced the desired effects in nonhuman primates (Meistrich et al, 2000; Kamischke et al, 2003) or in oncological patients treated with gonadotropin-releasing hormone analogs (Brennemann et al, 1994). Retransplantation of testicular stem cells is still in the early stages of development (Schlatt, 1999). At present, cryopreservation of sperm prior to oncological therapy represents the only option for maintaining reproductive capacity (Kliesch et al, 2000).
Although cryopreservation of sperm in adult patients is a routine procedure, only a small amount of information is available on the spermatogenetic capacity and feasibility of cryopreservation in adolescent oncological patients (Kliesch et al, 1996; Müller et al, 2000; Bahadur et al, 2002). In this study, we present an update of our previous study that consists of 72 additional adolescent patients (previously, 39 patients) (Kliesch et al, 1996).
Source: Journal of Andrology, Vol. 25, No. 4, July/August 2004.