Semen Cryopreservation

With the advancement of ART, all men diagnosed with cancer should be offered the option of semen cry-obanking, a procedure that provides the only reasonable chance of establishing pregnancy after therapy.37 Semen cryopreservation is a widely available and inexpensive option (< $1000) that yields good results.

Patients diagnosed with cancer used to be considered poor candidates for sperm cryopreservation because they present with disease-induced suboptimal semen quality and cryosensitivity. Men with Hodgkin's lymphoma have pre-freeze and post-thaw sperm quality that is below normal.38 39 However, as a general rule, there is no cancer group for which sperm cannot be retrieved and stored.40 Even the absence of spermatozoa in semen should not prevent physicians from attempting to preserve a patient's fertility. In many cancer patients who suffer from azoospermia before treatment, testicular sperm extraction "Onco-tese" may be successfully attempted (unilateral or bilateral), and the retrieved sperms may be cryopreserved for future use.41

Almost 40% of patients who cryopreserve their semen may have a healthy live birth using ART.33 Based on the experience at the Cleveland Clinic in the last two decades, the percentage decline in semen quality (from pre-freeze to post-thaw) in patients with cancer shows a similar trend that of normal donors. This suggests that the effect of cryodamage on spermatozoa from patients with cancer is similar to that of normal donors.42 43 Cryopreserving semen after the start of therapy can adversely affect their chromosomal structure, causing de novo mutations, but should still be attempted if the imperativeness of starting therapy outweighs the chance for cryopreservation, as viable sperm may still be recovered. Therefore, it is crucial to cryopreserve sperm before chemotherapy or radiotherapy and also to advocate the use of contraception during therapy and for 6 months after.

Only a small percentage of patients (< 10%) who bank their spermatozoa before chemotherapy or radiotherapy return for assisted reproduction.44-46 This finding may be explained by several reasons: recovery or waiting for possible resumption of spermatogenesis, short period from original illness, anxiety regarding potential risks for the children, and uncertainty about long-term health and, therefore, suitability to be par-ents.42 However, trends have started to change, and awareness of sperm banking has increased over the past 4 to 5 years, coinciding with the advent of ICSI.

In males with cancer, the extent of sperm DNA damage plays an important role in determining how semen should be cryopreserved before therapy begins. Specimens with high sperm concentration and motil-ity and low levels of DNA damage can be preserved in relatively large aliquots suitable for IUI. If a single specimen of good quality is available, then it should be preserved in multiple small aliquots suitable for IVF or ICSI.28

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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