You may be able to take certain steps and precautions to preserve fertility before, during and after treatment.
Options for sperm preservation before treatment
Sperm cryopreservation (freezing). To save sperm for future use, sperm freezing is a common, noninvasive option. Sperm freezing is also referred to as “sperm banking.” The process involves the collection of semen by masturbation. If there are sperm in the semen, they can be frozen and stored at a special facility for possible future use. Some hospitals have their own sperm bank programs. Sperm banking is a reliable and effective fertility preservation option with the highest likelihood of success. However, sperm banking may be a less successful approach for some patients, such as those with Hodgkin lymphoma, because they may already have low sperm counts caused by the cancer.
The American Society of Clinical Oncology (ASCO) guidelines recommend that sperm banking be offered to all patients assigned male at birth who have gone through puberty and who have a recent diagnosis of cancer. Most children have some sperm in their semen by about age 13. The optimal timing for sperm banking is prior to the start of therapy because the quality of the semen and the DNA integrity of the sperm can be affected even after a single dose of chemotherapy.
For patients who cannot perform masturbation for physical, emotional or religious reasons, other options to obtain sperm include:
- Vibratory stimulation. In this procedure, a special vibrator is placed at the base of the glans penis (the head of the penis) to cause ejaculation. The process requires no anesthetic or sedation.
- Electroejaculation. For this procedure the patient is under anesthesia. An electric probe is passed via the rectum and placed against the prostate to stimulate ejaculation.
- Medication for erectile disorder. If the patient is unable to achieve an erection, a doctor may prescribe a phosphodiesterase type 5 (PDE5) inhibitor, such as sildenafil (Viagra) or tadalafil (Cialis).
- Medication for retrograde ejaculation. If the patient experiences retrograde ejaculation (when semen enters the bladder instead of exiting through the penis during orgasm), a doctor may prescribe an alpha-agonist, such as pseudoephedrine (Sudafed).
- Testicular sperm extraction (TESE). For patients who have no sperm in their semen, this surgical procedure, performed under anesthesia, may be an option. The doctor removes pieces of tissue from the testes, which are then examined for mature sperm. The mature sperm can be removed from the tissue and frozen for possible future use.
Testicular shielding. A shield can be used to protect the testicles during radiation therapy. Shielding must be planned before treatment begins, and the shields must be used every day of treatment. Not all patients will be able to use shields, because sometimes the testes need to be treated with radiation.
Testicular tissue cryopreservation (TTC). For patients who have not yet gone through puberty and therefore do not produce mature sperm or other patients for whom sperm freezing is not possible, TTC may be an option. This method involves collecting and freezing a small amount of testicular tissue with the hope that the tissue will contain stem cells that would later produce mature sperm. No babies have yet been born as a result of using frozen testicular tissue. Researchers are studying options for obtaining viable sperm from frozen testicular tissue. Testicular tissue cryopreservation is available both outside clinical trials and as part of clinical trials. If you are interested in a clinical trial, talk to your treatment team.
Using frozen sperm after treatment
Depending on the number of vials stored and the number and quality of the sperm specimens, there are two ways to use frozen sperm— artificial insemination and in vitro fertilization (IVF). Artificial insemination involves the injection of semen into part of the reproductive tract of a partner with a uterus (or a surrogate) by a method other than sexual intercourse. Or, the sperm can be used to fertilize mature eggs, collected during an IVF cycle from a partner (or donor), in a laboratory to create embryos. The embryos are then transferred into the uterus of a partner or a surrogate who will carry the pregnancy.
Other Options
Donor sperm. Sperm donated by another person is used to produce a pregnancy through artificial insemination or IVF.
Related Links
- Download or order The Leukemia & Lymphoma Society’s free fact sheet, Fertility Facts.