Sperm cryopreservation in adolescent minors with cancer: factors predicting pre-treatment semen quality in 79 minors aged 1218 years over 10 years
Hoong Wei Gan1, Elizabeth Williamson2, Melanie Davies2 & Helen Spoudeas1
Background: Increased childhood cancer survival has resulted in an accruing cohort faced with potential infertility. We have previously shown that sperm cryopreservation is acceptable to 7080% of adolescents and testicular volume, LH and testosterone concentrations positively predict success in ~33% that bank. However, little is known about semen characteristics in relation to age and puberty. Here, we present data on our subcohort of 79 boys who produced a semen sample for potential banking before any cancer therapy.
Aims and methods: To determine the relationship between age, Tanner stage, endocrine biochemistry, gonadotoxicity risk and four semen characteristics (sperm concentration/ count/ motility and semen volume) in 79 of 222 adolescent cancer patients aged 1218 years (median 15.7) over a 10-year period by subcohort analysis.
Results: Higher age and plasma LH increased sperm concentration (age ρ=0.264, P=0.019; LH ρ=0.32, P=0.025), sperm count (age ρ=0.387, P=0.000; LH ρ=0.355, P=0.012) and particularly semen volume (age ρ=0.562, P=0.000; LH ρ=0.333, P=0.019), whilst testosterone only weakly correlated with sperm count (ρ=0.298, P=0.037). Semen volume was also strongly predicted by Tanner stage (ρ=0.5, P=0.035) and testicular volume (ρ=0.748, P=0.002). 20.2% (n=16) met WHO criteria for normal adult semen; these tending to be older (P=0.027) with higher FSH values (P=0.048). After age and gonadotoxicity risk-adjustment, only FSH independently predicted sperm concentration (P=0.002), sperm count (P=0.000) and the chance of having normal adult semen on all four parameters (OR 1.249, P=0.022). Notably all four patients with supraphysiological plasma FSH banked normal adult semen.
Conclusion: To our knowledge this large adolescent dataset is the first report of increasing semen volume with pubertal development as well as age (in health or disease). Whilst increased virilisation (testicular volume, LH, testosterone) is predictive of banking viable sperm, FSH determines semen quality with supraphysiological values not precluding banking or normal semen parameters in adolescent boys.