Background: Increased childhood cancer survival has resulted in an accruing adult cohort faced with potential infertility. Pre-treatment semen cryopreservation can protect reproductive capacity in adolescent minors, but continued unique legal, ethical and educational barriers prevent consistent service provision across the UK. The effect of pubertal maturation, disease and treatment on the ability to produce sperm also remains poorly defined in this cohort. We present our 10-year experience of providing such a service in a tertiary teenage oncology unit.
Aims: To ascertain the relationship between age, Tanner pubertal stage, endocrine biochemistry and gonadotoxicity risk with offer, uptake and success rates of semen cryopreservation in underaged males with cancer.
Methods: Retrospective audit of case notes and reproductive laboratory data of 204 males aged 1218 years (median 15.0) with new or relapsed malignancy in our unit in three consecutive cycles (January 1999 to September 2009).
Results: Semen cryopreservation was offered to 152/204 (75%) patients, particularly those who were older (Audit 1, P=0.002; Audit 2, P=0.069; Audit 3, P=0.000) and more pubertally mature (Audit 3, P=0.015). Pubertal staging was poorly assessed across all audit cycles compared to baseline endocrine biochemistry despite repeated recommendations (59/204, 29% vs. 145/204, 71%; P=NS between cycles). Of those offered, 71% attempted to store semen, with 51% of these producing viable samples. Advanced pubertal stage (Tanner 3+) was the only significant determinant of success (P=0.03), but not age, gonadotoxicity risk or plasma testosterone concentration. Correlational analysis further revealed no association between plasma LH/FSH/testosterone concentrations with sperm count or semen volume.
Implications: Semen cryopreservation is a viable fertility preservation option for adolescent cancer patients, and should be offered to all before treatment, acknowledging the caveat of a ~50% chance of success. Pubertal staging is the only significant prognosticator of this and should be routinely assessed as part of the counselling process.