Predictors of sperm recovery after cryopreservation in testicular cancer

Abstract

Our objective was to identify predictors of improved postthaw semen quality in men with testicular cancer banking sperm for fertility preservation. We reviewed 173 individual semen samples provided by 67 men with testicular germ cell tumor (TGCT) who cryopreserved sperm before gonadotoxic treatment between 1994 and 2010 at our tertiary university medical center. Our main outcomes measures were independent predictors for the greater postthaw total motile count (TMC) in men with TGCT. Men with NSGCT were more likely to be younger (P < 0.01) and had high cancer stage (II or III, P < 0.01) compared with men with seminoma. In our multiple regression model, NSGCT histology, use of density gradient purification, and fresh TMC > median fresh TMC each had increased odds of a postthaw TMC greater than median postthaw TMC. Interestingly, age, advanced cancer stage (II or III), rapid freezing protocol, and motility enhancer did not show increased odds of improved postthaw TMC in our models. In conclusion, men with TGCT or poor fresh TMC should consider preserving additional vials (at least 15 vials) before oncologic treatment. Density gradient purification should be routinely used to optimize postthaw TMC in men with TGCT. Larger, randomized studies evaluating cancer stage and various cryopreservation techniques are needed to assist in counseling men with TGCT regarding fertility preservation and optimizing cryosurvival.

A retrospective study on sperm banking: a Uruguayan experience

“…According to our results, the median age of the subjects storing semen samples prior to cancer treatment is 28 years (33-42), making them significantly younger than the individuals in the ART group (median age of 34 years, ranging between 28-40 years). Similar results have been reported in the literature ( Hotaling et al ., 2016 ; Tomlinson et al ., 2015 ). This clearly demonstrates the desire these patients have to preserve their chances of becoming parents, and the notion that sperm cryopreservation is the only option they have to fulfill their aspirations of parenthood.…”

Fertility Preservation Options for Cancer Patients

“…Men with testicular germ cell tumors have a sperm survival rate of only 44.8% and the lowest odds of having a post thaw total motile count above 5 million for intra uterine insemination. Therefore, men with testicular cancer with seminoma histology or lower fresh total motile count (<25 -30 million) should consider preserving additional vials (15 or more) before oncologic treatment [10] if sperm are intended to be used for intra uterine insemination. However, in situations of severe time constraint, cryopreservation of only one ejaculate in multiple vials is recommended so that the sperm can be used for ICSI which requires only one sperm per egg retrieved.…”