Semen quality in men with malignant diseases before and after therapy and the role of cryopreservation

Objective: To review the literature and answer questions about semen quality in young cancer patients before and after therapy and the importance of sperm cryopreservation. Methods: All aspects of sperm cryopreservation and effects of therapies on semen quality were examined on the basis of MedLine database searches. Results: Chemotherapy, radiation, or their combination results in a significant reduction of sperm quality and as a consequence an indefinite time of infertility follows. The type of cancer and the pretreatment sperm concentrations were the most significant factors governing posttreatment semen quality and recovery of spermatogenesis. Due to their age, fertility and sexual functioning are key issues for these patients. Yet there is no medical protection of the germinal epithelium available. Male germ cell transplantation is in its infancy and still there are no therapeutical options to improve spermatogenesis after damage has occurred. Consequently, cryopreservation represents the only preemptive measure for conserving fertility. Conclusion: This manuscript updates the current knowledge of diverse chemotherapeutic treatment regimens and their gonadotoxic effects as well as the development of posttreatment fertility in cancer patients. The importance and rationale of sperm cryopreservation are discussed and possible future options are highlighted. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.