Submitted by wcm_male_infert... on April 28, 2015 - 11:50am
May 19, 2016
TAKE-HOME MESSAGE
This study evaluated the effects of chemotherapy on pregnancy in male and female survivors of childhood cancer not exposed to pelvic or cranial radiotherapy. This study gathered data from a subset of the Childhood Cancer Survivor Study cohort which followed 5-year survivors of the most common types of childhood cancer treated at 27 institutions in the USA and Canada between 1970 and 1999. The data set included 10 ,938 survivors and 3949 siblings of survivors (the control group) who were studied for a median follow-up of 8 years. The results revealed that 38% of cancer survivors were able to achieve pregnancy compared with 62% of siblings, and 83% of the 38% experienced at least one childbirth compared with 90% of siblings. Comparison of specific chemotherapeutics revealed that greater doses of contemporary alkylating drugs and cisplatin were associated with a decreased likelihood of siring a pregnancy in male survivors of childhood cancer.
The authors conclude that consideration of fertility preservation prior to cancer treatment remains important in maximizing the reproductive potential of all young men and adolescents newly diagnosed with cancer.
– Gautam Jayram, MD
- Written by
- Selected Publication & Abstract
The authors have summarized important information from previously published articles on the effects of chemotherapy on future fertility. It has long been recognized that chemotherapy in the form of alkylating agents (eg, cyclophosphamide, ifosfamide, busulfan, etc) are highly toxic agents for reproductive potential. These agents are commonly used for lymphoma (Hodgkin’s/non-Hodgkin’s), ALL, CNS tumors, and bone tumors such as Ewing's sarcoma. Although certain regimens have been associated with nearly 100% azoospermia rates in men (eg, after COPP chemotherapy), the true fertility potential after treatment has not been as clear. This article emphasizes that the fertility effects for men who have been treated for cancer are likely more dramatic than for women, and that the effects are substantial. There is an approximately 43% reduction in fertility for men treated with alkylating agents and 28% reduction for men treated with other drugs.
Since men entering treatment are never certain how many courses or what future treatment may be needed, this article suggests that strong consideration of fertility preservation is necessary. Although we don't have a standard approach for male fertility preservation in the prepubertal individual, consideration of testicular biopsy for tissue cryopreservation is important in the early management of the young male scheduled for treatment. It is also not clear whether some men who did not have children could have been treated more effectively with assisted reproduction (that can be out of reach for some patients based on cost/insurance coverage considerations).
In summary, this article provides important evaluation that quantifies future fertility risk, especially for young men facing chemotherapy treatment for childhood cancers. The results of this study should be clearly understood by all experts in the field, with familiarity on the part of all urologists
Link to Full Article in The Lancet