Options for Men
Knowing that there are options for many men to protect or preserve their reproductive potential before cancer treatment begins can make it less challenging to discuss the possible reproductive side effects of treatment with your patients. There are two strategies that can be used – (1) removing and freezing gametes (sperm) or (2) taking steps to reduce the reproductive impact of cancer treatment. For interested patients, fertility preservation must be completed before treatment begins.
Preserving Gametes (Sperm)
Sperm bankingSperm banking is the freezing and storage of semen at a sperm banking facility. Semen is obtained through masturbation. It is generally recommended that men collect three specimens prior to the start of chemotherapy, with 24-72 hours of abstinence before and between each collection.
Testicular Sperm ExtractionThis technique involves the collection of sperm by surgical removal from the testicular tissue. The patient is sedated. A reproductive urologist removes small pieces of testicular tissue by biopsy or aspiration.
ElectroejaculationElectroejaculation is a way of stimulating a patient through the use of a mild electrical current to obtain a semen sample. First, the patient is placed under anesthesia. Then a reproductive urologist positions a rectal probe over the prostate gland.
Minimizing Reproductive Damage
Patients may also want to consider techniques that may reduce the potential reproductive damage caused by their cancer treatments. These include:
Testicular ShieldingTesticular shielding involves the placement of shields over the scrotal sac to reduce testicular exposure. Clamshell-like shields are made during simulation and used each day of treatment with pelvic or inguinal radiation therapy.
Nerve-Sparing SurgeriesSome cancer surgeries involve the removal of lymph nodes in the abdomen (retroperitoneal lymph node dissection [RPLND]), and these surgeries can damage the nerves involved in ejaculation. While this does not cause a man to be infertile, it does mean that, when ready to attempt pregnancy, sperm has to be retrieved in other ways. Nerve-sparing RPLND techniques should be discussed with appropriate patients, especially those interested in future fertility. Patients should also be offered sperm banking before treatment.