The relation between cancer, chemotherapy, radiation and infertility
Every year more than 50,000 children and adult men under the age of 45, in the U.S., are diagnosed with cancer. Even though most types of cancer treatments impact fertility, a significant number of men do not address fertility needs and regret it later in life, when cancer has thankfully become a thing of the past. Banking your sperm for future use can protect fertility, yet unfortunately, some cancer patients are not even aware of this option. Often, oncologists do not consistently discuss sperm banking with their patients. Even those that are aware have a lot to digest in a very short timeframe and may not have the mental strength to deal with the process of locating a clinic, scheduling an appointment, and going through with the uncomfortable process.
Sppare.me’s vision is to raise awareness about fertility preservation and educate cancer patients about their choices for securing fatherhood. Our mission is to provide a comfortable and yet reliable platform to assure this vision.
How do chemotherapy and radiation work and why do they risk fertility?
Chemotherapy and radiation treatments target rapidly dividing cells by damaging their DNA. As cancer cells are rapidly dividing and abnormally reproducing, chemotherapy and radiation can destroy large numbers of these harmful cells. Several tissues in the human body, such as hair follicles, gastrointestinal tract and reproductive tissues such as sperm cells, are constantly dividing similar to cancer cells. Treatments cannot appropriately distinguish between the good body cells and the bad cancer cells, making them targets. Sperm cells in particular, are a primary target during chemotherapy and radiation as these cells are constantly reproducing.
What is the level of influence of radiation and chemotherapy on fertility?
The level of influence of radiation depends on several factors, such as the dose to the testicles, the use of shielding, and fractionation of the doses. While doses of 1.5-4 Gy can result in permanent sterility, doses as small as 0.1 Gy can “only” decrease fertility. Total body irradiation (TBI) presents a relatively high risk, as it is estimated that 80% of men who undergo TBI will have permanent infertility.
Similarly, the impact of chemotherapy varies according to the different factors involved, such as the type of chemotherapy, the number of chemotherapy drugs received, the cumulative dose received, and the patient age (men older than 40 are less likely to remain fertile). For example, it is estimated that 90% of patients who receive high doses of alkylating chemotherapies will have long-term infertility (up to 4 years) or even permanent sterility following therapy.
So, am I at risk for infertility?
It is estimated that 30–75% of cancer survivors are at risk for iatrogenic infertility. As that is a large range, the bottom line is that it is extremely difficult to predict which men will become infertile while fighting cancer. Every man or child starting cancer treatment should consider himself vulnerable to losing fertility.
Which chemotherapy drugs can cause infertility?
Chemotherapies called alkylating agents are known to be the biggest offenders. Alkylating agents attach chemical groups that can form permanent covalent bonds with the guanine base of DNA, and prevent proper DNA replication (the focal process in dividing cells). In addition to Alkylating agents, other chemotherapy drugs can also affect fertility. Chemotherapies based on platinum compounds can cause prolonged azoospermia (the absence of motile, and hence viable, sperm in the semen) in up to 50% of patients. It is important to mention that in the last decade; many new chemotherapies and biological treatments have been developed to fight cancer. Their effect on fertility is not yet clear.
Several examples for chemotherapy drugs with known effect on fertility:
What are my options for preserving my fertility?
While there are several methods to restore your fertility after cancer such as Testicular Sperm Extraction and Testicular Tissue Freezing, cryopreservation (freezing & storage) of sperm is the only proven and most common method of fertility preservation in men, as it has been used for over 50 years.
How can I decide if I should bank my sperm? In one word – BANK. Bank with Sppare.me or bank somewhere else, but do not compromise your ability to father children. The benefits of banking sperm go beyond reproduction as preserving fertility has been deemed a positive factor in coping emotionally with cancer.
Weighing the positive effect and benefits of banking your sperm against the cost and efforts associated with the process – the answer is clear. (At least for us).
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American Cancer Society, Surveillance Research, 2016
Cancer: Principles & Practice of Oncology (7th edition), Link
Sperm cryopreservation before chemotherapy helps in the emotional battle against cancer, Link
American Society of Clinical Oncology, Journal of Clinical Oncology
Nonmalignant late effects after allogeneic stem cell transplantation, Link
Preserving fertility after cancer, A Cancer Journal for Clinicians, Link
Live Strong [dot] org, Article #1
Live Strong [dot] org, Article #2
National Center for Biotechnology Information, Article
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