Sperm Banking Can Preserve Fertility of Men with Leukemia
Leukemia is one of the most common cancers diagnosed in men of reproductive age. As multidrug chemotherapy and bone marrow transplantation have improved survival in these patients, more long-term cancer survivors are facing the issue of treatment-related morbidities, including infertility.
For many years it was not clear whether attempting to cryopreserve semen samples from men with cancer was a worthwhile effort. The illness itself appears to have a negative effect on semen quality, as indicated by the lower quality of semen samples from leukemia patients compared with those of healthy men.
Cancer therapy further impairs semen quality, so for the best chance of success, semen samples for cryopreservation should be provided before therapy begins. The process of cryopreservation can also further impair semen quality, and it is not always clear how many sperm of the already poor quality samples can survive the freezing process. All in all, in the past, a diagnosis of cancer often meant the end of a man's reproductive life.
Intracytoplasmic sperm injection (ICSI) as performed at the Cleveland Clinic Foundation Center for Reproduction has radically changed the outlook for these patients. With ICSI, an ovum can be fertilized with a single sperm, which often can be obtained even from poor-quality semen specimens.
Our lalest research into sperm banking for leukemia patients confirms that we can help these men preserve their fertility. We recommend that sperm cryopreservation be offered to all male leukemia patients of reproductive age before they begin cancer therapy.
In a recent study, we reviewed the records of 13 patients with acute leukemia and 12 patients with chronic leukemia who banked their sperm before receiving therapy. Semen characteristics of samples from these men were compared with those of healthy donors. We also examined the effects on the specimens of the type of leukemia and of freezing.
Results confirmed that men with leukemia have poor semen characteristics both before samples are frozen and after samples are thawed. Motile sperm count was radically lower among men with leukemia; samples from healthy controls had a median of 130 million sperm per milliliter, compared with a median of about 20 million in patient samples.
Sperm from patient samples were also less likely to survive freezing. Cryopreservation caused a 66% reduction in motile sperm count in patient samples, compared witll a 54% reduction in control samples.
Percent motility and curvilinear velocity, two other indicators of semen quality, were lower in the patient samples both before and after freezing. Although acute and chronic leukemia are different clinical entities, the type of leukemia had no effect on semen quality.
Semen quality from these men would have meant they had little chance of becoming fathers using older methods of assisted reproduction, such as intrauterine insemination. However, the patients' semen is of sufficient quality to use for ICSI. Therefore, we encourage patients who may want children to consider banking sperm before beginning cancer therapy.
It is important to recognize that patients may die from their disease, and that cryopreserved semen samples from deceased men raise serious ethical and legal questions. To avoid potential difficulties, patients should specify at the time of banking how their sperm and any embryos are to be used in the event of their death.
Center for Reproductive Medicine
The Cleveland Clinic
10681 Carnegie Avenue, X11
Cleveland, OH 44195 USA
Tel: (216) 444-9485
Fax: (216) 445-6049