Fertility and sexual dysfunction in young male cancer survivors

Abstract

Background: Newly emerging serious post-treatment complications among young male cancer survivors involve fertility and sexual function, preventing them from pursuing a normal family life.

Methods: We studied and summarized published studies that assess the relationship between cancer treatments and reduced spermatogenesis or sexual dysfunction.

Main findings: Infertility often occurs because of anticancer therapies that impair spermatogenesis. While some patients postremission functionally recover fertility, others experience a decreased sperm count and azoospermia. Fertility-preserving modalities are currently being promoted worldwide to preserve spermatogenesis following cancer therapy. Patients who can ejaculate and have sperm in their semen should cryopreserve semen. However, for patients who have never ejaculated before puberty or in whom spermatogenesis has not been established, testis biopsy is performed to collect and preserve sperm or germ cells. Fertility preservation is gaining popularity and requires continuous information dissemination to oncologists and cancer treatment professionals. Furthermore, male sexual dysfunction predominantly involves erectile dysfunction and ejaculation disorder.

Conclusion: Although preventive and therapeutic methods for these disorders have been established within urology, patients and medical professionals in other fields remain uninformed of these advances. Therefore, dissemination of information regarding fertility preservation techniques should be accelerated.

Keywords: chemotherapy; ejaculation; erectile dysfunction; radiotherapy; spermatogenesis.

FIGURE 1

Algorithm developed by Picton et al. for cryopreservation of testicular tissue and sperm in prepubertal and pubertal patients, which should be used prior to high‐risk treatments that may lead to infertility. Pubertal patients are first tested for semen, and the storage protocol is performed if the semen contains enough storable sperm. Patients who are unable to produce sperm (including those who cannot ejaculate) or those with oligozoospermia or azoospermia undergo testicular biopsy (Onco‐TESE). Intraoperative analysis is performed on the tissues obtained through biopsy, and any sperm detected are stored (mature testis protocol). The immature testis protocol is a method of cryopreserving tissues that contain sperm‐like cells (spermatogonia to spermatids). Since there is a high possibility that there are no sperm in the tissue, cryopreservation is expected with the hope that future medical advances will enable the differentiation of sperm‐like cells (germ cells) into sperm cells. In prepubertal patients, the tissue is collected and cryopreserved on the premise that masturbation is not possible (immature testis protocol).