Fertility preservation in males with cancer of trends, region development, and efficacy in mainland China from 16 regions Chinese sperm banks

Abstract

Purpose: Male cancer survivors experience confusion about fertility following cancer treatment. The aims of this study were to evaluate survivors' semen quality in different tumor type groups in China and to analyze the current situation and challenges of male cancer patients with sperm cryopreservation.

Methods: This was a multicenter retrospective study of male patients with cancer who underwent sperm cryopreservation in 16 regions of the national sperm banks over an 11-year period from 2010 to 2020.

Results: The number of male cancer patients with sperm cryopreservation showed an overall upward trend. The development of male cancer fertility preservation (FP) in the eastern, central, and western regions of Chinese displayed imbalance. There are seven tumor types for sperm preservation in the top incidence ten tumor types, including lymphoma, leukemia, nasopharyngeal carcinoma, sarcoma, thyroid cancer, and brain tumor. Moreover, nasopharyngeal carcinoma is a high incidence rate in China, which is related to high sperm preservation rate, different from other countries. The most percentage of males receiving sperm cryopreservation in the testicular cancers (15-39 years old) of China in 2020 was 5.55%, 1.29% in the lymphoma, and 0.39% in the leukemia. According to the type of cancer, a statistically significant lower pre-sperm density, total sperm output, and post-sperm density was observed in testicular cancers. It is worth noting that the prevalence of azoospermia 22.2% in leukemia patients attribute to urgent treatment before sperm cryopreservation. Disposition of cryopreserved sperm categories included continued storage (47.2%), discarded (9%), death (0.9%), and use (3.7%).

Conclusion: This study provides the first comprehensive national statistical census and review of fertility preservation in male cancer patients with respect to trends, prevalence, and cancer types. The development of male cancer fertility preservation in China is imbalanced and percentage of males receiving sperm cryopreservation in the adolescent and young adult cancers was low. Sixteen human sperm banks from China analyze current problems and challenges, and then prioritize steps toward the achievement of the FP strategy framework for Healthy China 2030.

Keywords: Fertility preservation; Male cancer; Semen quality; Sperm cryopreservation.

Fig. 1

Maps of contributing of sperm cryopreservation for Chinese male cancer patient agencies and Geographic Regions in China. Dots indicate the locations of the sperm cryopreservation for Chinese male cancer patient agencies

Fig. 2

A Percentages of men with cancer who banked sperm. B Changes over time in the number of patients referred to human banks for sperm cryopreservation from 2010 to 2020. C Change over time in the number of the patients referred for sperm cryopreservation of three most frequent types of cancer

Fig. 3

Comparison of cancer incidence, mortality among 15–39 population and fertility preservation of cancer men in China in 2020. A The top ten incidence, mortality of male (ages 15–39) and the top ten malignant tumors in male inducing sperm preservation in China. B Comparison between cancer cases male cancers (15–39 years old) and sperm cryostorage of cancer men in 2020. C Proportional distribution of sperm cryostorage of cancer type by age group. The minimum age of cancer patients was 13 and the maximum age was 64

Fig. 4

Flowchart of patients’ success in sperm sample production

Fig. 5

China challenges of FP in the process of Healthy China 2030 and FP strategy frame for Healthy China 2030. FP, fertility preservation; IVF, in vitro fertilization