Preserving the Future

Sperm banking offers fertility protection for men facing cancer treatment

Marcia Leonard, co-director of the U-M Comprehensive Cancer Center Survivorship Program

Learn more about fertility preservation.

U-M Comprehensive Cancer Center's Survivorship Program, encourages patients to talk to their doctors about the impact of treatment on fertility. Some cancer treatments may cause infertility, but not all. That's why it's important to speak to your doctor and to think ahead. Sperm banking is a good option for men who are at risk of infertility: Many children have been born using sperm that has been banked as long as 25 years.

But it's key to talk to your doctor about it before treatment begins. The University of Michigan Comprehensive Cancer Center recently became a participating partner in the Sharing Hope Program, which offers financial assistance for cancer patients seeking to preserve their fertility.

We talked to Marcia Leonard, co-director of the University of Michigan Comprehensive Cancer Center's Survivorship Program, about what men with cancer need to know about sperm banking.

Q. Who should consider sperm banking?

All males facing cancer treatment should talk with their doctor about infertility risks. Surgery and radiation affecting the reproductive organs can lead to infertility. Radiation to the brain can damage the pituitary gland and affect the ability to produce the hormones necessary to make sperm. Some forms of chemotherapy may be toxic to sperm-forming cells and may cause long-term damage. The key is to talk to your doctor to find out what your risks are before you begin treatment.

Q. What about families with young boys or teenagers?

We talk with families about the impact of cancer treatment on fertility, even if the patient is very young. We aim to discuss sperm banking with families if the patient is a boy older than 12. Although the initial treatments for some forms of leukemia and Hodgkin's lymphoma are thought to be less damaging to fertility, it's important to consider that disease status can change; more aggressive treatment, like a stem cell transplant, may be necessary if the cancer comes back. If a transplant is required, fertility is likely to be damaged -- and there may not be sufficient recovery from previous treatment to allow for sperm banking.

Q. Is sperm banking an option after chemotherapy begins?

If you don't In general, no. Chemotherapeutic drugs can have an immediate effect on sperm.

Q. Will treatment be delayed by sperm banking?

In some cases, yes, but only by a few days. Your doctor will advise you whether it's safe to proceed with sperm banking. In most cases, it is.

Chemotherapy Fertility Risks

Chemotherapy can damage the cells in the body that make sperm. The type of chemotherapy drugs most likely to damage these cells are part of a class called alkylating drugs. The higher the dose of a chemotherapy drug-or combination of drugs-the more likely fertility is to be impaired. Drugs linked to infertility include:

  • Busalfan
  • Carmustine (BCNU)
  • Chlorambucil
  • Cyclophosphamide
  • Lomustine (CCNU)
  • Melphelan
  • Nitrogen mustard
  • Procarbazine
  • Temozolomide
  • Thiotepa

Q. How does it work?

Sperm is collected through masturbation. The U-M Center for Reproductive Medicine will analyze and freeze the sample. A small portion will be thawed to determine the number and viability of the sperm after freezing and thawing. As many as half of the sperm in a sample may not survive the process, so the lab will take that into account when determining the ideal number of samples required to optimize the chances of reproduction in the future.

Q. How many visits does it usually require?

On average, our patients usually need to produce three samples to ensure an adequate number of sperm for future use. However, some men will produce samples with higher numbers of viable sperm, which means fewer visits to the lab will be needed. Other men may only be able to produce one sample, due to their treatment schedule or health. With the help of assisted reproductive technologies, pregnancies are possible with very small numbers of sperm.

Q. What if a patient isn't comfortable discussing masturbation?

We completely understand that this can be an embarrassing topic to discuss. But sperm banking is an important medical concern that has life-altering impact. Our goal is to help male patients have children in the future. We treat all of our patients with absolute professionalism, and we try to make an awkward situation as comfortable as possible.

Q. Can patients bring in samples from home?

Yes, our lab provides approved containers that patients may use at home to collect a sample. The sample must arrive at the clinic within one hour of ejaculation. Patients may also use a private, locked room at U-M's Briarwood Center for Reproductive Medicine.

Q. How much does it cost?

The cost for men who produce three samples is about $1,000. The Cancer Center is a partner in the Sharing Hope Program for Men, which offers financial assistance to families who earn less than $75,000 or individuals who earn less than $50,000.

Q: You mentioned that very few men who are eligible decide to bank their sperm. Why?

For many, it's just too embarrassing to talk about masturbation -- or they may have social or religious objections. Sometimes, the health-care team does not inform the patient. But I think the most common reason is that patients are simply overwhelmed. They are trying to cope with a tremendous amount of information related directly to their cancer diagnosis, and throwing infertility into the mix is just too much. But unfortunately, fertility is something that has to be considered up front, because sperm banking isn't always an option after treatment begins. We aim to help our patients overcome obstacles to maintaining their fertility in the future. Many men may be able to conceive naturally after treatment, but for those who do become infertile, sperm banking is their insurance policy. Learn more by watching "Preparing for the Future," a seven part video series.

 

Visit the Fertility Preservation web page.

Please call 734-763-5384 (Monday-Friday, 8am-5:pm EST). To refer a patient, please contact our M-Line service: 800-962-3555.

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Thrive Issue: 
Spring, 2010