Fertility considerations and methods of fertility preservation in patients undergoing treatment for cancer

When treating young patients with cancer, one is faced with the task of prolonging survival while limiting toxicity. Even when confronted with life-threatening illness, patients understandably place emphasis on fertility preservation. This is compounded with the fact that a substantial proportion of patients with certain malignancies, such as testicular cancer (TC), acute lymphoblastic leukemia (ALL), and Hodgkin's lymphoma (HL) have pretreatment reproductive potential. This chapter reviews the main effects of cancer treatment on fertility and presents the contemporary approach to fertility preservation. Some aspects of this chapter have been previously reviewed [1–3]. Effect of cancer on pretreatment fertility The cancer itself may cause impaired fertility, before any gonadotoxic treatment [4]. This effect is mainly documented in males with HL and TC. There is a significant prevalence of impaired spermatogenesis among patients with testicular germ cell cancers, before treatment [5]. Pretreatment azoospermia has been demonstrated in approximately one quarter of these patients, while another quarter has oligospermia [6]. There is also consistent evidence that only approximately 30% of male HL patients have normal pretreatment sperm samples, while the remainder have varying degrees of dyspermia [7]. There are conflicting reports on the effect of disease stage on sperm quality. A similar phenomenon has been shown in non-Hodgkin’s lymphoma (NHL) and other types of cancer, but is supported by less evidence than in HL and TC.