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Conception following medical treatments

For males who were treated at an earlier age, however (i.e. before the onset of puberty), the received wisdom is often that the prepubertal testis is less susceptible to damage by gonadotoxic agents and therefore the boy’s fertility is less likely to be affected when he reaches adulthood. However, the evidence to support this point of view is lacking and it has been suggested that there may still be sufficient cellular activity in the apparently quiescent (prepubertal) testis for significant gonadotoxic damage to occur. This is exemplified by a number of studies that have looked at the adult semen quality of childhood cancer survivors. For example, Lopez Andreu et al. and Relander et al. followed two independent cohorts (various diagnoses) of boys for over 13+ years and found that only 37 per cent and 63 per cent respectively had normal spermatogenesis as adults.

Similarly, a study of 33 males with a history of childhood cancer (with a median age at diagnosis of ten years old) found that only 33 per cent had normal semen quality as adults and 30 per cent were azoospermic. By contrast, a study by Byrne et al. of survivors of childhood acute lymphoblastic leukaemia found that only men treated with high-dose cranial radiotherapy had a significantly reduced fertility when compared with controls. Ironically, in those who were treated as prepubertal boys and who have permanent azoospermia as adults, there are very few options to assist with their infertility because they will not have had the opportunity to bank sperm prior to the onset of treatment. This represents significant challenges for the medical and scientific community as the survival rates of childhood cancer continue to improve.

For adult males who are intending to conceive with their partner, irrespective of whether they had medical treatments before or after puberty, the general opinion is that if normal levels of sperm production are occurring at the time that conception is being considered, then there should be no reason why the couple should not be able to conceive by methods of natural family planning and with no medical Online Viagra Store in Canada intervention. This is notwithstanding that the probability of subfertility in the female partner will be evident at a level consistent with the general population of pregnancy planners and this in itself may require the couple to need some form of assisted conception to overcome it (see below).

Unfortunately, the actual incidence of unassisted conception in men with a previous cancer diagnosis has not been systematically described for all medical conditions and treatment options. However, over a ten-year follow-up period of men with stage 1 testis tumour Herr et al. indicated that 65 per cent of couples that attempted a pregnancy were successful. In a further series of 63 patients with testicular germ cell malignancy 40 per cent of patients who attempted fatherhood were successful at initiating a pregnancy (although only 24% were without the assistance of assisted conception).