Cancer patients should be offered semen cryopreservation

EDITOR—M⊘ller and Skakkebæk have confirmed the association between male subfertility and subsequent testicular cancer.1 We and others have shown that men with malignant disease, and especially with testicular cancer, have reduced sperm quality at the time of diagnosis of their illness.2^–4 Further deterioration occurs due to the damaging effect of chemotoxic agents on spermatogenesis, which may be temporary or permanent.5 However, most men have sufficient suitable sperm for freezing before starting chemotherapy.

Survival of young men with cancer has improved in recent years. Progress in assisted reproductive techniques, and especially in micromanipulation and intracytoplasmic sperm injection, can secure the fertility potential of these men. Men with cancer, particularly those who have not completed their family yet, must have the opportunity to freeze semen samples for future use. Our results indicated that their probability of fathering their own genetic children is quite high.2 Moreover, patients' knowledge that their fertility potential is secured would help in the emotional battle against the cancer.

We wish to increase the awareness of general practitioners, oncologists, haematologists, and patients to the new opportunities opened to them in recent years. Our impression, after running a successful sperm cryopreservation programme for the past nine years, is that only a minority of eligible patients are offered sperm cryopreservation. We call on medical teams treating male cancer patients to refer them for semen cryopreservation in tertiary assisted conception centres before starting chemotherapy. These centres have the facilities and experience for cryopreservation and can offer appropriate assisted reproductive treatments.