Human Reproduction, Vol. 19, No. 6, 1448-1449,
June 2004
© 2004 European Society of Human Reproduction and Embryology
Live birth with sperm cryopreserved for 21 years prior to cancer treatment: Case report
1 Department of Reproductive Medicine, St Mary’s Hospital, Manchester M13 0JH and 2 Department of Clinical Oncology, Christie Hospital, Manchester, UK
3 To whom correspondence should be addressed. e-mail: greg.horne{at}cmmc.nhs.uk
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Abstract |
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Advances in cancer treatment have led to significant improvements in the likelihood of reaching remission and long-term survival for men. Chemo- and radiotherapy-induced infertility are significant treatment side effects. Cryopreservation before the start of treatment enables sperm to be stored, thereby preserving the man’s potential fertility. Here, we describe the successful use (with ICSI) of sperm cryopreserved prior to cancer treatment, for a total of 21 years. We believe this to be the longest period of sperm cryopreservation, resulting in a live birth, so far reported in the literature.
Key words: ART/cancer/cryopreserved/sperm
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Introduction |
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Testicular cancers are one of the most frequent malignant diseases in young men. Improved cancer treatment has significantly improved remission and long-term survival rates. The chance of survival in men with germ cell tumours may reach 90% (Germa et al., 2001
). Chemo- or radiotherapy-induced infertility is a major side effect of these improved survival rates. Not only can there be a reduction in sperm concentration due to the effects on the spermatogenic epithelium but treatment can also have mutagenic side effects (Morris, 2002). Semen cryopreservation prior to the start of therapeutic cancer treatment enables sperm to be stored and preserves the man’s potential fertility with the option of assisted reproductive techniques (ARTs) at a later date. This case history describes a live birth following ART utilizing sperm stored for 21 years, the longest reported in the literature. |
Case report |
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In 1979, the patient, then aged 17, was diagnosed with a malignant testicular teratoma necessitating a right orchidectomy. The tumour markers
-fetoprotein (AFP) and 
-HCG remained elevated, and a computed tomography (CT) scan demonstrated enlarged left para-aortic lymph nodes. He was immediately referred to the Sub-Fertility Laboratory at St Mary’s Hospital, where five ampoules of sperm were cryopreserved from four ejaculates (Table I). The patient then received a course of radiotherapy, which included the contralateral testicle within the radiation field. However, the tumour markers increased following completion of the radiotherapy. He was given four courses of chemotherapy (cisplatin, vinblastine and bleomycin). A para-aortic mass persisted accompanied by mild elevation of the tumour markers. In 1981, a laparotomy and resection of the retroperitoneal mass was performed. He remained well thereafter with no evidence of recurrence, and in 1992 was discharged from follow-up. At this point, he and his partner considered their future, including planning a family.
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In 1995, after 3 years of attempting to conceive naturally, the couple were referred to the Department of Reproductive Medicine, St Mary’s Hospital. A semen analysis in 1995 confirmed his persistent azoospermia. The waiting time for IVF treatment was 3 years. In 1998, following infertility investigations, which confirmed azoospermia, the couple (male age 36 years and his female partner, age 28 years) were accepted for treatment by IVF using ICSI. Four IVF/ICSI treatment cycles were performed, using all five ampoules of the cryopreserved sperm. Data on sperm quality both before and after cryopreservation and after preparation for ICSI are shown in Table I. Sperm quality post-thaw was good in all but one of the banked ejaculates, and fertilization and fresh embryo transfer were achieved in three of the four cycles, however, the outcome was unsuccessful. The second cycle produced poor quality embryos which were not transferred. In the fourth IVF cycle, sufficient embryos were created to allow three to be cryopreserved according to departmental policy (Horne et al., 1997
). The couple had their frozen embryos thawed and two transferred in 2001. The outcome was successful and a healthy baby boy weighing 3700 g was born in 2002. |
Discussion |
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This case report describes the storage of sperm for 21 years followed by a live birth following IVF/ICSI treatment. The semen was stored at a time of great emotional stress due to the initial cancer diagnosis and anticipation of therapy. Fertility was unlikely to be an immediate priority for a 17 year old. A recent cohort study has demonstrated that only 27% of men who stored semen at our centre prior to cancer treatment utilized their samples within 10 years. (Blackhall et al., 2002
). However, as in the present case, many patients requesting semen cryopreservation are young (median age 24 years; Blackhall et al., 2002) and hence are likely to delay starting a family. Since, in the UK, sperm can be stored until the man is aged 55 years (HFEA, 2001), this suggests that follow-up studies of cryobanked sperm utilization need to be extended to at least 25 years. With improvements in ART, e.g. the cryostorage of single sperm and their use via ICSI (Cohen et al., 1997), the chance of pregnancy for these couples is increasing. Semen cryopreservation should be offered to all men prior to chemotherapy or radiotherapy. Although there are some data to suggest that cryopreservation and thawing can induce DNA damage in sperm, at least from infertile men (Donnelly et al., 2001), there are no data to suggest that damage is increased by the period of storage. In our case, even after 21 years of storage, the percentage of motile sperm post-thaw was high. This case report provides evidence that long-term cryopreservation can successfully preserve sperm quality and fertility.
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References |
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TopAbstractIntroductionCase reportDiscussionReferences |
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Blackhall FH, Atkinson AD, Maaya MB, Ryder WDJ, Horne G, Brison DR, Lieberman BA and Radford JA (2002) Semen cryopreservation, utilisation and reproductive outcome in men treated for Hodgkin’s disease. Br J Cancer 87,381–384[CrossRef][ISI][Medline]
Cohen J, Garrisi GJ, Congedo-Ferrara TA, Kieck KA, Schimmel TW and Scott RT (1997) Cryopreservation of single human spermatozoa. Hum Reprod 12,994–1001.
Donnelly ET, Steele EK, McClure N and Lewis SE (2001) Assessment of DNA integrity and morphology of ejaculated spermatozoa from fertile and infertile men before and after cryopreservation. Hum Reprod 16,1191–1199.
Germa JR, Garcia Del Muro X, Maroto P, Lianes P, Arranz JA, Guma J, Aparico J, Satre J, Alba E, Terrasa J, Saenz A and Fernandez A (2001) Clinical pattern and therapeutic results obtained in germ-cell testicular cancer in Spain based on a consecutive series of 1250 patients. Med Clin Barcelona 116,481–486.[Medline]
HFEA. (2001) Code of Practice, 5th edn. HFEA, London.
Horne G, Critchlow JD, Newman MC, Edozien L, Matson PL and Lieberman BA (1997) A prospective evaluation of cryopreservation strategies in a two embryo transfer programme. Hum Reprod 12,542–547.
Morris ID (2002) Sperm DNA damage and cancer treatment. J Androl 25,255–261.
Submitted on October 6, 2003; accepted on March 16, 2004.
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