Weibring, K., Lundberg, F. E., Cohn-Cedermark, G., & Rodriguez-Wallberg, K. A. (2024). Parenthood in a Swedish prospective cohort of 1,378 adolescents and young adults banking semen for fertility preservation at time of cancer diagnosis. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2024.1502479
Weibring K, Lundberg FE, Cohn-Cedermark G, Rodriguez-Wallberg KA. Parenthood in a Swedish prospective cohort of 1,378 adolescents and young adults banking semen for fertility preservation at time of cancer diagnosis. Frontiers in endocrinology. 2024. doi:10.3389/fendo.2024.1502479
Weibring, Kristina, et al. "Parenthood in a Swedish prospective cohort of 1,378 adolescents and young adults banking semen for fertility preservation at time of cancer diagnosis." Frontiers in endocrinology, 2024.
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Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.056d84691
Most fathers among sperm-banking cancer survivors conceived naturally
A Swedish cohort study of 1,378 adolescents and young adults who banked sperm at cancer diagnosis found that about 8 out of 10 men who became fathers afterward conceived naturally. Fewer than 2 out of 10 of those fathers used assisted reproductive techniques (ART). Of 1,357 eligible men, 493 became fathers.
Key Findings
Of 1,357 survivors eligible for analysis, 493 (36%) became fathers after cancer treatment: 399 (81%) conceived naturally, 87 (18%) used assisted reproductive techniques, and 7 (1%) adopted.
Of the 399 men who conceived naturally, 236 (59%) had been treated for testicular cancer, 75 (19%) for lymphoma and 14 (4%) for acute leukemia.
Of the 1,357 survivors, 92 (6.8%) used their cryopreserved sperm for IVF/ICSI, and 34 of those 92 (37%) became fathers using their frozen sperm.
Ten years after cryopreservation, 45% (95% CI, 0.38–0.51) of men with seminoma and 52% (95% CI, 0.45–0.59) of men with non-seminoma had become fathers.
Among men with acute leukemia, 31% (95% CI, 0.19–0.44) had become fathers by five years after cryopreservation, with death counted as a competing risk.
Interpretation
The study is an observational cohort with registry follow-up of men referred to one regional program in Stockholm between 1988 and 2020. The authors report no data on the desire to start a family in the full cohort, on natural attempts that did not lead to treatment, or on female partner factors. The registers lacked information on comorbidities, lifestyle and cancer treatment details. Men may have had children before cryopreservation. Short follow-up may underestimate use of frozen sperm. The authors assumed the male partner's cancer history was the main factor in any infertility.
RRM Context
Restorative reproductive medicine evaluates both partners and looks for the cause of reduced fertility. The authors call a thorough medical evaluation of the female partner crucial. They write that future infertility studies should include female and male factors. Earlier studies they cite suggest that 15%-30% of young male cancer survivors may have transient infertility lasting months or years.
Our editorial summary of this paper, not the article's abstract.
Abstract
The possibility of future parenthood is a highly relevant issue for patients of reproductive age facing oncologic treatment. This study aimed to investigate how fatherhood was achieved in a patient cohort of adolescents and young adults (AYAs) banking semen at time of cancer diagnosis and to determine the effectiveness of cryopreservation aimed at fertility preservation in the cohort. Observational cohort study examining AYAs with a cancer diagnosis who underwent semen banking for fertility preservation at Karolinska University Hospital 1988-2020, as part of the Stockholm regional fertility preservation program. This cohort is being prospectively followed since time of referral to the program, with most individuals included when presenting with primary cancers (Study Registration: ClinicalTrials.gov NTC04602962). Individuals achieving adulthood in the cohort were followed-up regarding their reproductive outcomes by linking to the Swedish Multi-generation Register, to identify fatherhood through natural conception or adoption, and to the Swedish National Quality Registry for Assisted Reproduction to identify parenthood through medical assistance, including the use of own sperm either cryopreserved or fresh, or donor sperm. Of the 1,378 patients referred during the study period, 1,357 were eligible for fatherhood analysis (aged >20 years at the end of follow-up, December 31, 2021). In total, 493 men became fathers following cancer treatment: 399 (81%) did so naturally, 87 (18%) via assisted reproductive techniques (including two using donor sperm), and 7 (1%) through adoption. Of the 92 patients who used their cryopreserved sperm for assisted reproductive techniques, 34 (37%) successfully fathered a child. The patients may have had children prior to cryopreservation. A large proportion of AYA cancer survivors achieved fatherhood through natural conception in this cohort, whereas less than 1 in 5 survivors needed medical assistance to conceive. Although a low utilization rate of cryopreserved sperm was found in this cohort, its use was highly effective in the group that developed infertility. At present there are no standardized predictors of testicular toxicity after cancer treatment, and inter-individual variability is high. Further research is needed to identify patients at risk of infertility who would benefit from fertility preservation.
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