Assisted Reproduction Freezing and Storage
RRM Academy Synopsis
One Canadian clinic saw 3.2% of cancer patients use banked sperm
At one clinic, about 3 out of 100 cancer patients who banked sperm used it. A 20-year review of 2504 patients at a Canadian academic fertility center found this. Another 2.5% transferred samples to other clinics. Among 67 couples with reviewable outcomes, 53.7% had at least one clinical pregnancy after insemination or IVF.
Key Findings
- Of 2504 patients, 81 (3.2%) used their samples at the clinic, 452 (18.1%) discarded them, 62 (2.5%) transferred them, and 1864 (74.4%) still have samples stored.
- The 81 patients who returned did so 1 to 131 months after banking, with a median of 18 months. Most patients (80%) returned within 3 years.
- Among the 67 couples with reviewable outcomes, 36 (53.7%) had at least one clinical pregnancy. The rate was 6.6% per IUI cycle and 30.8% per IVF embryo transfer.
- Couples with a positive pregnancy result had on average 1.9 more usable embryos per IVF cycle (p=0.02). Sperm concentration and total motile count were not associated with a higher chance of pregnancy.
- Referrals grew from 60 patients in 2001 to 205 in 2020. Testicular cancer (29.5%) and lymphoma (26.9%) were the most common diagnoses.
Interpretation
The study is a retrospective chart review at one Toronto fertility center, so it describes what happened without explaining why. Age was missing for 38.5% of patients, and outcomes could be reviewed for 67 of the 81 who returned. Too few patients returned for the authors to adjust for partner age or fertility history. The pregnancy rates use different bases: per couple, per IUI cycle, and per embryo transfer. The authors do not know why patients discarded their samples or did not return. The study reports clinical pregnancies and gives no live birth figures.
RRM Context
Restorative reproductive medicine evaluates both partners. Couples with a positive pregnancy result also had more eggs injected and more usable embryos per IVF cycle. The authors take this to imply a possible female factor contribution. The authors also raise a return of natural sperm production as one possible reason patients did not use their samples. Restorative clinicians ask what has recovered and why conception is or is not happening.
Abstract
Many cancer treatments pose a threat to fertility for patients. Semen cryopreservation before cancer treatment is an effective method to preserve fertility. There are sparse long-term data on the usage of samples from Canadian oncology sperm banks. A retrospective chart review of all oncology sperm banking samples at a Canadian academic fertility centre from 2001 to 2020 was conducted. From 2001 to 2020, 4521 samples were banked by 2504 patients. The most frequent diagnoses among these patients were testicular cancer (29.5%) and lymphoma (26.9%). Of these patients, only 81 (3.2%) patients returned to use their samples with intrauterine insemination (IUI) or in vitro fertilisation (IVF) treatment and 62 (2.5%) patients transferred their samples to another clinic. The time between banking and return for usage of the sperm ranged from 1 to 131 months with a median of 18 months after banking. A total of 66 IVF cycles (104 embryo transfers) and 101 IUI cycles from 67 patients were reviewed. Of the 67 couples who used their samples, 53.7% achieved a clinical pregnancy. The clinical pregnancy rate was 6.6% per cycle for IUI and 30.8% per embryo transfer for IVF. Higher sperm concentration or total motile count was not associated with a higher chance of pregnancy. Patients who conceived had on average 1.9 ± 0.8 (p=0.02) more usable embryos per cycle than those who did not conceive. Sperm cryopreservation provides a valuable option for patients with cancer to achieve parenthood after potentially gonadotoxic cancer treatment. However, the overall usage of banked oncology sperm samples is very low.
