The increasing number of cancer survivors is attributed to advances in cancer treatment. However, these treatments can have adverse effects on male fertility, either temporarily or permanently. For adult males undergoing treatment for cancer who are concerned about their future fertility, sperm cryopreservation (storing sperm at a very low temperature) is the most effective method for preserving fertility. This procedure is integral to assisted reproductive technologies (e.g. IVF) and should be initiated before the onset of fertility-compromising oncological procedures. This study by Li et al aimed to evaluate the effectiveness of sperm cryopreservation in preserving fertility and reproductive outcomes in male cancer patients, with a particular emphasis on the effects of various assisted reproductive technology methods on reproductive outcomes when using cryopreserved sperm.

Authors conducted an extensive literature search for relevant studies published through to 31 December 2021, in the following databases: CENTRAL, CNKI, Cochrane Systematic Reviews, EMBASE, MEDLINE, PUBMED, and Web of Science. They included all studies that reported offering or attempting to cryopreserve sperm before or during cancer treatment in male patients considered at risk of treatment-related fertility impairment.
This meta-analysis included 69 non-randomized studies, with 32,234 patients referred for sperm analysis and 23 178 patients cryopreserving at least one sperm sample.
The pooled failed-to-cryopreserve rate was 10% (95% CI, 8–12%), and the sperm disposal and sperm use rates were 23% (95% CI, 16–30%) and 9% (95% CI, 8–10%), respectively.
The pregnancy, miscarriage, and delivery rates were 28% (95% CI, 22–33%), 13% (95% CI, 10–17%), and 20% (95% CI, 15–25%), respectively.

Subgroup analysis showed higher pregnancy and delivery rates, as well as a lower failed-to-cryopreserve rate, in recent studies compared to those released a decade ago.
The studies from Asia reported higher sperm disposal and pregnancy rates than in other continents.
Study analysis showed clinical pregnancy rates per cycle of 34% (27–41%), 24% (14–35%), and 9% (5–15%) and delivery rates per cycle of 23% (17–30%), 18% (11–26%), and 5% (1–9%) for ICSI, IVF, and IUI, respectively.
In conclusion, this study supported previous reports that sperm cryopreservation is an effective method of fertility preservation in male patients with cancer. The rate of use of frozen sperm in the review underestimated the actual rate, making it meaningful to actively recommend fertility preservation to patients with cancer. ART plays an important role in fertility preservation and pregnancy achievement, with ICSI resulting in better clinical outcomes than IVF and IUI in patients with cancer. Hence, fertility preservation still requires the involvement of oncologists, reproductive medicine clinicians, andrologists, and embryologists.
Source: Li et al.; Human Reproduction Open, 2024, 2024(1), hoae006 https://doi.org/10.1093/hropen/hoae006