It is known that male cancer survivors are more likely to have infertility problems than others. This is mainly due to the use of various surgical, chemo and radiotherapy procedures which can have a negative impact on seminal quality, can compromise ejaculation or hypothalamic, pituitary and/or testicular function. In recent decades, advances in the field of oncology have led to an average 10-year survival rate which reaches almost 80% in patients with cancer onset in childhood, adolescence and young adults. Therefore, the increase in the population of young male survivors of cancer consequently leads to an increase in subjects showing reduced fertility. for these subjects the most obvious way to obtain paternity is to resort to Medically Assisted Procreation techniques (MAP), in particular those of II level such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
Conception through the IVF technique is more common in cases of less severe forms of male infertility, while the use of the ICSI technique is recommended for men with more severe impairment of fertility.
A study was recently published in the journal Human Reproduction that analyzed paternity rates with the use of PMA techniques after cancer treatments and identified the subgroups of male cancer survivors who have the highest percentage of children conceived using techniques PMA discriminating between IVF and ICSI.
Based on Swedish birth registry data, we identified a total of 1181488 men who conceived their firstborn in Sweden between 1994 and 2014. Of these, 26901 fathers had a cancer diagnosis, of which those with cancer were excluded. diagnosed with cancer less than 12 months after conception of the offspring, or with a diagnosis of cancer after conception of the offspring (n=21 529). The remaining fathers who had a history of cancer (n=5372) were divided into three groups based on their age at cancer diagnosis (<15, ≥15, and <24 or ≥24 years). Fathers without cancer diagnoses (n=1154587), were included as controls. We evaluated associations between IVF or ICSI use and cancer history using logistic regression models, unadjusted and adjusted for paternal education, father's age at delivery, and year of conception.
Among childhood cancer survivors, 6.0% conceived using PMA techniques, while this proportion is 10.1% for adolescents and young adults, 13.3% for adults, and 3.0% for controls. Adult cancer survivors achieved conception following both ICSI and IVF, while adolescent, young adult and childhood cancer survivors have a statistically significant probability of conceiving through ICSI. Compared with the general population, childhood, adolescent and young adult, and adult cancer survivors were all more likely to father a child through ART using donated sperm (33.3%, 7.6%, and 8.3%, respectively). Patients treated for malignancies in the male reproductive organs or hematologic or lymphatic system, particularly those diagnosed in adolescence or young adulthood and later, are more likely to conceive using the ICSI technique. These results highlight which groups of male cancer survivors would benefit from access to fertility carethereby improving future fertility treatment policies.