**6. Social importance and psychological aspects around banking oncology patients, adolescent and young adults**

When an individual is diagnosed with cancer almost every aspect of their physical and psychosocial well-being is altered. Quite often in clinical practice, the long term effects of cancer therapy on a patients' ability to have children in the future is not adequately addressed (Thaler-DeMers, et al., 2001). While the priority is to eliminate the cancer and save their life, fertility preservation especially among adolescent or young adults to ensure the potential of procreation with their own gametes after treatment, needs to be considered. Impaired spermatogenesis has been demonstrated before treatment in some patients with malignancies, depending on their location (eg. testicular cancer) or type (eg.Hodgkin's lymphoma) (Rueffer et al., 2001). Current treatment options such as surgery, chemotherapy and/or radiation can impair spermatogenesis and sexual function and lead to temporary or permanent infertility (Magelssen et al., 2006).

The scale of negative effects of cancer treatment on spermatogenesis depend on the specific gonadotoxicity of administered chemotherapeutic agents, number of chemotherapy treatment cycles, radiotherapy field location and dosage, type and stage of the cancer, and age of the patient. Considering combination cancer therapy, uncertainty in individual response to treatment and the large number of confounding variables, it becomes very challenging to assess the risk of iatrogenic infertility in many patients. The ability of cancer survivors to have their own biological offspring is very important for many oncology patients, especially at younger ages (Schover et al., 1999). Advances in early diagnostic investigation and treatments have led to increasing numbers of young cancer survivors. Unfortunately up to 30% of childhood cancer survivors are permanently sterile following cancer treatment (Tournaye et al., 2004). In Canada and the United States, cancer in patients 15 to 29 years of age who can benefit from sperm banking is nearly three times more common than in patients younger than 14 years (Bleyer et al., 2006). Early germ cells, (spermatogonia) are very sensitive to radiation and chemotherapy. Even low doses or a single dose treatment can potentially cause functional impairment of spermatogenesis. With increase in dosage or duration of the treatment, initially spermatocytes get damaged and as treatment progresses spermatids also become damaged. Radiation doses of less than 0.8 Gy can result in oligospermia and doses between 0.8 and 3 Gy can result in azoospermia (Rivkees & Crawford, 1988).

Cryopreservation of semen has changed the reproductive prospects for young patients diagnosed with cancer. Unfortunately, banking services continue to be underutilized since cancer patients and their families are not always informed about the potential fertility risks associated with cancer treatments, or the availability of banking. According to some surveys, less than 20% of patients undergoing chemotherapy or radiation treatment are informed about the adverse effects of such treatment on spermatogenesis or are offered sperm banking for fertility preservation. Cancer patients are usually under huge physiological and time pressure to make cryopreservation decisions while dealing with a life threatening situation. To complicate matters, some young patients are unable to produce semen samples by masturbation. In such cases, PVS or electro-ejaculation under general anaesthetic might be required. Surgical retrieval of testicular tissue may be an option for

Cryopreservation of Human Spermatozoa

**8. References** 

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prepubertal boys who are not capable of producing mature sperm. Testicular tissue cryopreservation has been reported in boys with cryptorchidism to preserve fertility (Bahadur et al., 2000). Cryopreserved testicular tissues can be autografted to restore reproductive functions; however recurrence of neoplastic process is a concern in oncology patients and such procedures are still considered to be experimental (Hwang & Lamb, 2010). A multi-disciplinary team approach is important to ensure that patients have the opportunity to preserve their fertility potential if they elect to do so.

The posthumous use of semen is an entirely separate and complex ethico-legal subject. The ethical and legal aspects of posthumous assisted reproduction have been recently addressed by the European Society of Human Reproduction and Embryology Task Force on Ethics and Law (ESHRE, 2006).
