Electroejaculation as a method of fertility preservation in boys diagnosed with cancer A single center experience and review of the literature

Capsule:
Semen cryopreservation is an option to preserve fertility and should be offered to all pubertal boys diagnosed with cancer. If masturbation fails, electroejaculation can be considered as a useful option for semen cryopreservation.

Authors:
Maria Adank, B.S., Wendy van Dorp, M.D., Marij Smit, M.D., Ph.D., Niels van Casteren, M.D., Ph.D., Joop Laven, M.D., Ph.D., Rob Pieters, M.D., Ph.D., Marry van den Heuvel-Eibrink, M.D., Ph.D.

Volume 102, Issue 1, Pages 199–205.e1

Abstract:

Objective:
To evaluate the feasibility of electroejaculation to perform semen cryopreservation in pubertal boys before gonadotoxic therapy and to review the literature on this topic.

Design:
Retrospective cohort study and review of the literature.

Setting:
Academic children’s hospital.

Patient(s):
Boys diagnosed with cancer to whom sperm cryopreservation was offered before the start of gonadotoxic therapy.

Intervention(s):
We studied the outcome of electroejaculation, including patient characteristics, hormone levels, and pretreatment semen parameters.

Main Outcome Measure(s):
Semen cryopreservation.

Result(s):
Pretreatment semen samples were obtained by masturbation in 106/114 boys with cancer, of which 78/106 were adequate for preservation. Electroejaculation was offered to 11 boys, of which three of 11 samples appeared adequate for preservation. Reviewing all reported electroejaculation cases in children with cancer in the literature, 13/29 (45%) cases were successful. Testosterone levels were higher in patients with successful sperm yield obtained by electroejaculation (median, 8.3 nmol/L [5.2–42.4] in successful harvests, vs. median 1.7 nmol/L [0.01–17.9] in unsuccessful harvests).

Conclusion(s):
Semen cryopreservation should be offered to all pubertal boys diagnosed with cancer. If masturbation fails, electroejaculation can be considered as a useful option for semen cryopreservation and leads to adequate material for cryopreservation in about half of the cases.

  • Jason Kovac

    From the abstract it is difficult to tell if the authors noted the age of these boys. Furthermore, if testosterone levels were higher in boys with successful sperm yield, should we be measuring testosterone as a means of telling if the procedure would be successful?

  • Electroejaculation is a very specialized procedure that may not be able to be performed at most centers that treat young men with cancer. It requires sedation or general anesthesia. Given the study’s success rates in only 3/11 when masturbation failed, I think testicular sperm extraction and cryopreservation should also be considered as a viable option for those wishing to preserve fertility for the future with minimal addition of risk/co-morbidities. .

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