Correspondence

Case 15-2004: Cancer Therapy and Sperm Banking

N Engl J Med 2004; 351:510July 29, 2004

Article

To the Editor:

With regard to Case 15-2004 (May 13 issue),1 I would like to add an important point to the discussion of the impact of cancer therapy on fertility. Although the authors correctly note the association between testicular irradiation and the impaired synthesis of testosterone, they do not comment on the greater threat to spermatogenesis posed by the high doses of testicular radiation (18 Gy) and cyclophosphamide that were used to treat this patient. Doses of radiation above 4 Gy lead to azoospermia in most men,2 and alkylating agents such as cyclophosphamide are a common cause of infertility.3 Because of this treatment toxicity, young men should be offered the opportunity to bank sperm before undergoing cancer therapy involving alkylating agents or testicular irradiation.4 This simple procedure can be overlooked in the busy initial stage of therapy; however, permanent infertility may result. Fortunately, banked sperm can subsequently be used in assisted reproductive techniques to achieve fertility with high rates of success.

John K. Amory, M.D.
University of Washington, Seattle, WA 98195
jamory@u.washington.edu

4 References

1. 1

   Case Records of the Massachusetts General Hospital (Case 15-2004). N Engl J Med 2004;350:2081-2087
   Full Text | Web of Science | Medline

2. 2

   Rowley MJ, Leach DR, Warner GA, Heller CG. Effect of graded doses of ionizing radiation on the human testis. Radiat Res 1974;59:665-678
   CrossRef | Web of Science | Medline

3. 3

   Howell SJ, Shalet SM. Male hypogonadism resulting from cancer and cancer treatments. In: Winters SJ, ed. Male hypogonadism. Totowa, N.J.: Humana Press, 2004:247-62.
   

4. 4

   Anger AT, Gilbert BR, Goldstein M. Cryopreservation of sperm: indications, methods and results. J Urol 2003;170:1079-1084
   CrossRef | Web of Science | Medline

Author/Editor Response

We appreciate the information provided by Dr. Amory. Infertility is a major concern after stem-cell transplantation.1,2 We agree that sperm banking should be offered before chemotherapy is started.

Fortunately, in this case, our patient did bank sperm before proceeding with chemotherapy. One year after undergoing allogeneic stem-cell transplantation, he continues to do well.

Karen K. Ballen, M.D.
Robert P. Hasserjian, M.D.
Massachusetts General Hospital, Boston, MA 02114

2 References

1. 1

   Chatterjee R, Kottaridis PD. Treatment of gonadal damage in recipients of allogeneic or autologous transplantation for hematological malignancies. Bone Marrow Transplant 2002;30:629-635
   CrossRef | Web of Science | Medline

2. 2

   Sanders JE, Hawley J, Levy W, et al. Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation. Blood 1996;87:3045-3052
   Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   Clement K. Gwede, Susan T. Vadaparampil, Sarah Hoffe, Gwendolyn P. Quinn. (2012) The role of radiation oncologists and discussion of fertility preservation in young cancer patients. Practical Radiation Oncology
   CrossRef

2. 2

   Gwendolyn P. Quinn, Susan T. Vadaparampil, Clement K. Gwede, Cheryl Miree, Lindsey M. King, Heather B. Clayton, Crystal Wilson, Pamela Munster. (2007) Discussion of fertility preservation with newly diagnosed patients: oncologists’ views. Journal of Cancer Survivorship 1:2, 146-155
   CrossRef