Fertility preservation, when done prior to certain cancer treatments, is an important but sometimes over-looked part of the cancer patient’s experience. Last week we posted information on the fertility preservation options for women. Today we are focusing on the options for men. See the article below for more information on or watch the video here.
What are the main options for a pre-treatment adult male?
The options for men are sperm banking which is the most common, testicular sperm extraction which is little bit more in depth and can be done before or after treatment, and testicular tissue freezing which is very experimental and not commonly done in a lot of different places and you‘d have to work with urologist that’s comfortable doing that.
Sperm banking is the most common option for men. It’s readily available. There’s not a large time frame that needs to happen. Generally, men are referred to the urologist and able to be seen rather quickly. The urologist is able to do a quick exam and then able to have them produce a sample. So there’s not a lot of time that’s involved and men can do several samples before their actual treatment starts.
Say a man has a week before treatment starts, he might be able to do two or three samples before that. Even if he’s not able to do several samples, he’s generally able to, at least, do one sample before treatment starts and there’s not a lot of time that’s involved with that. They’re able to bank whatever is available. With advances like ICSI through in vitro fertilization, men don’t need several samples in order to achieve a pregnancy later on. They just really need a few good sperm.
Testicular sperm extraction is an outpatient procedure that an urologist would do where they actually go in and look through the testicular tissue to see if they can find any sperm and to try to extract those sperm in order to use it for ICSI to achieve a pregnancy. And then testicular tissue freezing is actually where they would go in and remove tissue and freeze it, hopefully prior to treatment, but it is very experimental.
This week, the media is highlighting a new study that claims that being vegetarian or vegan could lead to lower fertility among men. So, what are the facts? Read the article below.
Does Being Vegetarian Really Lower Your Fertility?
(Published in Care2 by Steve Williams)
Presented at the American Society for Reproductive Medicine’s annual conference this month, the research by Loma Linda University Medical School in southern California reportedly compares results from sperm analyses that were carried out during 2009-2013. The research involved 443 meat-eaters, 26 vegetarians and five vegans and was looking at sperm motility, concentration and overall health.
The researchers say they found that vegetarians had an average sperm count at the 50 million/milliliter mark. The five vegans had a similar level. This is in comparison to meat eaters, who reportedly had a figure closer to 70 million/milliliters. The researchers also say that vegetarians and vegans had a lower sperm motility than meat eaters, 33 percent compared to 58 percent.
The researchers note that the lower results from vegetarians and vegans do not put those members of the sample into the infertile range. They would fall within the “normal” bracket, but at the lower end of the scale.
Researcher Dr. Eliza Orzylowska told the Telegraph: “We found that diet does significantly affect sperm quality. Vegetarian and vegan diets were associated with much lower sperm counts than omnivorous diets. Although these people are not infertile, in is likely to play a factor in conception, particularly for couples who are trying to conceive naturally, the old fashioned way.”
“The theory that we have come up with is that vegetarians are replacing meat with soy, which contains phytooestrogens and could be affecting fertility,” adds Dr. Orzylowska. “For children who have grown up with those kind of diets, it may have impacted on sperm quality from puberty.”
Dr. Orzylowska also reportedly suggested that another reason for the difference in sperm count and motility might be due to a B12 deficiency in vegetarian and vegan people.
As the research is being presented at a conference and does not yet seem to have been published, we are forced to react only to the comments and reports on that research as we know them.
By any stretch of the imagination, the sample size comparing vegetarians and vegans to meat eaters is low, and while this was a systematic analysis of over four years worth of data, it is incredibly limited in its scope and gives us nothing of itself that is convincing about vegetarian, vegan or even meat-eating diets. That’s not to say it isn’t interesting, but as the researchers themselves will admit, this is a starting point and not a definitive answer surrounding soy and male fertility. To try to find a more concrete insight of this subject, we have to look at the existing body of research and why soy has been suggested as a factor in lower fertility among men.
It is true that when in the body, phytoestrogen (essentially plant-derived estrogen) mimics the female sex hormone estrogen and under certain circumstances and when consumed in very high quantities — one study identified a man as consuming three quarts of soy milk a day for six months, which far exceeds most consumption by vegans and vegetarians — can have the potential to affect our sex hormone balance. For instance, some studies have shown that it can lead to a decrease in libido and even erectile dysfunction in men, though there’s no concrete evidence of more pronounced changes like men developing breast tissue.
When it comes to fertility, a study in 2008 of 99 men who attended a fertility clinic in America found a similar pattern as the above: the more soy that a man tended to eat, the greater the reduction in sperm quantity and motility. However, the researchers in that case stressed that the reduced fertility tended to overlap with the men in the sample being overweight, which is a known factor for a drop in fertility in both men and women. At the time it was acknowledged that, given the fact that soy is a staple across Asia, if soy were to reduce fertility indiscriminately, researchers would expect a more pronounced pattern of fertility reduction, but there isn’t one.
Indeed, soy consumption has not been proved to have a big impact on sex hormones in most healthy men or even primates and for the vast majority of men, consuming normal to moderately high levels of soy appears safe. In fact, it might carry some benefits, such as possibly reducing the risk of prostate cancer and cardiovascular disease.
So the current body of evidence that we do have does not support the stated hypothesis, but unfortunately it is one that the media has focused on and is repeating without proper context or balance.
While it may ultimately be that phytoestrogens do play a part in reducing fertility for some men (though again, not to the point of making them infertile), and probably when combined with an underlying health condition like obesity or, for instance, diabetes, it remains the consensus that for the vast majority of people soy is an acceptable, even potentially healthier, food choice.
What was the moment of recognition when you knew you were fertility challenged? Kristen Darcy, author and fertility coach, is inviting you to join in the conversation and share your story about “the moment I knew.” Read her article below.
The Moment I Knew About My Fertility Challenges
(by Kristen Darcy)
October is upon us and so are the creepy, ghoulish, dark Halloween decorations displayed everywhere. I’ve read that Halloween sales totaled 6.9 billion dollars in 2013 or $75 per capita. Halloween spending even beat out the Easter bunny. I am so curious why we have embraced this eerie event. Maybe it’s because we can pretend for an evening to be someone else?
So here’s another statistic that’s scary when you first hear it:
Twenty-five percent of infertile couples have more than one factor that contributes to their infertility. That means a quarter of all couples experiencing fertility challenges will have more than one issue. YIKES, EEK!
Let’s share and scream this month by joining in the conversation about “the moment I knew.”
What was the moment of recognition when you knew you were fertility challenged? Where were you? Were you alone? In a doctor’s office? On the phone? What did you do? That moment of knowing is a demarcation line in your life. In a way, your innocence was taken and life as you dreamed was forever changed…
Share with all of us through the hashtag #TheMomentIKnew and then call into Tell All Tuesday this month to gain comfort, support and understanding. You’re not alone.
Tell All Tuesday
October 28th at 7pm
Spooky! Thoughts that Go Bump in the Night! How to practice re-wiring your thoughts by observing your emotional triggers!
#TheMomentIKnew was during the post-coital exam when I learned there were two lonely sperm swimming in a circle. The floor feel out of the room. I wanted to run out naked from the waist down because all I wanted to do was cry! The doctor wasn’t an RE, but an OBGYN and it wasn’t handled well at all. And as the saying goes, it was all down hill from that moment on. I was part of the 25% referred to above.
With Halloween coming, let’s share and release the hellishness of the diagnosis of our fertility challenges.
RSVSP at Kristen@kristendarcy.com
The Center for Advanced Reproductive Services is a vital part of the University of Connecticut School of Medicine. The School of Medicine provides postgraduate training for more than 550 newly graduated M.D.s each year. As part of this program, The Center is home to some of the few postgraduate fellowships for Reproductive Endocrinology and Infertility available in the United States. Due to The Center’s national reputation as a “Center of Excellence,” acceptance to one of our 3 fellowship positions is very competitive.
More about the program here.
In recognition of Breast Cancer Awareness Month, we are continuing with posts to raise awareness of fertility preservation to those facing a cancer diagnosis. Fertility preservation, when done prior to certain cancer treatments, is an important but often over-looked part of the cancer patient’s experience.
See the article below for more information on the fertility preservation options for women or watch the video here.
What is a summary of the fertility preservation options for women?
(Ralph Kazer, M.D., Professor, Ob/Gyn, Oncofertility Consortium, Feinberg School of Medicine, Northwestern University)
Patients who are facing treatment for cancer, which may involve either chemotherapy or radiation therapy or both, potentially have a number of options to explore if they are interested in preserving their childbearing potential.
In the first place, patients always have the option of foregoing any particular strategy for fertility preservation if, for example, it’s not thought that their therapy is likely to have a significant impact on their fertility. Or if they don’t want to carry out one of these options for any other reason.
Active strategies for fertility preservation include, in the first place, something called emergency in vitro fertilization, or emergency IVF for short. This is a strategy which exploits a technology which is currently used primarily to treat infertility patients. It involves harvesting eggs or oocytes from the patient before she starts her therapy, fertilizing them, presumably with her husband’s sperm, and freezing or cryopreserving the embryos for future use. This is a mature technology with a fairly high success rate and it is probably the most commonly used option that we offer at Northwestern.
Some patients don’t have a mate; some patients are single and wish to defer the choice of a mate into the future. Those patients have the option of participating in a research protocol, which involves freezing their eggs before they are fertilized. The reason that this is experimental is because, technically, it is significantly more difficult to freeze unfertilized eggs than fertilized eggs.
A third option, which also involves a research protocol, is the retrieval and freezing of ovarian tissue. This particular option is most appropriate for patients who have a very, very short time frame leading up to their treatment. A timbered which would not permit the medical part of the therapy required for harvesting eggs. Or, patients who, for some other reason, are concerned about the potential effect of the drugs that are used in emergency IVF on their cancer. So these patients may enroll in the study, which involves surgically removing one of their ovaries and freezing or cryopreserving the ovarian tissue for later use. The technology for using that kind of tissue for making babies down the road is still very, very much cutting edge. Babies have been born after frozen tissue has been transplanted back into patients after they’ve had their cancer treatment, but the overall picture for this technology is very much in the future.
Two Silicon Valley giants now offer women a game-changing perk: Apple and Facebook will pay for employees to freeze their eggs.
Perk Up: Facebook and Apple Now Pay for Women to Freeze Eggs
(Published on NBC News by Danielle Friedman)
Facebook recently began covering egg freezing, and Apple will start in January, spokespeople for the companies told NBC News. The firms appear to be the first major employers to offer this coverage for non-medical reasons.
“Having a high-powered career and children is still a very hard thing to do,” said Brigitte Adams, an egg-freezing advocate and founder of the patient forum Eggsurance.com. By offering this benefit, companies are investing in women, she said, and supporting them in carving out the lives they want.
When successful, egg freezing allows women to put their fertility on ice, so to speak, until they’re ready to become parents. But the procedure comes at a steep price: Costs typically add up to at least $10,000 for every round, plus $500 or more annually for storage.
With notoriously male-dominated Silicon Valley firms competing to attract top female talent, the coverage may give Apple and Facebook a leg up among the many women who devote key childbearing years to building careers. Covering egg freezing can be viewed as a type of “payback” for women’s commitment, said Philip Chenette, a fertility specialist in San Francisco.
The companies offer egg-freezing coverage under slightly different terms: Apple covers costs under its fertility benefit, and Facebook under its surrogacy benefit, both up to $20,000. Women at Facebook began taking advantage of the coverage this year.
While techniques and success rates are improving, there’s no guarantee the procedure will lead to a baby down the road. The American Society for Reproductive Medicine doesn’t keep comprehensive stats on babies born from frozen eggs – in fact, the group cautions against relying on egg freezing to extend fertility – though experts say the earlier a woman freezes her eggs, the greater her chances of success. Doctors often recommend women freeze at least 20 eggs, which can require two costly rounds.
But in the two years since the ASRM lifted the “experimental” label from egg freezing, experts say they’ve seen a surge in women seeking out the procedure. Fertility doctors in New York and San Francisco report that egg-freezing cases have nearly doubled over the past year.
For many women, taking the step to boost their chances of having kids in the future is worth the uncertainty. A majority of patients who froze their eggs reported feeling “empowered” in a 2013 survey published in the journal Fertility and Sterility. Women who know they want kids someday “can go on with their lives and know that they’ve done everything that they can,” said Chenette.
Egg freezing has even been described as a key to “leveling the playing field” between men and women: Without the crushing pressure of a ticking biological clock, women have more freedom in making life choices, say advocates. A Bloomberg Businessweek magazine cover story earlier this year asked: Will freezing your eggs free your career? “Not since the birth control pill has a medical technology had such potential to change family and career planning,” wrote author Emma Rosenblum.
News of the firms’ egg-freezing coverage comes in the midst of what’s been described as a Silicon Valley “perks arms race.” It’s only the latest in a generous list of family and wellness-oriented health benefits from Apple and Facebook (whose COO, of course, is feminist change agent and “Lean In” author Sheryl Sandberg). Both companies offer benefits for fertility treatment and adoption. Facebook famously gives new parents $4,000 in so-called “baby cash” to use however they’d like.
Silicon Valley firms are hardly alone in offering generous benefits to attract and keep talent, but they appear to be leading the way with egg freezing. Advocates say they’ve heard murmurs of large law, consulting, and finance firms helping to cover the costs, but no companies are broadcasting this support. “It’s very forward-looking,” said Eggsurance’s Adams.
Companies may be concerned about the public relations implications of the benefit – in the most cynical light, egg-freezing coverage could be viewed as a ploy to entice women to sell their souls to their employer, sacrificing childbearing years for the promise of promotion.
“Would potential female associates welcome this option knowing that they can work hard early on and still reproduce, if they so desire, later on?” asked Glenn Cohen, co-director of Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, in a blog post last year. “Or would they take this as a signal that the firm thinks that working there as an associate and pregnancy are incompatible?”
But the more likely explanation for lack of coverage is simply that egg freezing is still new, and conversation around the procedure has only recently gone mainstream. “I think we’ve reached a tipping point,” said Adams. “When I used to say ‘egg freezing,’ people would stare at me with their mouths open.” Now? Most people know someone who’s done or considered it.
Many large companies adopt new benefits in response to employee demand – firms have recently started to offer benefits for transgender employees, for example. As women’s awareness of egg freezing grows, more employers may jump on the band wagon.
“The attitude toward egg freezing is very different,” and more positive, than just a few years ago, said Christy Jones, founder of Extend Fertility, a company that offers and promotes egg freezing across the country. Women are making the proactive decision to freeze their eggs at a younger age, and the choice is “more one of empowerment than ‘this is my last chance.’”
EggBanxx, the first service to help women finance egg freezing, has recently begun to capitalize on this shift by hosting “egg-freezing parties,” where experts educate guests. “Maybe you haven’t found Mr. Right just yet or perhaps you would like more time to focus on your education or career,” the company website says. “Whatever the reasons, freezing your eggs now will allow you to tackle conception later.”
Women generally need about two weeks of flexibility for one cycle of egg freezing. After about ten days of fertility drug injections, patients undergo a relatively short outpatient procedure – and they’re “back to work the next day,” said Lynn Westphal, Associate Professor Obstetrics and Gynecology at Stanford University Medical Center. From there, eggs are frozen and stored until a woman is ready to use them, at which point she’ll begin the process of in vitro fertilization.
Once a woman freezes her eggs, she may never return to use them, fertility doctors report. Some women get pregnant the old-fashioned way, others make different life plans. Westphal compares egg freezing to car insurance: You hope you don’t have to use what you’ve put away, but if you find yourself in a situation where you need to, you’re glad to have the protection.
Will the perk pay off for companies? The benefit will likely encourage women to stay with their employer longer, cutting down on recruiting and hiring costs. And practically speaking, when women freeze their eggs early, firms may save on pregnancy costs in the long run, said Westphal. A woman could avoid paying to use a donor egg down the road, for example, or undergoing more intensive fertility treatments when she’s ready to have a baby.
But the emotional and cultural payoff may be more valuable, said Jones: Offering this benefit “can help women be more productive human beings.”
CT Spotlight talks to Dr. DiLuigi about the Center’s new location in Farmington. See the video below.
The possibility of an adolescent male becoming infertile as a result of treatment for cancer should be discussed soon after a diagnosis is made, according to an expert in the field. Unfortunately, these discussions rarely take place, despite recommendations from the American Society of Clinical Oncology.
Read the article below.
Tell Boys With Cancer About Ways to Preserve Fertility
(Published on Medscape Medical News by Fran Lowry)
“Fertility preservation can be a difficult topic to discuss with an adult in the setting of an acute cancer diagnosis, and this issue can be even more challenging to address with a child and their parents,” Robert E. Brannigan, MD, professor of medicine at the Northwestern University Feinberg School of Medicine in Chicago, writes in a comment published in the October issue of the Lancet Oncology.
The comment was prompted by a study published in the same issue by Daniel M. Green, MD, from St. Jude Children’s Research Hospital in Memphis, Tennessee, and colleagues, which showed that cyclophosphamide reduces sperm irreversibly after treatment, rendering patients infertile.
Results of the study were presented earlier this year at the American Society of Clinical Oncology (ASCO) annual meeting, as reported by Medscape Medical News.
“My concern is that, while an excellent, outstanding job is being done with the treatment of pediatric cancer, very often the fertility preservation issue is overlooked,” Dr. Brannigan told Medscape Medical News.
There are a number of reasons for this, including a lack of awareness among pediatric oncologists of the ASCO recommendations on fertility preservation, and the fact that they rarely cross paths with fertility specialists, he said.
“There was a survey done in 2011 of the attitudes and practice patterns of pediatric oncologists toward fertility preservation. Only 44% of respondents reported being familiar with the ASCO fertility preservation recommendations, and only 39% reported routine use of them to guide decision-making for patient care,” Dr. Brannigan reported.
Respondents to that survey also noted barriers to fertility preservation for their male patients. These included the need to start treatment right away because of aggressive disease and discomfort discussing sperm banking, he noted.
Another common obstacle to fertility preservation in the pediatric population is the fact that pediatric healthcare facilities are often located far from reproductive health centers. As a consequence, little or no dialogue takes place between pediatric oncologists and reproductive specialists.
What Can Be Done?
Pediatric oncology patients want to know about preserving their fertility, Dr. Brannigan said.
“We have done some focus groups on this at our institution, and it is very clear that the adult survivors of pediatric cancers feel very strongly that the issue of preserving their fertility should have been raised with them and their parents at the time of their diagnosis and treatment,” he said.
Centers treating children with cancer should identify reproductive specialists who can come and discuss the issue and help provide advice and care, Dr. Brannigan said. It is unreasonable to expect the pediatric oncology provider to have these discussions with their patients. “I think it is unreasonable to expect the pediatric oncology provider to have these discussions with their patients. We need experts in the area to be available to do this. We’ve done it at our institution and it has worked very nicely,” he said
At the moment, there is no effective way to preserve the fertility of a prepubertal boy with cancer. But most adolescent male oncology patients are capable of providing semen of sufficient quality for cryopreservation before initiation of cancer therapy, he said.
“They can preserve their fertility by banking sperm. The doctor treating them must look at this as being something that is worthwhile, has value, is important,” Dr. Brannigan explained. “There are some men who become infertile as a result of their therapy and, while they are incredibly grateful for the excellent care they received and for surviving their cancer, they really wish that someone would have gone the extra step to help avert their infertility.”
Dr. Green and colleagues provide important information, but prospective studies initiated at the time of cancer diagnosis are needed to provide the most meaningful insight into fertility preservation issues, he added.
Longitudinal studies tracking infertility are also needed to shed light on the eventual reproductive outcomes for childhood cancer survivors.
“Collectively, this work will enable clinicians to more effectively stratify the risk of future fertility impairment in the aftermath of a cancer diagnosis and cancer therapy,” Dr. Brannigan said.
New research suggests that moderate alcohol intake every week is linked to poorer sperm quality in otherwise healthy young men. And the higher the weekly tally of drinks, the worse the sperm quality seems to be, the findings indicate, prompting researchers to suggest that young men should be advised to steer clear of habitual drinking. Read the article below.
Moderate Weekly Alcohol Intake Linked to Poorer Sperm Quality in Healthy Young Men
(Published in Science Daily)
They base their findings on 1221 Danish men between the ages of 18 and 28, all of whom underwent a medical examination to assess their fitness for military service, which is compulsory in Denmark, between 2008 and 2012.
As part of their assessment, the military recruits were asked how much alcohol they drank in the week before their medical exam (recent drinking); whether this was typical (habitual); and how often they binge drank, defined as more than 5 units in one sitting, and had been drunk in the preceding month.
They were also invited to provide a semen sample to check on the quality of their sperm, and a blood sample to check on their levels of reproductive hormones.
The average number of units drunk in the preceding week was 11. Almost two thirds (64%) had binge drunk, while around six out of 10 (59%) said they had been drunk more than twice, during the preceding month.
The analysis showed that after taking account of various influential factors, there was no strong link between sperm quality and either recent alcohol consumption or binge drinking in the preceding month.
But drinking alcohol in the preceding week was linked to changes in reproductive hormone levels, with the effects increasingly more noticeable the higher the tally of units.
Testosterone levels rose, while sex hormone binding globulin (SHBG) fell; similar associations were also evident for the number of times an individual had been drunk or had binge drunk in the preceding month.
Almost half (45%, 553) of the men said that the quantity of alcohol they drank in the preceding week was typical of their weekly consumption.
And in this group the higher the tally of weekly units, the lower was the sperm quality, in terms of total sperm count and the proportion of sperm that were of normal size and shape, after taking account of influential factors.
The effects were evident from 5+ units a week upwards, but most apparent among those who drank 25 or more units every week.
And total sperm counts were 33% lower, and the proportion of normal-looking sperm 51% lower, among those knocking back 40 units a week compared with those drinking 1-5.
Habitual drinking was associated with changes in reproductive hormone levels, although not as strongly as recent drinking, while abstinence was also linked to poorer sperm quality.
This is an observational study, so no definitive conclusions can be drawn about cause and effect. And the researchers point out that the findings could be the result of reverse causation — whereby men with poor quality sperm have an unhealthier lifestyle and behaviours to start with.
But animal studies suggest that alcohol may have a direct impact on sperm quality, they say.
“This is, to our knowledge, the first study among healthy young men with detailed information on alcohol intake, and given the fact that young men in the western world [drink a lot], this is of public health concern, and could be a contributing factor to the low sperm count reported among [them],” they suggest.
And they conclude: “It remains to be seen whether semen quality is restored if alcohol intake is reduced, but young men should be advised that high habitual alcohol intake may affect not only their general health, but also their reproductive health.”
The above story is based on materials provided by BMJ-British Medical Journal.
Every October, we are reminded to celebrate the progress made in the fight against breast cancer and advocate for further advances.
While the success of cancer treatments continues to rise, the side effects of those treatments are still being realized. For women, certain therapies can cause ovarian damage or failure, early menopause, genetic damage to growing eggs and other reproductive problems. For men, cancer treatments can cause damage to the testes and interfere with sperm production.
The Center for Advanced Reproductive Services is a select member of the Oncofertility Consortium — an exclusive nationwide group of researchers who are dedicated to the advancement of technologies that will provide improved fertility preserving options to cancer patients with threatened fertility.
This special membership allows us to participate in and have access to the latest clinical research, expand current knowledge of all issues related to cancer treatments and fertility, and be on the forefront of discovering new technologies and methods that successfully preserve fertility.
This month we will be posting resources from the Oncofertility Consortium that will help you navigate the complex fertility issues facing patients with cancer and other serious diseases.