The Big C

Cancer, also referred to as ‘the big C’, an ailment that sadly touches our lives with an increasing incidence day after day, whether you are man or woman, young or old, no one is considered immune against, and despite being on the verge of rise, the currently offered medical remedies are on the rise too.

Yes, the big C is not any more a frightening nightmare, as was seen in the past. Oncology researchers have pioneered numerous state of the art remedies that have revolutionized the way medicine is being practiced today.

After enduring the painful diagnosis, one generally worries about the other ‘C’; Chemotherapy and other cancer related therapies which are popularly known for their serious side effects, and immediately an image of a balding and wasted patient is displayed in our minds. This too has changed. Modern therapies are less damaging and less toxic to our bodies.

With all that being said, fertility remains an issue following the initiation of chemotherapy and/or radiation therapy, and this happens for several reasons. In males, fertility requires healthy testes supported by intact brain glands. The testis serves two functions, namely, sperm formation and testosterone hormone production, both of which are crucial for human reproduction.

Unfortunately the testis and brain glands are sensitive to all sort of noxious exposures, and may express tremendous reduction in function when exposed to hazardous insults as chemotherapy or radiation, resulting in deterioration of sperm counts and testosterone secretion.

When exposed to radiation or chemotherapy, secretion of male reproductive hormones are reduced, additionally sperm formation is hindered, initially resulting in a release of reduced number of sperms most of which are abnormal sperms, and soon afterwards the condition may reach complete arrest of sperm formation.

By the time cancer treatment ends, the recovery of the reproductive function is unpredictable, as it depends on the type and duration of therapy given. Additionally, even if the sperm numbers have not dramatically declined, other parameters may get undoubtedly altered e.g. DNA-integrity which determines the potency of sperm function, hence, it is advised to postpone pregnancy for some time until full recovery of the testis.

Proper counseling of male patients with reproductive concerns about fertility preservation remains crucial before starting any cancer related therapy.

Being aware of this, it has become so crucial to preserve sperms prior to initiation of therapy in a process called sperm freezing i.e. sperm banking, which has become a widely adapted practice, worldwide. This grants the male patient significant security concerning his reproduction, and offering a chance through which the patient can still father a child in the unfortunate event of altered sperm production, and hence with the help of assisted reproduction e.g. In-vitro Fertilization (IVF), the stored sperms can be used in the reproductive labs to fertilize the partner’s egg and induce pregnancy.

Many would ask about the effectiveness of frozen sperms when compared to freshly delivered ones, well, this too has been studied, and results showed that frozen sperms are equally functional and can result in same rates of fertilization when compared to fresh sperms.

When it comes to pre-pubertal male children, things get complicated, a pre-pubertal child is not expected to give a semen sample and hence, before cancer treatment is initiated, its advised ‘though still under research’, to surgically remove and store by freezing small testicular tissues (biopsies) which happen to contain spermatic stem cells (cells that can become sperms later on in life after puberty). These tissues are subsequently used later in life either by transplanting them again into the testis once therapy is over or simply incubating them in the lab and growing sperms from the stem cells within, then using them in assisted reproduction after puberty and adulthood.

Finally, and as an act of wisdom, be advised to discuss your reproductive concerns with the treating physician who will educate you on the proper ways to preserve your fertility prior to commencing any cancer therapy, and as a result, fathering a child can still be feasible after your journey with cancer treatment is over, despite any unfortunate decline in your reproductive function.