Over the past decades, more and more attention has been paid to the sperm preservation for male cancer patients in China. However, very few studies concerning a large amount of cancer patients was reported on sperm preservation in China up to now except two studies with small samples [13, 14]. The only human sperm bank of Guangdong province is located in Guangzhou, the capital of Guangdong Province, listed as one of China's mega cities with a permanent resident population near 20 million, one of the three major medical center cities in China, an international trade center and transportation hub in the world. The data of sperm-cryopreserved cancer patients from this sperm bank would well represent the current status of fertility preservation for male cancer patients in South China, concerning propaganda and education on fertility preservation, the willingness of cancer patients to preserve fertility, the economic situation of those patients enough to undertake sperm preservation and the scale of sperm bank.
The current study shows the largest number of cancer patients pursuing sperm cryopreservation before anticancer treatment in South China, consequently offering sound data on semen quality for cancers located in different system. In the human sperm bank of Guangdong Province, there are more and more cancer patients to perform sperm cryopreservation successfully, with the number increasing year by year as the same trend in published literatures [15, 16], and more tumor types are involved. Being two major tumors occurring in childbearing age, testicular cancer and lymphoma are two types of most common tumors for the subjects with sperm preservation before or after anticancer treatments, as identically described in most of studies [17–19]. As a regional tumor with high incidence, nasopharyngeal carcinoma has become the third main reason of sperm storage for those newly diagnosed cancer patients. The data also present that the cancer families in South China have a higher awareness of fertility preservation, regardless of the number or the types of cancer patients with successful sperm cryopreservation.
The cancers located in reproductive system in this study were almost testicular germ cell tumors, a group of heterogeneous cancers occurring in male germ cells, and seminomas and non-seminomas being the main type of them [20, 21]. Previous investigations indicated that the semen quality of testicular cancer patients without any treatment was poorer than that of other types of cancers for the combined influences of such factors as preexisting defects in reproductive cells, part tumor effect, endocrine disorder, autoimmune and systemic effects of cancer itself [22, 23]. The majority of literatures demonstrated that alterations of sperm concentration were observed for testicular cancer patients [18–19, 22, 24–28]. It was reported that significantly poor semen quality was observed in sperm concentration and progressive motility in a retrospective study involving 4480 male cryopreserved patients with several types of cancer and systematic disease in reproductive age . In the present study, the results showed that the patients with tumor in reproductive system had poorer sperm quality, especially in sperm concentration and pre-freezing progressive motility, than those with cancers in non-reproductive systems, which was generally consistent with results in the previous study . The present study observed that 85.8% of patients with cancer in non-reproductive systems were normozoospermic, higher than 59.9% of those with cancer in reproductive system. Similarly, other studies reported that the patients with Hodgkin’s disease had better semen quality than those with testicular cancer [29, 30]. The sperm quality of cancer patients was significantly affected by the location and the type of tumors before anti-cancer treatment.
For patients with testicular cancers, reduced semen quality especially in sperm concentration and motility has been attributed to the following possible factors. Histopathological study of testis from testicular cancer patients demonstrated that spermatogenesis in 94% of patients occurred in areas far away from the cancer . However, a previous study showed that testis had less than a 50% opportunity with functional spermatogenesis if more than 50% of the testis was cancer-involved . All of the patients with testicular cancers in those studies were observed a reduced normal spermatogenesis in tissue smears, led by reduced amount of normal testicular tissue to produce sperm accompanied with the cancer directly immersing into the testis . The hypothalamic–pituitary-testicular (HPT) axis is usually affected by testicular seminoma and spermatogenesis is accordingly disturbed, leading to decreased sperm quality or even azoospermia [32, 33]. Previous studies have shown that the levels of such tumor markers as beta-hCG and AFP were increased in patients with testicular cancers, in relation with reduced spermatogenesis and increased testosterone [34, 35]. Furthermore, it is often occurred in cancer patients that the cytokine-mediated inflammatory response of the whole body is usually activated by tumor itself, leading to fever, malnutrition, and stress on the body, even cancer cachexia . Fluctuation of temperature in cancer patients’ body and testicular would have further influences in spermatogenesis .
The anticancer treatments mainly include surgery, chemotherapy and radiotherapy. It was reported that the cancer therapies such as chemotherapy and radiotherapy for male patients would make direct injury to spermatogenic epithelium and cause oligozoospermia or even azoospermia, during which the reproduction function was deeply damaged . It was noted that surgical treatment would be effective to the fecundity of patients with testicular cancer . Previous study showed that the patients with testicular cancers had no better semen quality just after orchiectomy than before the surgery . Similarly, the present study indicated that the anticancer surgery had a negative effect on semen quality for patients with testicular cancers. But the surgery treatment would lead to reduced semen quality such as sperm concentration, pre-progressive motility, post-progressive motility, post-motility and normal sperm morphology for all sperm cryopreserved patients with cancers in the current study.
The present study has some highlights and limitations. The first highlight is delineated that this study is the first one displaying the results of sperm cryopreservation in the largest number of newly diagnosed cancer patients from China. The second highlight is that the patients were grouped by the cancers’ location because cancers located in reproductive system would strongly impair the spermatogenesis and sperm transport, with the sperm quality directly affected by those cancers themselves. One of the limitations is that as a retrospective study, it has some inevitable and inherent biases in the current study. Secondly, as described in the previous study, we did not collect data of the clinical stage for all cancers and therefore were unable to precisely evaluate the side effects of cancer clinical stages on semen quality .