Storing reproduction for oncological patients: some points for discussion

Since the introduction of sophisticated techniques of assisted reproduction such as IVF and ICSI, all male patients that undergo a cancer treatment jeopardizing their future fertility status should be offered the opportunity to bank their semen. Only azoospermic semen samples are to be rejected for pre-treatment banking. Patients who became severely oligospermic or azoospermic after chemotherapy but did not bank their semen, are often not allowed to have assisted reproduction because of the concerns about the mutagenic aspects of their treatment. In a small case series (n = 10), we recovered testicular sperm for ICSI in 40% of patients who became azoospermic after chemotherapy. Since, so far, the few clinical data available do no not suggest an increased risk for congenital anomalies in children born from patients obtaining a pregnancy during chemotherapy, the question remains whether the concerns raised about treating patients who became oligozoospermic or azoospermic or even about semen banking during chemotherapy are incontestable.