Male fertility-implications of anticancer treatment and strategies to mitigate gonadotoxicity

With the advent of the modern cancer treatment, survival rates have improved substantially raising new concerns towards quality of life issues such as future fertility and offspring welfare. Cancer researchers are expanding their focus beyond survival and recurrence rates to include maximization of fertility potential for young cancer patients. Despite promising cure rates with chemotherapy, studies have shown it to act as a double edge sword by adversely affecting male fertility. Chemotherapeutic agents act by hindering rapidly proliferating cells, hence exerting their gonadotoxic effect. The extent of damage to germ cells and eventual fecundity depends on the class of chemotherapeutic agent, dosage, spermatogenetic stage targeted as well as the original pretreatment fertility potential of the patient. In this review, we provide a contemporary overview of the effects of anticancer agents on male fertility. Gonadotoxicity caused by these agents will be analyzed followed by the contemporary measures to preserve future fertility. Both established and potential strategies of fertility preservation will be discussed with emphasis on cryopreservation and its efficacy in conjunction with assisted reproductive technologies in addition to the current recommendations for this preservation modality. Finally, contemporary research on the welfare of offspring of cancer survivors will be reviewed.