Immune Checkpoint Inhibitors and Male Fertility: Should Fertility Preservation Options Be Considered before...

Area of Science:

• Oncology
• Immunology
• Reproductive Medicine

Background:

• Immune checkpoint inhibitors (ICIs) are increasingly used in cancer therapy, including in pediatric patients.
• While effective, ICIs can cause immune-related adverse events affecting various organs.
• The impact of ICIs on male reproductive health, specifically testicular function and spermatogenesis, remains poorly understood.

Purpose of the Study:

• To review the current evidence on the association between ICI treatment and disruptions in spermatogenesis.
• To explore potential direct and indirect mechanisms by which ICIs may affect testicular function.
• To highlight specific ICIs (CTLA-4, PD-1, PD-L1) and their potential reproductive implications.

Main Methods:

• Literature review of studies investigating ICI effects on the male reproductive system.
• Analysis of proposed mechanisms including inflammation, immune cell infiltration, and hormonal axis disruption.
• Focus on ICIs targeting CTLA-4, PD-1, and PD-L1.

Main Results:

• Evidence suggests ICIs may directly harm testicular tissue and spermatogenesis through inflammation.
• Indirect effects via the hypothalamic-pituitary-gonadal axis may lead to testosterone deficiency (hypogonadism).
• Both primary and secondary hypogonadism are potential consequences affecting fertility.

Conclusions:

• ICI treatment poses potential risks to male fertility and spermatogenesis.
• Further research is crucial to elucidate these risks and establish management strategies.
• Open discussion between clinicians and patients regarding fertility preservation is essential before initiating ICI therapy.