This is a video about the effects of treatment for lymphoma on
male fertility and what potentially can be done to prevent that. We talk about things that
you might want to do before treatment starts and also in the longer term, what
you can do if you find you have got problems with fertility after your
treatment is finished and you want to start a family.
The basis for male fertility is about producing sperm in the testes and that
normally starts at puberty. Men often carry on producing sperm
right throughout their entire lives. Men don't go through an equivalent of a
menopause where they stop being fertile. One of the problems with many
treatments for cancers, including lymphomas, is that they affect dividing cells.
Producing sperm is one of those key areas in the body where there is lots
of cell division going on and you're producing lots and lots of sperm every second of
the day. So it's a very sensitive system to chemotherapy.
But that need not necessarily be permanent.
What you often find is that if you look at a man's sperm count during or
after his chemotherapy for lymphoma, it will often be very, very poor but
with time, that may well recover and he will go on, in the longer term, to be as fertile as
he would have been. Unfortunately, with some treatments that
damage sperm production permanently, there may be a longer term effect on male
fertility and then we need to think about doing something in advance,
or if this hasn't happened then, potentially what treatments can be offered to try
and restore or replace your fertility longer term when you come to want to start that family.
One of the key issues is to speak
to your medical team and have a good conversation about what treatment
they're going to give you and whether it is likely to affect your
fertility; if it is, then you have to discuss with them whether you need to
see a fertility specialist to think about what you can do about it
before your treatment starts. It's really important that anything like
sperm storage is done before treatment starts because once it does start your
sperm count is going to fall very rapidly and it'll be too late.
Most people with lymphoma will be treated with chemotherapy. In many
cases, that will reduce your sperm count really quite drastically but in many
men, this will only be temporary and will recover afterwards. Some therapies, though,
for more advanced disease may well have a permanent effect. For those
individuals, it's really important for you to store some sperm
before treatment. Radiotherapy can also have an effect on your sperm production,
particularly when the radiotherapy is going to be actually at the testes
themselves, where the sperm are being produced.That is often actually a
more serious thing than chemotherapy and is more likely to be permanent.
Again, get your specimen stored before you start any treatments.
The third type of therapy is the more modern, biological therapies.
Unfortunately we really don't have a lot of information about the effects of
these on male fertility. It might be better to be safe than sorry
and think about storing a specimen even if you then don't need to use it later on.
If your oncologist thinks your therapy
will put your fertility at risk, you can go and
see a fertility team at your local hospital or local IVF unit, and they're
probably going to discuss with you about storing sperm before treatment starts.
There's nothing that needs to be done to you before that –
you can just go in and produce a specimen. You often have time to
produce 2 or 3 before treatment starts.
One of the problems with lymphoma is that sometimes your sperm count is actually
already affected by the disease before the treatment starts so some men will
already have quite a poor sperm count before they even start
treatment. In those situations, the lab will be analysing your sperm count
and be able to say how good it is. If it's not very good, you perhaps have
more of a need to store several specimens before you
start treatment, rather than if it is absolutely fine, they might suggest you just store 1 or 2.
So your medical team should refer
you to the local fertility centre where you can discuss storing
specimens to use later on. What happens is that you produce
a specimen by masturbation and that is then processed by the lab and they will
store it frozen in liquid nitrogen, so very, very cold, and it will then remain
active and effective and useful, basically indefinitely. The lab team
will get you to fill in some consent forms and they'll explain to you
exactly how long it can be stored for and your use of it
thereafter and how good it is when they start analysing the specimens.
They will tell you what sort of treatment you may be able to use it for
in the longer term. So this is clearly something that can be done by any man
who's gone through puberty. Teenage boys who started to go through puberty may
well find that they are also able to do it. It can be a bit embarrassing to
discuss it but it's something that has to be done before treatment starts.
Boys who haven't gone through puberty yet, or are at just at early puberty,
aren't able to produce a sperm specimen by masturbation and ejaculation. And then
the question is, can we still offer them something to help preserve their fertility?
At the moment this is all very experimental but there are a lot of
groups in the UK, and indeed around the world, who are looking at ways of helping
these young boys restore their fertility. Essentially what that
involves at the moment is looking at ways of taking a biopsy, a small piece of the
testes tissue itself, which involves an operation before the treatment for
lymphoma starts. That tissue can then be frozen and then potentially, when the
young man as he will then be (which may be 15-20 years later)
wants to use it, it's a question of how you might use this. At the moment
these things really are experimental and we don't know how best to use that
tissue to restore fertility but there are certainly clinics around the UK and
around the world that are starting to store testes tissue because we hope that by the
time that young man is wanting to use it, we'll know how best to use
it and be able to use it effectively to make him fertile again.
So when you've recovered from your lymphoma and your treatment’s all behind
you and you're thinking about starting a family,
many men remain fertile and go on to have the family
they want without any further problems. Of course, in the general
population, infertility is very, very common so it may be that you and your
partner were destined to have problems anyway – it may be nothing to do with
the treatments. If you've been trying to have a family for a while and it's
not working out, then both of you need to get referred by your doctor to the
clinic and they'll do tests to see where the problem might be. You can't
assume that it's due to the lymphoma; it may be something else entirely.
But of course if you've had chemotherapy or particularly radiotherapy to the
testes, you may be worried that your sperm count isn't very good.
It's very easy to get that tested to see whether you really do have a problem
or whether things are fine, and then your doctors can look for other reasons
why you and your partner haven't been able to have a family yet – so getting your sperm count
tested is perhaps the first step. If your sperm count really isn't very good
anymore, then the question is, do you have sperm stored that could be used,
or are you still producing some sperm that could be used, or actually,
are there unfortunately just no sperm there anymore. The situation with all
those things determines what therapies could be useful for you.
So for men who have very low sperm counts or men who have sperm stored
but it isn't terribly good or there is not an awful lot of it,
you might look at assisted conception treatments. This involves IVF
(in-vitro fertilisation) or a variant of that called ICSI (intracytoplasmic sperm injection).
These treatments involve your female
partner going through a series of injections to stimulate her ovaries. That
takes 2 or 3 weeks. The eggs are then removed from her and then
either mixed with your sperm, which could be fresh or it could be the frozen
specimen. Or if it's really low, the embryologist can pick up
individual sperm and inject them 1 at a time into each egg. Those eggs will
then be fertilised and go on to form embryos over the next day or 2. Within a few days, the dividing,
developing embryos will be put back in your partner's womb with a view to hoping that she falls pregnant.
That could be done with very, very low sperm counts, whether it's
the fresh specimen that you are producing now, or with a specimen that you produced in the past
that was poor and that's still the best you have got.
If you're not producing any sperm at all anymore and you haven't got anything
stored, then the option for you in terms of what medical therapy can do for you
is really thinking about sperm donation. Many clinics have services where
they're able to use donated sperm from fertile men to treat
your partner. Often the treatment is very straightforward and will be
intrauterine insemination, where you are just putting the sperm into the womb
at the right time of month or, if that’s unsuccessful, using the donor
sperm in an IVF type cycle.