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Chemotherapy & Male Fertility: Preserving Fatherhood Options Before Treatment
Chemotherapy—especially alkylating agents like cyclophosphamide, cisplatin, and busulfan—damages spermatogonial stem cells, causing temporary or permanent azoospermia.
Key Facts
- Risk depends on drug type, cumulative dose, age, and baseline fertility.
- Spermatogenesis takes ~74 days; recovery (if it occurs) may take months to years.
- Some men retain residual sperm production even after high‑dose chemo.
Fertility Preservation Options
- Sperm Cryopreservation (Gold Standard): Collect before treatment. Multiple samples recommended.
- Testicular Sperm Extraction (TESE): For azoospermic men; retrieves sperm directly from testis.
- Testicular Tissue Freezing: Experimental for prepubertal boys.
- Gonadal Shielding: During pelvic radiation.
Post‑Treatment Follow‑Up
- Semen analysis at 6–12 month intervals.
- If azoospermia persists, IVF/ICSI with frozen sperm or TESE sperm.
- Donor sperm or adoption if no viable sperm.
Discuss fertility before starting chemo. Oncology‑fertility referral is standard of care.
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