The determination of reproductive safety in men during and after cancer treatment

Fertility-related concerns are frequently encountered in the course of providing care to oncologic patients. Male cancer survivors who desire paternity after cancer treatment face the question of whether their posttherapy sperm can be safely used in either natural or assisted conception attempts. Although the reproductive risks of using sperm genetically compromised by chemotherapy or radiotherapy include impaired embryonal development, pregnancy loss, and congenital anomalies in offspring, there is a general lack of consensus in the literature concerning the persistence of sustained genotoxic effects, making it difficult to assuredly quantify the level of risk involved. Transmission of chemotherapeutic agents via seminal plasma is another potential risk that has not yet been well evaluated. Sperm chromosomal aneuploidy rates and DNA fragmentation indices provide means of assessing genomic damage that could prove useful in genetic counseling efforts. Ultimately, additional research is needed to clarify investigational discrepancies and establish a stronger body of evidence that would allow for the development of clinical guidelines to assist cancer patients considering posttreatment conception in their decision-making processes.