Cancer and fertility: how to keep alive the hopes of fatherhoodTracey R
We tend to take many things for granted in this good land. That is, until a serious medical illness such as cancer shows an ugly head and puts paternity at risk. Not only does cancer treatment often have sterilizing effects on fertility, but the rush to treat the disease may set aside efforts to preserve future fertility. Shoot the healing canons and check for collateral damage later.
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Fortunately, medical care is now better not only to cure cancer, but also to improve the quality of life of survivors. And, without a doubt, fertility is a key quality of life problem after cancers are cured. For men, the battle for fertility is fought on two fronts: the preservation of fertility seeks to protect men (and children) from the damaging effects of sperm that often accompany cancer treatment; the restoration of fertility allows male survivors to overcome infertility so that they can father children.
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Classical techniques for the preservation of fertility in men include the gonadal shield and the sperm bank. Gonadal shielding uses lead-based devices to protect the testicles from the sterilizing effects of radiation treatment. The sperm bank is the process of freezing a healthy sperm before cancer treatment begins for later use. But there is more. For patients who are too young to deposit sperm, for those who have very little time to store sperm, or for those who do not have ejaculated sperm, the recovery of testicular sperm by biopsy (TESE) or needle aspiration (TESA) ) for banks it is now possible before treatment for cancer. And, in selected cases of testicular cancer, we no longer need to remove the entire testicle, but now we can remove only the cancerous nodule inside the testicle, leaving the rest intact and fertile. Even in cases where the entire testicle must be removed, we can freeze the sperm from the testicle immediately after taking it out and before sending it for a medical examination to detect cancer. These are now considered routine approaches to the preservation of fertility in men.
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The restoration of fertility for men has also seen real progress. The “mapping” of sperm can help men who no longer have sperm in their ejaculation due to cancer treatment. It is a non-invasive and non-surgical way to determine if sperm is present in the testicle, even though there are no sperm in the ejaculate. In men who have nerve injuries due to cancer surgery that affect their ability to ejaculate, a special medical instrument can produce an ejaculation for fertility purposes in a process called “electroejaculation.” These techniques have become valuable tools to help men who were told they were “sterile” after cancer treatment in the past to become parents today.
The most interesting research area on fertility restoration involves stem cell technology. The “promise” of stem cells in the cure of diseases will probably also find its way into the field of fertility. In children with cancer, ejaculated sperm is not present. Despite this, it may be possible to freeze the stem cells in your testicles before sterilizing cancer treatment. After thawing, these same cells can be used to create sperm after ripening in a Petri dish or after replacing them in the testis. It has been done in animals, but not yet in humans, but we are very, very close. Also on the horizon is the ability to take the skin of a sterile man, turn the skin cells into stem cells and then “lead” them to become sperm on a plate. So, soon, the preservation of fertility can go from science fiction to reality.
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