Fertility preservation of adult and prepubertal male cancer patients

Although the prevalence of malignant diseases affecting boys and men in fertile age is constantly increasing worldwide, meanwhile a continuous improvement in the effectiveness of oncological treatments can also be observed. As a result, quality of life, especially fertility preservation gained paramount importance for cancer survivors. Recently, no clinical guideline for male fertility preservation, patient coordination, or dedicated infrastructure is available in Hungary. The most recent and relevant international and Hungarian literature data are reviewed and the domestic experience analyzed gained by the relevant specialities. Authors summarize the potential fertility risks of different oncological treatments for boys and men of reproductive age, and the fertility preservation methods available to them, with a special focus on pre- or peripubertal boys and testicular cancer patients. We summarize our results in a clinical recommendation reflecting a multidisciplinary approach. Our publication can also be the basis for the first national oncofertility preservation guideline for male oncological patients. The most effective way to preserve fertility in post-pubertal men is sperm cryopreservation prior to oncological treatment, which can be supplemented by assisted ejaculation techniques or surgical sperm retrieval in the case of ejaculation inability. Sperm cryopreservation is also possible in adolescent men, but the sampling process can often be difficult for them. In such cases, and in preor peripubertal aged boys, cryopreservation of surgically retrieved sperms or spermatogenetic stem cells can be performed, however, the possibilities for later use of the stem cells are currently experimental. Patients with testicular tumors require a special approach. Based on our results, it is clearly necessary to establish a fertility preservation system based on the close cooperation of the andrology and oncology team according to a unified professional guideline, which requires the provision of the right place, the training of human resources, and the creation of the infrastructural, financing and legal environment. The fertility preservation for boys and men of reproductive age with malignant diseases is below the ideal level in Hungary. From an individual and social point of view, it is extremely important that the affected patients have access to the most modern procedures in the right place and in the right way.