P-400 Fertility preservation in male patients with cancer: a systematic review and meta-analysis
Authors: Li Q , Chuan H 
Published: June 2023

Abstract

Study question
Whether the fertility preservation can benefit male patients with cancer.

Summary answer
Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer.

What is known already
Sperm cryopreservation is the only way to efficiently preserve male fertility. It is an important procedure in assisted reproductive technologies (ART). Recently, due to remarkable advances in cancer treatment, an increasing number of studies have reported the outcomes of sperm cryopreservation in patients with cancer.

Study design, size, duration
Systematic review and meta-analysis to summarize the current evidence on sperm cryopreservation and reproductive outcomes in male patients with cancer. 69 non-randomized studies were included in the meta-analysis. These included 32,234 patients referred for sperm analysis and 23,178 whose sperm was cryopreserved at least once. CENTRAL, CNKI, Cochrane Systematic Reviews, EMBASE, MEDLINE, PUBMED, and Web of Science were searched from inception through December 31, 2021.

Participants/materials, setting, methods
All studies reporting on offering or attempting to cryopreserve sperm before or during cancer treatment in male patients considered at risk of treatment-related fertility impairment were included. The pooled failed-to-cryopreserve, sperm disposal and sperm use rate in male patients with cancer. Meanwhile, the pooled pregnancy, miscarriage and delivered rates after sperm cryopreservation in male patients with cancer.

Main results and the role of chance
69 non-randomized studies were included with 32,234 patients referred for sperm analysis and 23,178 patients cryopreserving at least one sperm sample. The pooled failed-to-cryopreserve rate was 10% (95% confidence interval [CI], 8–12%), and the sperm disposal and sperm use rate were 23% (95% CI, 16–30%) and 9% (95% CI, 8–10%). The pregnancy, miscarriage, and delivery rates were 28% (95% CI, 22–33%), 13% (95% CI, 10–17%), and 20% (95% CI, 15–25%), respectively. Subgroup analysis showed higher pregnancy and delivery rates and a lower failed-to-cryopreserve rate in recent studies than in older ones. Clinical pregnancy rates per cycle of 34% (27–41%), 24% (14–35%), and 9% (5–15%) and delivery rates per cycle of 23% (17–30%), 18% (11–26%), and 5% (1–9%) for ICSI, IVF, and IUI, respectively.

Limitations, reasons for caution
The use of average results obtained in each included study without the patient-level data might represent the first source of bias. Furthermore, we did not analyze data on congenital abnormalities based on pregnancy outcomes because congenital abnormalities were rarely reported.

Wider implications of the findings
Our study supported previous reports that sperm cryopreservation was an effective method of fertility preservation in male patients with cancer. Meanwhile, frozen sperm use rate in our review underestimated the actual rate, making it meaningful to actively recommend fertility preservation to patients with cancer.

Trial registration number
not applicable