Abstract
Infertile male cancer survivors may benefit from the use of sperm cryopreserved before starting antineoplastic treatments or by attempting testicular sperm retrieval, if they did not bank sperm, or by using donor sperm.
Intrauterine insemination (IUI) with cryopreserved sperm provides a clinical pregnancy rate of 13.1% per cycle with a live birth rate of 9.3%. IUI is simple and affordable but requires sperm of good quality. Intrauterine insemination with donor sperm (IUI-D) provides higher success rates, although there are no specific reports in cancer survivors. In unselected population, live birth rates per IUI-D range from 8.4% in the natural cycle to 21.3% using hormonal stimulation.
Conventional in vitro fertilization (IVF) is more complex and expensive but can be used with sub-optimal sperm and provides higher success rates than IUI (clinical pregnancy rate of 27.8% per cycle with a live birth rate of 24.6%). Intracytoplasmic sperm injection (ICSI) is the most efficient option when sperm parameters (number, motility, and morphology) are very poor. ICSI clinical pregnancy rate and live birth rate per cycle are 38.2% and 32.9%, respectively. The ICSI combined with surgically retrieved testicular sperm (TESE or micro-TESE) is the most expensive option with clinical pregnancy rate per cycle of 32.3% and the live birth rate of 23.9%.