Publication:

Effect of malignancy on semen quality in men undergoing fertility preservation prior to cancer treatment

Background Advances in cancer therapy have significantly improved survival rates, making fertility preservation an essential component of cancer care in young men. While gonadotoxic effects of chemotherapy and radiotherapy are well established, the impact of malignancy itself on semen parameters prior to treatment remains controversial. To evaluate semen parameters in men with various malignancies prior to chemotherapy or radiotherapy and to compare semen quality between testicular and non-testicular cancers.

Methods This single-center retrospective study included 130 male cancer patients referred for sperm cryopreservation between January 2015 and December 2024. Patients who had received prior chemotherapy or radiotherapy were excluded. Semen samples obtained before initiation of cancer treatment were analyzed for sperm concentration, total motility and progressive motility according to World Health Organization (WHO) criteria, 6th edition 2021. Semen parameters were compared across different malignancy types, including testicular and non-testicular cancers.

Results The mean age was 25.25 years. Out of 130 patients, 104 patients (80%) had abnormal morphology. Normozoospermia was observed in 13.07% of patients, while 86.9% had at least one semen abnormality. Testicular malignancies were associated with a significantly higher proportion of subnormal sperm concentration (<16 million/ml) compared to non-testicular cancers (58.1% vs. 35.6%, p=0.015). Total sperm motility showed a significant association with cancer type (p=0.034), with hematological and musculoskeletal malignancies demonstrating higher rates of reduced motility. Progressive motility did not differ significantly between testicular and non-testicular cancers.

Conclusions A substantial proportion of men with cancer exhibit impaired semen parameters even before initiation of gonadotoxic therapy. Testicular malignancy is significantly associated with reduced sperm concentration, while systemic malignancies may adversely affect sperm motility. Early referral for fertility preservation should be strongly recommended for all reproductive-age men diagnosed with cancer.