Original Title: Application 1435 Part A

Authors' recommendations: Comparative Safety - For the majority of males (94%) scheduled to undergo gonadotoxic treatment, producing a sperm sample is non-invasive and relatively easy. However, techniques used to extract testicular tissue or sperm from the testicles or epididymis in those who are pre-pubertal, azoospermic or unable to ejaculate, are invasive and require anaesthesia, and therefore have risk associated with them. Likewise, re-implantation of testicular tissue has theoretical risks involved. Comparative effectiveness - For pre-pubertal boys, the assessment suggested that, relative to no cryopreservation, cryopreservation of testicular tissue in pre-pubertal boys has inferior safety and uncertain effectiveness. For post-pubertal males, men who cryopreserved sperm were more likely to become fathers, than those who did not. However, the rate of fatherhood in those men who cryopreserved sperm samples as compared to those who did not, was confounded by the fact that those who were interested in becoming fathers, were more likely to cryopreserve their sperm. There was a trend favouring the use of fresh sperm, collected post-gonadotoxic treatment, rather than cryopreserved sperm for pregnancy rates, but there was no difference in paternity rates. Therefore, if men are able to produce sperm after gonadotoxic treatment, their chances of fathering a child are the same with or without the use of cryopreserved sperm. However, the key benefit of having cryopreserved sperm is so that it can be used if the male cannot produce sperm after gonadotoxic treatment. Clinicians are unable to predict which patients will be infertile following gonadotoxic treatment. Those couples who underwent assistive reproductive therapy (ART) using cryopreserved sperm were over twice as likely to have a live birth than those who relied on testicular sperm extraction (TESE) post-treatment. For approximately half of the azoospermic patients and a small proportion of other patients with impaired fertility, cryopreservation of sperm prior to treatment may be their only change of having biological children. Fertility preservation allows the potential for patients to have a biological family in the future with substantial improvements in their satisfaction and quality of life.

Project Status: Completed

URL for project: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1435-public

Year Published: 2017

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/B82B7C383F44B6ACCA25801000123C27/$File/1435-Final-PSD.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)