Current Urology Reports

, 20:51 | Cite as

Non-oncologic Indications for Male Fertility Preservation

  • Heiko Yang
  • Joris Ramstein
  • James SmithEmail author
Men's Health (A Dabaja, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Men’s Health


Purpose of Review

To explore non-oncologic indications for male fertility preservation.

Recent Findings

Common scenarios in which male fertility could be irreversibly compromised include autoimmune conditions requiring treatment with cyclophosphamide, gender dysphoria prior to starting hormone therapy, military deployment, and critical illness. Fertility preservation should be considered with particular attention to the timing and logistics specific to each scenario.


Recognition and familiarity with such situations will help physicians provide better counseling to patients and their families, improve the quality of decision-making, and ultimately reduce missed opportunities and regret.


Male fertility preservation Cyclophosphamide Gender dysphoria Postmortem sperm retrieval Military deployment 


Compliance with Ethical Standards

Conflict of Interest

Heiko Yang, Joris Ramstein, and James Smith each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Cooper GS, Stroehla BC. The epidemiology of autoimmune diseases. Autoimmun Rev. 2003;2(3):119–25.CrossRefGoogle Scholar
  2. 2.
    Smith ZL, Werntz RP, Eggener SE. Testicular cancer: epidemiology, diagnosis, and management. Med Clin North Am. 2018;102(2):251–64.CrossRefGoogle Scholar
  3. 3.
    Condorelli M, Demeestere I. Challenges of fertility preservation in non-oncological diseases. Acta Obstet Gynecol Scand. 2019;98(5):638–46.CrossRefGoogle Scholar
  4. 4.
    Zakhem GA, Motosko CC, Mu EW, Ho RS. Infertility and teratogenicity after paternal exposure to systemic dermatologic medications: a systematic review. J Am Acad Dermatol. 2019;80(4):957–69.CrossRefGoogle Scholar
  5. 5.
    Aguilar-Mahecha A, Hales BF, Robaire B. Chronic cyclophosphamide treatment alters the expression of stress response genes in rat male germ cells. Biol Reprod. 2002;66(4):1024–32.CrossRefGoogle Scholar
  6. 6.
    Vernet P, Aitken RJ, Drevet JR. Antioxidant strategies in the epididymis. Mol Cell Endocrinol. 2004;216(1–2):31–9.CrossRefGoogle Scholar
  7. 7.
    Wyrobek AJ, Schmid TE, Marchetti F. Relative susceptibilities of male germ cells to genetic defects induced by cancer chemotherapies. J Natl Cancer Inst Monogr. 2005;2005(34):31–5.CrossRefGoogle Scholar
  8. 8.
    • Glen CD, Dubrova YE. Exposure to anticancer drugs can result in transgenerational genomic instability in mice. Proc Natl Acad Sci U S A. 2012;109(8):2984–8 Convincingly demonstrates in an animal model that cyclophosphamide can have a permanent teratogenic effect, strengthening the argument for fertility preserving before any treatment is initiated.CrossRefGoogle Scholar
  9. 9.
    Tiseo BC, Bonfá E, Borba EF, Munhoz GA, Wood GJA, Srougi M, et al. Complete urological evaluation including sperm DNA fragmentation in male systemic lupus erythematosus patients. Lupus. 2019;28(1):59–65.CrossRefGoogle Scholar
  10. 10.
    Currey HL, et al. Comparison of azathioprine, cyclophosphamide, and gold in treatment of rheumatoid arthritis. Br Med J. 1974;3(5934):763–6.CrossRefGoogle Scholar
  11. 11.
    Meistrich ML, Wilson G, Brown BW, da Cunha MF, Lipshultz LI. Impact of cyclophosphamide on long-term reduction in sperm count in men treated with combination chemotherapy for Ewing and soft tissue sarcomas. Cancer. 1992;70(11):2703–12.CrossRefGoogle Scholar
  12. 12.
    Paoli D, Rizzo F, Fiore G, Pallotti F, Pulsoni A, Annechini G, et al. Spermatogenesis in Hodgkin’s lymphoma patients: a retrospective study of semen quality before and after different chemotherapy regimens. Hum Reprod. 2016;31(2):263–72.PubMedGoogle Scholar
  13. 13.
    Pavin NF, et al. Tribulus terrestris protects against male reproductive damage induced by cyclophosphamide in mice. Oxidative Med Cell Longev. 2018;2018:5758191.CrossRefGoogle Scholar
  14. 14.
    Shabanian S, et al. The effects of vitamin C on sperm quality parameters in laboratory rats following long-term exposure to cyclophosphamide. J Adv Pharm Technol Res. 2017;8(2):73–9.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Aghaie S, Nikzad H, Mahabadi JA, Taghizadeh M, Azami-Tameh A, Taherian A, et al. Protective effect of combined pumpkin seed and ginger extracts on sperm characteristics, biochemical parameters and epididymal histology in adult male rats treated with cyclophosphamide. Anat Sci Int. 2016;91(4):382–90.CrossRefGoogle Scholar
  16. 16.
    Wiepjes CM, Nota NM, de Blok CJM, Klaver M, de Vries ALC, Wensing-Kruger SA, et al. The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): trends in prevalence, treatment, and regrets. J Sex Med. 2018;15(4):582–90.CrossRefGoogle Scholar
  17. 17.
    Auer MK, Fuss J, Nieder TO, Briken P, Biedermann SV, Stalla GK, et al. Desire to have children among transgender people in Germany: a cross-sectional multi-center study. J Sex Med. 2018;15(5):757–67.CrossRefGoogle Scholar
  18. 18.
    Wierckx K, van Caenegem E, Pennings G, Elaut E, Dedecker D, van de Peer F, et al. Reproductive wish in transsexual men. Hum Reprod. 2012;27(2):483–7.CrossRefGoogle Scholar
  19. 19.
    Hamidi O, Davidge-Pitts CJ. Transfeminine hormone therapy. Endocrinol Metab Clin N Am. 2019;48(2):341–55.CrossRefGoogle Scholar
  20. 20.
    Kent MA, Winoker JS, Grotas AB. Effects of feminizing hormones on sperm production and malignant changes: microscopic examination of post orchiectomy specimens in transwomen. Urology. 2018;121:93–6.CrossRefGoogle Scholar
  21. 21.
    • Adeleye AJ, et al. Semen parameters among transgender women with a history of hormonal treatment. Urology. 2019;124:136–41 Shows that feminizing hormone therapy and short-term withdrawal of therapy have varying deleterious effects on semen analysis parameters.CrossRefGoogle Scholar
  22. 22.
    Mattawanon N, Spencer JB, Schirmer DA, Tangpricha V. Fertility preservation options in transgender people: a review. Rev Endocr Metab Disord. 2018;19(3):231–42.CrossRefGoogle Scholar
  23. 23.
    Returning home from Iraq and Afghanistan: assessment of readjustment needs of veterans, service members, and their families. Mil Med, 2014. 179(10): p. 1053–5.Google Scholar
  24. 24.
    Nnamani NS, Janak JC, Hudak SJ, Rivera JC, Lewis EA, Soderdahl DW, et al. Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project. J Trauma Acute Care Surg. 2016;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S95–9.CrossRefGoogle Scholar
  25. 25.
    Machen GL, Harris SE, Bird ET, Brown ML, Ingalsbe DA, East MM, et al. Utilization of cryopreserved sperm cells based on the indication for storage. Investig Clin Urol. 2018;59(3):177–81.CrossRefGoogle Scholar
  26. 26.
    Angus DC, Linde-Zwirble WT, Sirio CA, Rotondi AJ, Chelluri L, Newbold RC 3rd, et al. The effect of managed care on ICU length of stay: implications for Medicare. JAMA. 1996;276(13):1075–82.CrossRefGoogle Scholar
  27. 27.
    Wu AW, Pronovost P, Morlock L. ICU incident reporting systems. J Crit Care. 2002;17(2):86–94.CrossRefGoogle Scholar
  28. 28.
    Young MP, Birkmeyer JD. Potential reduction in mortality rates using an intensivist model to manage intensive care units. Eff Clin Pract. 2000;3(6):284–9.PubMedGoogle Scholar
  29. 29.
    Hall MJ, Levant S, DeFrances CJ. Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000-2010. NCHS Data Brief. 2013;(118):1–8.Google Scholar
  30. 30.
    Rothman CM. A method for obtaining viable sperm in the postmortem state. Fertil Steril. 1980;34(5):512.CrossRefGoogle Scholar
  31. 31.
    Ethics Committee of the American Society for Reproductive Medicine. Electronic address, a.a.o. and M. Ethics Committee of the American Society for Reproductive. Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion. Fertil Steril. 2019;111(4):659–63.CrossRefGoogle Scholar
  32. 32.
    Rao JK, Anderson LA, Lin FC, Laux JP. Completion of advance directives among U.S. consumers. Am J Prev Med. 2014;46(1):65–70.CrossRefGoogle Scholar
  33. 33.
    • Waler NJ, et al. Policy on posthumous sperm retrieval: survey of 75 major academic medical centers. Urology. 2018;113:45–51 A thorough examination of ethical considerations surrounding posthumous sperm retrieval with data from multiple academic centers. Shows that majority hospitals do not have a written policy.CrossRefGoogle Scholar
  34. 34.
    Ravitsky V. Posthumous reproduction guidelines in Israel. Hast Cent Rep. 2004;34(2):6–7.Google Scholar
  35. 35.
    Kerr SM, Caplan A, Polin G, Smugar S, O'Neill K, Urowitz S. Postmortem sperm procurement. J Urol. 1997;157(6):2154–8.CrossRefGoogle Scholar
  36. 36.
    Ethics Committee of the American Society for Reproductive, M. Posthumous collection and use of reproductive tissue: a committee opinion. Fertil Steril. 2013;99(7):1842–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyUniversity of California San FranciscoSan FranciscoUSA
  2. 2.School of MedicineUniversity of California San FranciscoSan FranciscoUSA

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