Electroejaculation as a method of fertility preservation in boys diagnosed with cancer: A single-center experience and review of the literature

Objective To evaluate the feasibility of electroejaculation to perform semen cryopreservation in pubertal boys before gonadotoxic therapy and to review the literature on this topic. Design Retrospective cohort study and review of the literature. Setting Academic children's hospital. Patient(s) Boys diagnosed with cancer to whom sperm cryopreservation was offered before the start of gonadotoxic therapy. Intervention(s) We studied the outcome of electroejaculation, including patient characteristics, hormone levels, and pretreatment semen parameters. Main Outcome Measure(s) Semen cryopreservation. Result(s) Pretreatment semen samples were obtained by masturbation in 106/114 boys with cancer, of which 78/106 were adequate for preservation. Electroejaculation was offered to 11 boys, of which three of 11 samples appeared adequate for preservation. Reviewing all reported electroejaculation cases in children with cancer in the literature, 13/29 (45%) cases were successful. Testosterone levels were higher in patients with successful sperm yield obtained by electroejaculation (median, 8.3 nmol/L [5.2-42.4] in successful harvests, vs. median 1.7 nmol/L [0.01-17.9] in unsuccessful harvests). Conclusion(s) Semen cryopreservation should be offered to all pubertal boys diagnosed with cancer. If masturbation fails, electroejaculation can be considered as a useful option for semen cryopreservation and leads to adequate material for cryopreservation in about half of the cases.