Optimizing oncofertility:Evidence based protocols for cryopreservation of germ cells and gonadal tissue in adolescent cancer patients

Oncofertility involves the cryopreservation of germ cells and gonadal tissue but its efficacy to protect the germ cell from cancer affected patients is not clear due to interplay of critical factors during freeze and warming, such as cancer type, patient age, quality of germ cells and protocol employed. Despite advances and introduction of various adjuvants for cryoprotection gaps remain in techniques, access and clinical validation. Additionally, human sperm population in the ejaculate is highly heterogeneous rendering it extremely difficult to perform sperm selection for assisted reproduction. Due to precious nature of spermatozoa from cancer patients, we propose that additional cytological parameters may be considered to prevent iatrogenic damage to spermatozoa and to improve the effectiveness of sperm cryopreservation. Hence, it is imperative to better understand sperm physiology in men with cancer and to evaluate the effects of various steps in freezing. This will enable innovative strategies to define specific protocol to retain sperm functionality in cancer survivors. With this knowledge, new and effective evidence based ejaculate specific cryopreservation protocols can be designed.