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Authors
Supervisors
Tombal, Bertrand  
 ;
Tosco, Lorenzo
Abstract
(en) This research examines the role of sperm cryopreservation in oncological care and in the evolving field of male contraception. A general decline in male fertility has been observed since the 1970s, characterized by a progressive deterioration in both the quantity and quality of sperm parameters, linked to environmental, behavioural, and iatrogenic factors. In oncology, sperm cryopreservation is widely recommended prior to gonadotoxic treatments such as chemotherapy or radiotherapy, particularly in cases of testicular cancer. However, clinical practices vary significantly across countries, especially regarding the optimal timing of preservation: before or after orchidectomy. In the context of couple contraception, men are increasingly involved in decision-making. Vasectomy remains the most commonly performed and reliable permanent method, with a post-procedure regret rate of approximately 7%. Given the potentially irreversible nature of the induced sterility, a European pre-vasectomy regret risk score has been developed. Validated by an international expert panel and a clinical study, this score incorporates key factors such as age (< 35 years), impulsivity (BIS-15 > 30), and the perceived sharing of contraceptive responsibility within the couple. A score ≥ 4 indicates the need for targeted counselling on sperm cryopreservation, while a score ≥ 7 warrants an additional 4-month reflection period. Two sine qua non conditions must be met: a clear understanding of the potentially irreversible nature of the sterility and the absence of any desire for future children. A Belgian medico-economic analysis demonstrates that reimbursing sperm cryopreservation for high-risk patients could generate substantial savings for the healthcare system by favouring less expensive intrauterine insemination over costly in vitro fertilisation in subsequent fertility treatments. A prospective European validation study is currently underway.
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Degraeve, A. (2026). Cryopreservation and male fertility. https://hdl.handle.net/2078.5/275976