Translated from the original German version
When a germ cell tumour is diagnosed in a young man, the procedure is straightforward: sonographic findings, then examination of tumour markers and finally testicular ablation followed by radio- or chemotherapy. What is all too often forgotten, however, is a potential desire to have children later in the life of the currently still young patient.
During the anti-tumour treatment itself, the germ cells undergo severe destruction, which often renders the patient unable to reproduce "under their own steam" later in life. It is possible to obtain and freeze sperm cells before surgery and especially before possible radiotherapy or chemotherapy in order to protect the patient's fertility. As of 1 July 2021, the costs of this so-called cryopreservation as a reproductive reserve are covered by health insurance funds, including all subsequent costs in Germany. Before July 2021, those affected still had to bear the costs of fertility preservation themselves. The current situation thus represents an important innovation that should be further publicised and taken advantage of in practice.
The Cryopreservation Policy has been in force since 1 July 2021. What does the directive contain and how is it implemented in practice? Professor MD Sabine Kliesch offered some valuable insights into this at this year's UroAktuell training program in Berlin.
From a medical point of view, cryopreservation of sperm, for instance, is particularly indicated prior to surgical removal of the gonads, prior to radiotherapy affecting the gonads and in the case of any potentially germ-damaging medication. Thus, the indication can also apply outside the field of oncology.
Before you can provide counselling and carry out cryopreservation, you must comply with the guidelines for assisted reproduction issued by the German Medical Association (Bundesärztekammer) and have a licence in accordance with §20b or §20c of the German Medicines Act (AMG).
Furthermore, fertility centres or specialised practices with the following additional qualifications may advise on and carry out cryopreservation: Centres or practices with the additional qualification "reproductive endocrinology", "gynaecological sonography" as well as "operative gynaecology" and "reproductive biology". For treatment of male patients, however, an additional certificate in "andrology" is required.
In the case of male patients, cryopreservation may be carried out by specialists with additional training in andrology.
The following andrological EBM billing codes are relevant for the counselling of young men about cryopreservation: 08623 andrological consultation, 08640 extraction, examination and preparation of sperm, 08641 preparation and examination of testicular tissue, 08645 preparation and freezing of sperm cells, 08647 thawing and preparation of sperm cells or germ cell tissue, 08648 sperm preparation from testicular tissue after testicular sperm extraction.
The cryopreservation policy is a real milestone in the care of patients undergoing potentially germ cell damaging therapies. There are some good regulatory requirements in place that need to be met before cryopreservation can be performed. Nevertheless, there are still unanswered questions regarding the care of some of the patients, e.g.
Source: Prof. Dr. med. Sabine Kliesch "ANDROLOGIE - Medikamentöse Tumortherapie, Fertilität und Sexualität", UroAktuell 2022, Berlin