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Bitan R, Magnezi R, Kedem A, Avraham S, Youngster M, Yerushalmi G, Kaufman S, Umanski A, Hourvitz A, Gat I. Autologous sperm usage after cryopreservation-the crucial impact of patients' characteristics. Andrology 2024; 12:527-537. [PMID: 37528799 DOI: 10.1111/andr.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The wide implementation of sperm freezing presents a growing burden on sperm banks. OBJECTIVES To evaluate sperm freezing and usage patterns over 30 years, according to demographic parameters of age at first cryopreservation and number of children, and indication for cryopreservation. MATERIAL AND METHODS This retrospective, population based, cohort study included all sperm cryopreservation cases performed at a tertiary referral center from October 1993 to December 2021, among patients aged 18 years and older. First, we determined the interval between first sperm sample and use. Then, we examined sperm usage separately for: (1) age, comparing patients grouped into 5-year age cohorts; (2) paternal status according to number of children; (3) indication, comparison among seven indications. Secondary analysis included correlations between main age groups and paternal status versus the four most common indications found. RESULTS During the study period 1490 men who cryopreserved sperm met the inclusion criteria. Average age at cryopreservation of the first sample was 33.9 ± 8.1 years. Average age at first sperm use was 37 ± 8.5 years. Cumulative sperm usage was 38.7% after 17.8 years. Increasing age was associated with progressive increase in sperm usage rate and shorter preservation period. Use significantly decreased with increasing number of children. Examination of seven reasons for sperm cryopreservation found the highest cumulative sperm usage was related to azoospermia (67.7%), followed by functional cryopreservation (39.3%), oligoasthenoteratospermia (27.3%), other (26.5%), patient's request (24%), cancer (19%), and systemic disease (7.2%). Secondary analysis defined specific usage patterns mainly related to age and indication, with less of an effect based on the number of children. DISCUSSION AND CONCLUSION After decades of cryopreservation, the paradigm of sperm cryopreservation is mostly related to cancer patients. This should be reevaluated and evolve to include broader patient-targeted factors and perceptions.
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Affiliation(s)
- Roy Bitan
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | - Racheli Magnezi
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel
| | - Alon Kedem
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Avraham
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | | | - Gil Yerushalmi
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | - Sarita Kaufman
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | - Ana Umanski
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | - Ariel Hourvitz
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Itai Gat
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Tzrifin, Israel
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Sarian G, Chalas C, Le Teuff G, Fayech C, Dumas A, Demoor-Goldschmidt C, Fresneau B. Post-treatment sperm cryopreservation practices in childhood and young adult cancer survivors. Reprod Biomed Online 2024; 48:103573. [PMID: 38113762 DOI: 10.1016/j.rbmo.2023.103573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 12/21/2023]
Abstract
RESEARCH QUESTION What are current practices of post-treatment fertility preservation in male childhood cancer survivors (CCS) who have not benefitted from pre-therapeutic fertility preservation in France and other European countries? DESIGN A survey was conducted of all fertility preservation centres in France (n = 30) and European fertility specialists (n = 9) in five European countries. Eight clinical cases and 40 questions were included to assess the effect of age at diagnosis, type of treatment (alkylating-agents, orchidectomy, testicular radiotherapy) and sperm parameters on the probability of a post-treatment fertility preservation proposal. Demographic characteristics of the responding practitioner were also collected. RESULTS Post-treatment sperm cryopreservation was proposed by 100% of fertility specialists in cases of severe oligoasthenoteratozoospermia, 77-88% in cases of moderate oligoasthenoteratozoospermia and in 65-77% in cases of sperm motility and vitality impairment. In cases of normal sperm parameters, 27-54% of fertility specialists would propose post-treatment sperm cryopreservation. These results did not differ significantly according to the type of treatment received or to responder-related factors. Practices of European specialists were also guided by sperm parameter results; 44-67% of specialists responding that they would propose sperm cryopreservation in cases of moderate to severe sperm parameter alterations. CONCLUSION Post-treatment semen analysis could be widely proposed to CCS who have not benefitted from pre-therapeutic fertility preservation. Post-treatment fertility preservation could be proposed in cases of persistent moderate to severe sperm parameter alterations. Guidelines would be important to homogenize practices and to encourage oncologists to refer CCS for fertility assessments.
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Affiliation(s)
| | - Céline Chalas
- Hospital Cochin, University of Paris-Cite, Department of Reproductive Biology-CECOS, Paris, France; Fédération française des CECOS, Toulouse, France
| | - Gwénaël Le Teuff
- Gustave Roussy, Paris-Saclay University, Department of Biostatistics and Epidemiology, Villejuif, F-94805, France
| | - Chiraz Fayech
- Gustave Roussy, Paris-Saclay University, Department of Children and Adolescents Oncology, Villejuif, F-94805, France
| | - Agnès Dumas
- University of Paris-Cite, ECEVE UMR 1123, F-75010 Paris, France; Inserm, Center for Research in Epidemiology and Public Health, U 1018, Epidemiology of Radiation, Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- Inserm, Center for Research in Epidemiology and Public Health, U 1018, Epidemiology of Radiation, Villejuif, France; University Hospital of Angers, Department of Pediatric Oncology and Hematology, Angers, France; Centre François Baclesse, Department of Radiotherapy and Protontherapy, Caen, France; Centre François Baclesse, Department of Supportive Care, Caen, France
| | - Brice Fresneau
- Gustave Roussy, Paris-Saclay University, Department of Children and Adolescents Oncology, Villejuif, F-94805, France; Inserm, Center for Research in Epidemiology and Public Health, U 1018, Epidemiology of Radiation, Villejuif, France.
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Ghidei L, Sullivan J, Valero Carrion RJ, Schammel J, Lipshultz L, McKenzie LJ. Current Gaps in Fertility Preservation for Men: How Can We do Better? J Clin Oncol 2022; 40:2524-2529. [PMID: 35724344 DOI: 10.1200/jco.21.02714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Luwam Ghidei
- Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, One Baylor Plaza, Houston, TX
| | - John Sullivan
- Department of Urology, Baylor College of Medicine, One Baylor Plaza, Houston, TX
| | | | - Joshua Schammel
- Department of Urology, Baylor College of Medicine, One Baylor Plaza, Houston, TX
| | - Larry Lipshultz
- Department of Urology, Baylor College of Medicine, One Baylor Plaza, Houston, TX
| | - Laurie J McKenzie
- Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, One Baylor Plaza, Houston, TX.,Department of Gynecology Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Levi-Setti PE, Negri L, Baggiani A, Morenghi E, Albani E, Dioguardi CMC, Specchia C, Patrizio P. Testicular sperm extraction and intracytoplasmic sperm injection outcome in cancer survivors with no available cryopreserved sperm. J Assist Reprod Genet 2020; 37:875-882. [PMID: 31981037 DOI: 10.1007/s10815-020-01697-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 01/17/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess rates of successful testicular sperm retrieval and intracytoplasmic sperm injection (ICSI) outcome in cancer survivors affected by non-obstructive azoospermia (NOA) or retrograde ejaculation (RE)/failure of emission (FOE). METHODS A retrospective analysis of cancer survivors who did not cryopreserve sperm prior to treatment undergoing testicular sperm extraction (TESE). Non-cancer NOA patients and neurologic RE/FOE were the control group. RESULTS A total of 97 cancer survivors were offered TESE and 88 (91%) accepted. Sperm was retrieved and cryopreserved in 34/67 patients with NOA (50.7%) and in 21/21 patients affected by RE/FOE (100%). Sperm retrieval rates were similar in the control group (44.9% in NOA and 100% in RE/FOE). The ICSI cumulative pregnancy rate (60%) and live birth rate (40%) per couple in 30 NOA men did not differ from controls (50.0 and 46.5%, respectively; p = 0.399/0.670). The cumulative pregnancy rate (66.7%) and live birth rate (55.6%) in 18 RE/FOE men did not differ from the control group (38.9 and 33.3%, respectively; p = 0.181/0.315). The cancer type and the resulting infertility disorder (NOA or RE/FOE) were not associated with ICSI outcomes. Female partner age was inversely related to the cumulative live birth rate, being fourfold lower (11.5%) in women ≥ 40 years and 48.8% in younger women (p = 0.0037). CONCLUSIONS The rate of successful TESE and the ICSI outcome in cancer survivors with NOA and RE/FOE is the same as non-cancer azoospermic patients. Female partner age (older than 40 years) was associated with a significant reduction in live birth rates after TESE-ICSI procedures.
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Affiliation(s)
- Paolo Emanuele Levi-Setti
- Humanitas Fertility Centre, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Obstetrics, Gynaecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, CT, USA.
| | - Luciano Negri
- Humanitas Fertility Centre, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Annamaria Baggiani
- Humanitas Fertility Centre, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elena Albani
- Humanitas Fertility Centre, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Carola Maria Conca Dioguardi
- Humanitas Fertility Centre, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Cristina Specchia
- Humanitas Fertility Centre, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Pasquale Patrizio
- Department of Obstetrics, Gynaecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, CT, USA
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Delayed childbearing and female ageing impair assisted reproductive technology outcome in survivors of male haematological cancers. J Assist Reprod Genet 2018; 35:2049-2056. [PMID: 30097765 DOI: 10.1007/s10815-018-1283-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/02/2018] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To analyse the impact of female characteristics on assisted reproductive technology outcome among male haematological cancer survivors. METHODS A retrospective analysis of 93 haematological cancer survivors attending our tertiary referral fertility centre between June 1998 and June 2017 for achieving fatherhood with assisted reproductive technology treatments. RESULTS A progressive increase in the median female age was observed during the study period (32.2 years until the year 2007 and 36.9 years from the year 2012). Fifty-five out of 93 patients were treated with intracytoplasmic sperm injection (ICSI) (113 ovarian stimulations, 108 ICSI procedures). Cryopreserved ejaculated sperm was used in 28 couples, fresh sperm in 19, and thawed testicular sperm in 8 couples. Mean female age at ovarian stimulation was 37.0 ± 4.7 years. Twenty-six pregnancies resulted in a full-term birth (23% per started ovarian stimulation; 43.6% per couple) and 33 children were born. No significant differences were observed according to source of sperm (fresh, frozen, testicular) and multivariate analysis confirmed that maternal age was the only variable inversely related to the cumulative delivery rate, being five times lower (15.7%) when the female partner was ≥ 40 years (OR = 0.22, 95% CI 0.06-0.77) vs. 58.3% with younger women (p = 0.0037). CONCLUSIONS Delayed childbearing and female ageing affect ICSI outcome in couples where the male is a survivor of haematological cancer. This topic should be discussed when counselling male cancer patients about fertility preservation.
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