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Bitan R, Kedem A, Avraham S, Youngster M, Yerushalmi G, Kaufman S, Umanski A, Hourvitz A, Gat I. Cryopreserved testicular spermatozoa among patients with azoospermia. J Assist Reprod Genet 2024; 41:2099-2105. [PMID: 38878197 PMCID: PMC11338998 DOI: 10.1007/s10815-024-03167-w] [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: 11/17/2023] [Accepted: 06/03/2024] [Indexed: 08/22/2024] Open
Abstract
PURPOSE To investigate cryopreserved testicular spermatozoa among patients with azoospermia. METHODS In this retrospective study spanning from October 1993 to December 2021, we examined men diagnosed with azoospermia who underwent testicular spermatozoa cryopreservation. Data from medical records included utilization and disposal of sperm samples, age at initial cryopreservation. We analyzed the data over 20 years using Kaplan-Meier curves, compared age with the log-rank test, and assessed hazard ratios (HR) with 95% confidence intervals (CI) using Cox regression analysis. RESULTS A total of 356 patients with a mean age of 32.1 ± 6 were included. Of these, 225 patients utilized thawed testicular sperm for fertility treatments, with 118 patients using all their frozen straws and 107 patients partially using their stored straws. Additionally, 29 patients opted for disposal (six patients partially used their testicular spermatozoa before disposal), resulting in 108 patients who neither used nor disposed of their straws. From a laboratory standpoint, nearly 90% of patients contributed a single testicular sample, which was subsequently divided and cryopreserved as straws, with a median of 4 straws per sample. Notably, in the older age group (> 35 years old), there were a significantly lower usage rate and a higher disposal rate compared to the younger age groups (p < 0.05 for both), corroborated by univariable Cox analysis. CONCLUSIONS This extensive study unveils unique patterns in the preservation and disposal of testicular spermatozoa among azoospermic patients. Most patients utilize a significant portion of their stored samples, while older patients tend to use their testicular spermatozoa less frequently.
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Affiliation(s)
- Roy Bitan
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Israel.
| | - Alon Kedem
- IVF Department, Shamir Medical Center, Zerifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Avraham
- IVF Department, Shamir Medical Center, Zerifin, Israel
| | | | | | - Sarita Kaufman
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Israel
| | - Ana Umanski
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Israel
| | - Ariel Hourvitz
- IVF Department, Shamir Medical Center, Zerifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Itai Gat
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Israel
- IVF Department, Shamir Medical Center, Zerifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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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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