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Pozzi E, Belladelli F, Corsini C, Boeri L, Capogrosso P, Fallara G, Candela L, Bertini A, Cattafi F, Raffo M, Cazzaniga W, Ventimiglia E, d'Arma A, Alfano M, Matloob R, Papaleo E, Candiani M, Montorsi F, Salonia A. Contemporary Diagnostic Work-Up for Male Infertility: Emphasizing Comprehensive Baseline Assessment. World J Mens Health 2024; 42:42.e63. [PMID: 39028127 DOI: 10.5534/wjmh.240069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 07/20/2024] Open
Abstract
Infertility is a prevalent issue affecting many couples during their reproductive years, with a significant number facing challenges in conceiving despite regular unprotected intercourse. Male factor infertility (MFI) contributes significantly to these cases, with a significant proportion of men lacking an identifiable etiology. As such, a thorough assessment of MFI has become increasingly vital for personalized management. This position paper from the Andrology team at IRCCS Ospedale San Raffaele emphasizes a comprehensive and individualized approach to MFI work-up, addressing the evolving challenges encountered in clinical practice. Our approach involves a thorough diagnostic work-up to identify the underlying causes of MFI, integrating insights from extensive literature review and our proprietary data. Our data demonstrates that an extensive diagnostic assessment allows us to identify at least one underlying cause of MFI in most infertile men. However, challenges persist in diagnosing less severe phenotypes with unclear etiology. We discuss the importance of individualized MFI work-up and its implications for developing rational therapeutic protocols. Lastly, this paper highlights the necessity for a personalized diagnostic assessment, addressing the daily clinical challenges and emphasizing tailored approaches to try to improve outcomes among couples seeking first medical help for infertility.
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Affiliation(s)
- Edoardo Pozzi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Belladelli
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Corsini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Candela
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Bertini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Cattafi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimiliano Raffo
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rayan Matloob
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Papaleo
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Candiani
- University Vita-Salute San Raffaele, Milan, Italy
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
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Jach R, Pabian W, Spaczyński R, Szamatowicz J, Zbroch T, Knapp P, Smolarczyk R, Kolawa W, Bodnar L, Kurzawa R, Zawirska D, Krzakowski M, Radowicki S, Fijuth J, Wielgoś M, Wysocki P, Kozioł K, Zalewski K, Warzocha K, Hałaburda K, Rdwan M, Radwan P, Jabłoński MJ, Kojs Z, Wołczyński S, Pawelczyk L, Kluz T, Lukaszuk K. Recommendations of the Fertility Preservation Working Group in Oncological, Hematological and Other Patients Treated With Gonadotoxic Therapies "ONCOFERTILITY" (GROF) of the Polish Society of Oncological Gynecology. J Adolesc Young Adult Oncol 2017; 6:388-395. [PMID: 28657411 DOI: 10.1089/jayao.2017.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert Jach
- 1 Department of Endocrinologic Gynecology and Gynecology, University Hospital in Krakow , Krakow, Poland
| | - Wojciech Pabian
- 1 Department of Endocrinologic Gynecology and Gynecology, University Hospital in Krakow , Krakow, Poland
| | - Robert Spaczyński
- 2 Gynaecology and Obstetrics Clinical Hospital of K. Marcinkowski Medical University in Poznań , Poznań, Poland
| | | | - Tomasz Zbroch
- 4 Artemida-Gynaecology, Endocrinology and Reproductive Medicine Centre , Białystok, Poland
| | - Paweł Knapp
- 3 Medical University of Białystok , Białystok, Poland
| | - Roman Smolarczyk
- 5 Princess Anna Mazowiecka Clinical Hospital in Warsaw , Warsaw, Poland
| | - Wojciech Kolawa
- 6 G. Narutowicz Municipal Specialist Hospital in Krakow , Krakow, Poland
| | | | | | - Daria Zawirska
- 1 Department of Endocrinologic Gynecology and Gynecology, University Hospital in Krakow , Krakow, Poland
| | | | | | - Jacek Fijuth
- 10 Oncological Haematology Centre in Łódź , Łódź, Poland
| | | | - Piotr Wysocki
- 1 Department of Endocrinologic Gynecology and Gynecology, University Hospital in Krakow , Krakow, Poland
| | | | | | | | | | - Michał Rdwan
- 15 GAMETA Infertility Treatment Clinic , Rzgów, Poland
| | - Paweł Radwan
- 15 GAMETA Infertility Treatment Clinic , Rzgów, Poland
| | | | - Zbigniew Kojs
- 17 Oncology Centre-M. Skłodowska-Curie Institute , Krakow, Poland
| | | | - Leszek Pawelczyk
- 2 Gynaecology and Obstetrics Clinical Hospital of K. Marcinkowski Medical University in Poznań , Poznań, Poland
| | - Tomasz Kluz
- 18 Department of Obstetrics and Gynecology, Fryderyk Chopin University Hospital No 1, Faculty of Medicine, Rzeszow University , Rzeszow, Poland
| | - Krzysztof Lukaszuk
- 10 Oncological Haematology Centre in Łódź , Łódź, Poland,11 Medical University of Warsaw , Warsaw, Poland,12 "nOvum" Medical Clinic , Warsaw, Poland,13 Świętokrzyskie Oncology Centre , Kielce, Poland
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Agarwal A, Ong C, Durairajanayagam D. Contemporary and future insights into fertility preservation in male cancer patients. Transl Androl Urol 2016; 3:27-40. [PMID: 26816750 PMCID: PMC4708292 DOI: 10.3978/j.issn.2223-4683.2014.02.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In recent years, survival rates of cancer patients have increased, resulting in a shift of focus from quantity to quality of life. A key aspect of quality of life is fertility potential; patients suffering from iatrogenic infertility often become depressed. Since many cancer therapies—chemotherapy, radiotherapy and/or surgery—and even cancer itself have detrimental effects on the male reproductive system, it is important to preserve fertility before any treatment commences. Currently, the only reliable method of male fertility preservation is sperm banking. For patients who are unable to provide semen samples by the conventional method of masturbation, there are other techniques such as electroejaculation, microsurgical epididymal sperm aspiration and testicular sperm extraction that can be employed. Unfortunately, it is presently impossible to preserve the fertility potential of pre-pubertal patients. Due to the increasing numbers of adolescent cancer patients surviving treatment, extensive research is being conducted into several possible methods such as testicular tissue cryopreservation, xenografting, in vitro gamete maturation and even the creation of artificial gametes. However, in spite of its ease, safety, convenience and many accompanying benefits, sperm banking remains underutilized in cancer patients. There are several barriers involved such as the lack of information and the urgency to begin treatment, but various measures can be put in place to overcome these barriers so that sperm banking can be more widely utilized.
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Affiliation(s)
- Ashok Agarwal
- Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chloe Ong
- Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Damayanthi Durairajanayagam
- Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Chiba K, Fujisawa M. Fertility preservation in men with cancer. Reprod Med Biol 2014; 13:177-184. [PMID: 29662373 DOI: 10.1007/s12522-014-0180-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/07/2014] [Indexed: 12/23/2022] Open
Abstract
Due to recent advances in medical technologies, cancer has become more curable and chronic, and post-treatment quality of life, including male fertility, has become an important issue. Cancer itself can affect spermatogenesis through complex interactions, and cancer treatment such as surgery, radiotherapy and chemotherapy, all have certain detrimental effects on spermatogenesis. Currently, sperm cryopreservation before cancer treatment is the mainstay of fertility preservation, and is recommended by numerous guidelines. Although fertility preservation should be discussed with all cancer patients before treatment, it still remains underused. Postpubertal patients who are unable to bank sperm may undergo testicular sperm extraction before treatment. For prepubertal boys, there is no clinically established guideline for fertility preservation. Investigations such as spermatogonial stem cell culture are ongoing, and may lead to clinical options for fertility preservation in the future.
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Affiliation(s)
- Koji Chiba
- Division of Urology, Department of Surgery Related, Faculty of Medicine Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho, Chuo-Ku 650-0017 Kobe Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho, Chuo-Ku 650-0017 Kobe Japan
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Sperm banking is of key importance in patients with prostate cancer. Fertil Steril 2013; 100:367-72.e1. [DOI: 10.1016/j.fertnstert.2013.03.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/10/2013] [Accepted: 03/29/2013] [Indexed: 01/01/2023]
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Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2013; 31:2500-10. [PMID: 23715580 PMCID: PMC5321083 DOI: 10.1200/jco.2013.49.2678] [Citation(s) in RCA: 1089] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To update guidance for health care providers about fertility preservation for adults and children with cancer. METHODS A systematic review of the literature published from March 2006 through January 2013 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Panel reviewed the evidence and updated the recommendation language. RESULTS There were 222 new publications that met inclusion criteria. A majority were observational studies, cohort studies, and case series or reports, with few randomized clinical trials. After review of the new evidence, the Update Panel concluded that no major, substantive revisions to the 2006 American Society of Clinical Oncology recommendations were warranted, but clarifications were added. RECOMMENDATIONS As part of education and informed consent before cancer therapy, health care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, the Update Panel encourages providers to advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm and embryo cryopreservation as well as oocyte cryopreservation are considered standard practice and are widely available. Other fertility preservation methods should be considered investigational and should be performed by providers with the necessary expertise.
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Affiliation(s)
- Alison W. Loren
- Alison W. Loren, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Anthony J. Magdalinski, Private Practice, Sellersville, PA; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Lindsay Nohr Beck, LIVESTRONG Foundation's Fertile Hope Program, Austin, TX; Kutluk Oktay, Innovation Institute for Fertility Preservation, New York Medical College, Rye and New York, NY; Lawrence Brennan, Oncology Hematology Care, Crestview Hills, KY; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn Quinn, Moffitt Cancer Center, Tampa, FL; and W. Hamish Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Pamela B. Mangu
- Alison W. Loren, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Anthony J. Magdalinski, Private Practice, Sellersville, PA; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Lindsay Nohr Beck, LIVESTRONG Foundation's Fertile Hope Program, Austin, TX; Kutluk Oktay, Innovation Institute for Fertility Preservation, New York Medical College, Rye and New York, NY; Lawrence Brennan, Oncology Hematology Care, Crestview Hills, KY; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn Quinn, Moffitt Cancer Center, Tampa, FL; and W. Hamish Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Lindsay Nohr Beck
- Alison W. Loren, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Anthony J. Magdalinski, Private Practice, Sellersville, PA; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Lindsay Nohr Beck, LIVESTRONG Foundation's Fertile Hope Program, Austin, TX; Kutluk Oktay, Innovation Institute for Fertility Preservation, New York Medical College, Rye and New York, NY; Lawrence Brennan, Oncology Hematology Care, Crestview Hills, KY; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn Quinn, Moffitt Cancer Center, Tampa, FL; and W. Hamish Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Lawrence Brennan
- Alison W. Loren, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Anthony J. Magdalinski, Private Practice, Sellersville, PA; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Lindsay Nohr Beck, LIVESTRONG Foundation's Fertile Hope Program, Austin, TX; Kutluk Oktay, Innovation Institute for Fertility Preservation, New York Medical College, Rye and New York, NY; Lawrence Brennan, Oncology Hematology Care, Crestview Hills, KY; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn Quinn, Moffitt Cancer Center, Tampa, FL; and W. Hamish Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Anthony J. Magdalinski
- Alison W. Loren, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Anthony J. Magdalinski, Private Practice, Sellersville, PA; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Lindsay Nohr Beck, LIVESTRONG Foundation's Fertile Hope Program, Austin, TX; Kutluk Oktay, Innovation Institute for Fertility Preservation, New York Medical College, Rye and New York, NY; Lawrence Brennan, Oncology Hematology Care, Crestview Hills, KY; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn Quinn, Moffitt Cancer Center, Tampa, FL; and W. Hamish Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Ann H. Partridge
- Alison W. Loren, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Anthony J. Magdalinski, Private Practice, Sellersville, PA; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Lindsay Nohr Beck, LIVESTRONG Foundation's Fertile Hope Program, Austin, TX; Kutluk Oktay, Innovation Institute for Fertility Preservation, New York Medical College, Rye and New York, NY; Lawrence Brennan, Oncology Hematology Care, Crestview Hills, KY; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn Quinn, Moffitt Cancer Center, Tampa, FL; and W. Hamish Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Gwendolyn Quinn
- Alison W. Loren, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Anthony J. Magdalinski, Private Practice, Sellersville, PA; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Lindsay Nohr Beck, LIVESTRONG Foundation's Fertile Hope Program, Austin, TX; Kutluk Oktay, Innovation Institute for Fertility Preservation, New York Medical College, Rye and New York, NY; Lawrence Brennan, Oncology Hematology Care, Crestview Hills, KY; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn Quinn, Moffitt Cancer Center, Tampa, FL; and W. Hamish Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - W. Hamish Wallace
- Alison W. Loren, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Anthony J. Magdalinski, Private Practice, Sellersville, PA; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Lindsay Nohr Beck, LIVESTRONG Foundation's Fertile Hope Program, Austin, TX; Kutluk Oktay, Innovation Institute for Fertility Preservation, New York Medical College, Rye and New York, NY; Lawrence Brennan, Oncology Hematology Care, Crestview Hills, KY; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn Quinn, Moffitt Cancer Center, Tampa, FL; and W. Hamish Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Kutluk Oktay
- Alison W. Loren, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Anthony J. Magdalinski, Private Practice, Sellersville, PA; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Lindsay Nohr Beck, LIVESTRONG Foundation's Fertile Hope Program, Austin, TX; Kutluk Oktay, Innovation Institute for Fertility Preservation, New York Medical College, Rye and New York, NY; Lawrence Brennan, Oncology Hematology Care, Crestview Hills, KY; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn Quinn, Moffitt Cancer Center, Tampa, FL; and W. Hamish Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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Salonia A, Matloob R, Saccà A, Ferrari M, Gallina A, Castiglione F, Abdollah F, Raber M, Brigante C, Candiani M, Rigatti P, Montorsi F. Are Caucasian-European men delaying fatherhood? Results of a 7 year observational study of infertile couples with male factor infertility. ACTA ACUST UNITED AC 2011; 35:125-32. [DOI: 10.1111/j.1365-2605.2011.01197.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Yee S, Fuller-Thomson E, Dwyer C, Greenblatt E, Shapiro H. "Just what the doctor ordered": Factors associated with oncology patients' decision to bank sperm. Can Urol Assoc J 2011; 6:E174-8. [PMID: 21539768 DOI: 10.5489/cuaj.10084] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this cross-sectional study was to explore factors associated with oncology patients' decision to bank sperm prior to cancer treatment. MATERIALS AND METHODS Patients who were referred to the oncology sperm banking program between January 2009 and March 2010 were invited to complete an 18-item questionnaire during one of their sperm banking visits. RESULTS Of the 157 cancer patients referred to the Mount Sinai Oncology Sperm and Tissue Bank for sperm banking during the 15-month period, 79 questionnaires were returned (50% response rate). Of the respondents, 89% were informed about sperm banking by their physician. Future family planning was cited as the main reason to bank. Cost was not a barrier for the vast majority of respondents. Forty percent of respondents banked sperm within 4 days prior to initiating cancer treatment. Most respondents relied on their physician for verbal information on sperm banking. Eighty-one percent were unaware of any patient organizations that have educational materials on oncology fertility preservation. CONCLUSION Sperm banking prior to cancer treatment is the only proven method of preserving fertility for cancer patients. The two main determinants associated with deciding whether to bank sperm were: the physician's recommendation and the patient's desire for future fatherhood. Physicians play a key role in influencing patients' decisions. The recommendation to bank sperm is a persuasive message if patients are clearly informed about their potential risk of infertility post-cancer treatment, and that sperm banking is an effective way of preserving fertility. Providing patients with education materials might enhance compliance in sperm banking.
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Affiliation(s)
- Samantha Yee
- Centre for Fertility and Reproductive Health, Mount Sinai Hospital, Toronto, ON; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
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Gupta S, Agarwal A, Sharma R, Ahmady A. Recovery, Preparation, Storage and Utilization of Spermatozoa for Fertility Preservation in Cancer Patients and Sub-Fertile Men. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/205891581000100204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sperm cryopreservation is an important part of an infertility program for patients undergoing infertility treatments, fertility assurance for vasectomy cases, and for fertility preservation due to cancer or other medical conditions. With recent developments in reproductive technology, even men with severely impaired sperm parameters can benefit from cryopreservation as procedures such as intra-cytoplasmic sperm injection (ICSI) require only a few sperm to achieve fertilization and pregnancy. The increasing success of cancer treatment and concerted efforts to ensure quality of life after successful treatment have placed great emphasis on the need to preserve the reproductive capability of young men. It is a highly effective method of protecting male fertility potential, and involves collection, freezing, and long-term storage of sperm. Based on the etiological condition of the patients, sperm can be collected by ejaculation or by surgical retrieval from epididymis or testes. The option to bank sperm should be offered systematically to all patients who may benefit. However, this is not a standard of practice yet; it may be overlooked due to lack of physician awareness regarding the need for fertility preservation and the effectiveness of this option, and/or overestimating the limitations of poor baseline sperm quality leading physician to view cryopreservation as futile. Failure to offer cryopreservation ignores the only possible reproductive option available to certain patients.
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Affiliation(s)
- Sajal Gupta
- Centre for Reproductive Medicine, Glickman Urological & Kidney Institute, & Obstetrics and Gynaecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ashok Agarwal
- Centre for Reproductive Medicine, Glickman Urological & Kidney Institute, & Obstetrics and Gynaecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Reecha Sharma
- Centre for Reproductive Medicine, Glickman Urological & Kidney Institute, & Obstetrics and Gynaecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Ahmady
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA
- MacDonald IVF and Fertility program, University Hospitals Case Medical Centre, Cleveland, OH
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Gilbert E, Adams A, Mehanna H, Harrison B, Hartshorne GM. Who should be offered sperm banking for fertility preservation? A survey of UK oncologists and haematologists. Ann Oncol 2010; 22:1209-1214. [PMID: 21030380 DOI: 10.1093/annonc/mdq579] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fertility after cancer therapy is a significant quality-of-life concern for many patients, their partners and families. Authoritative guidance states that men whose fertility may be affected by impending therapies should be offered sperm banking. Yet some patients are not offered this opportunity and are thereby disadvantaged. We sought to understand oncologists' and haematologists' decision making concerning sperm-banking referrals. DESIGN We surveyed all oncologists and haematologists on the Royal College of Radiotherapists' Faculty of Oncology and British Society for Haematology circulation lists. RESULTS From 2357 across all specialties, 499 responses were received: 253 haematologists and 246 oncologists (21% response rate). Twenty-one percent of respondents were unaware of local policies on sperm banking and 42% considered that sperm banking should be offered to more patients. Respondents' decisions reveal either assumptions about patients' needs based on characteristics such as age, sexual orientation and severity of illness or the influence of their own moral conclusions upon their patients. The survey identified paucity of training for clinicians, information for patients and systematic recording of discussions about fertility. CONCLUSIONS A robust care infrastructure supporting male fertility storage is needed urgently to include targeted information for cancer clinicians and patients, identified individuals responsible for coordination and documentation of discussions with patients.
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Affiliation(s)
- E Gilbert
- Warwick Medical School, University of Warwick
| | - A Adams
- Warwick Medical School, University of Warwick
| | - H Mehanna
- Warwick Medical School, University of Warwick; Institute of Head and Neck Studies and Education
| | | | - G M Hartshorne
- Warwick Medical School, University of Warwick; Centre for Reproductive Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
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Editorial comment on: paternity and testicular function among testicular cancer survivors treated with two to four cycles of cisplatin-based chemotherapy. Eur Urol 2010; 58:140-1. [PMID: 20395038 DOI: 10.1016/j.eururo.2010.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Premature ejaculation (PE) is the most common male sexual problem worldwide affecting 22–38% of men. It has a significant morbidity both on patients and their partners, causing distress, anxiety and relationship difficulties. The mainstay of treatment is a combined approach using behavioural therapies and non-licensed medication such as topical anaesthetic preparations, selective serotonin re-uptake inhibitors and phosphodiesterase-5 inhibitors. In recent years, there has been a greater emphasis placed on researching novel treatments and exploring the on-demand use of current preparations. This review provides an overview of current accepted treatments and emerging agents for the use in PE.
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Affiliation(s)
- E J McCarty
- Department of Genitourinary Medicine, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK
| | - W W Dinsmore
- Department of Genitourinary Medicine, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK
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