The use of pornographic materials by adolescent male cancer patients when banking sperm in the UK: Legal and ethical dilemmas

Effect of sexual arousal on semen parameters during abstinence

Semen analysis and physical examination are performed while first evaluation for patients with male infertility. Alcohol, smoking and dietary habits can affect the semen parameters. This study aimed to evaluate whether semen parameters are changed with sexual arousal. After excluding, 100 patients with ages of 18-45 were included to the study. All semen analysis were performed with three days of sexual abstinence. An identified 20 min video link was determined to the patients and while the sexual abstinence were told to watch this video once a day; after 3 days abstinence semen analysis was examined again. In the detailed examination normal spermatozoa ratio (Tygerberg strict criteria), spermatozoa concentration, semen volume, total motility and progressive motility ratios were noted. When the two semen analysis from the same patient are compared, it was observed that all parameters did not change except semen volume and total motile sperm count (p < 0.001). In conclusion, to understand the effect of sexual arousal during the sexual abstinence, we need studies with high patient number and longer follow-up.

Immune-Related Prognostic Model in Colon Cancer: A Gene Expression-Based Study

Mounting evidence supports that the malignant phenotypes of cancers are defined not only by the intrinsic activity of tumor cells but also by immune cells that are recruited and activated in tumor-related microenvironment. Here, we developed a diagnostic and prognostic model for colon cancer, based on expression profiles of immune-related genes and immune cell component. As a result, we found that B cell infiltration ratio, CD4+ T cells, as well as immune-related genes of TRIB3, CHGA, CASP7, LGALS4, LEP, NOX4, IL17A, and HSPD1 may be highly relevant with clinical outcome of colon cancer.

Should fertility clinics divest themselves of pornography?

Some commentators object to the way in which fertility clinics make pornography available to men as an aid to masturbation when those men produce sperm for evaluation, storage or IVF. These objections typically rely on claims that pornography is generally harmful to women, unnecessary and dissociates sexual acts from conception. In light of these objections, certain commentators want fertility clinics to divest themselves of pornography, but these objections to pornography are not morally convincing. In general, pornography can have psychological value to men masturbating 'on demand' in clinical contexts. Not all erotica must, either, work to the disadvantage of women in its means of production or social effects. Moreover, the sexuality expressed in masturbation has a value of its own, and conception apart from sexual intercourse is morally defensible on its own. Divestment from pornography would do little to constrain the putative harms of pornography because clinics consume only a fractional amount of the total amount of pornography available. The provision of pornography is a defensible clinical practice, even if it is not absolutely necessary to all men in producing a sperm sample important to their fertility or their interests in donating gametes.

Contemporary and future insights into fertility preservation in male cancer patients

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.

Preserving Fertility in Children and Adolescents with Cancer

In the face of excellent survival rates for pediatric and adolescent cancer, preserving the opportunity to have biological children is an important component of long term quality of life. Yet, modern chemotherapeutic regimens continue to pose a threat to fertility. The only fertility preservation methods available to pre-pubertal children of both genders is cryopreservation of gonadal tissue, a highly experimental intervention, or shielding/re-location of reproductive tissue in the setting of radiation. These techniques are available in the post pubertal population as well, but post pubertal patients also have the option for cryopreservation of gametes, a process that is much simpler in males than females. For this reason, prior to the initiation of therapy, sperm banking should be considered standard of care for males, while consideration of embryo or oocyte cryopreservation should be limited to those females at risk of developing ovarian failure. Attention to reproductive health and fertility preservation should continue after the completion of therapy. Establishing programs that streamline access to current fertility preservation techniques will assist in ensuring that all eligible patients can avail themselves of current options.

Randomised controlled trial of whether erotic material is required for semen collection: impact of informed consent on outcome

Semen is collected to evaluate male fertility or cryostore sperm preferentially in laboratories but such collection facilities have no standard fit-out. It is widely believed but untested whether providing erotic material (EM) is required to collect semen by masturbation in the unfamiliar environment. To test this assumption, 1520 men (1046 undergoing fertility evaluation, 474 sperm cryostorage, providing 1932 semen collection episodes) consecutively attending the semen laboratory of a major metropolitan teaching hospital for semen analysis were eligible for randomization to be provided or not with printed erotic material EM (X-rated, soft-core magazines) during semen collection. Randomization was performed by providing magazines in the collection rooms (as a variation on non-standard fit-out) on alternate weeks using a schedule concealed from participants. In the pilot study, men were randomized without seeking consent. In the second part of the study, which continued on from the first without interruption, an approved informed consent procedure was added. The primary outcome, the time to collect semen defined as the time from receiving to returning the sample receptacle, was significantly longer (by ~6%, 14.9 ± 0.3 [mean ± standard error of mean] vs. 14.0 ± 0.2 minutes, p = 0.02) among men provided with EM than those randomized to not being provided. There was no significant increase in the failure to collect semen samples (2.6% overall) nor any difference in age, semen volume or sperm concentration, output or motility according to whether EM was provided or not. The significantly longer time to collect was evident in the pilot study and the study overall, but not in the main study where the informed consent procedure was used. This study provides evidence that refutes the assumption that EM needs to be provided for semen collection in a laboratory. It also provides an example of a usually unobservable participation bias influencing study outcome of a randomized controlled trials.

A national study of the provision of oncology sperm banking services among Canadian fertility clinics

The purpose of this study was to survey the current state of oncology sperm banking services provided by fertility clinics across Canada. A total of 78 Canadian fertility facilities were invited to complete a questionnaire related to the availability, accessibility, affordability and utilisation of sperm banking services for cancer patients. The total response rate was 59%, with 20 (69%) in vitro fertilisation clinics and 26 (53%) other fertility centres returning the survey. A total of 24 responding facilities accepted oncology sperm banking referrals. The time frame to book the first banking appointment for 19 (79%) facilities was within 2 days. Inconsistent practice was found regarding the consent process for cancer patients who are of minority age. Eight (33%) facilities did not provide any subsidy and charged a standard banking fee regardless of patients' financial situations. Overall, the utilisation of oncology sperm banking services was low despite its availability and established efficacy, suggesting that Canadian cancer patients are notably underserved. The study has highlighted some important issues for further consideration in improving access to sperm banking services for cancer patients, especially for adolescents. Better collaboration between oncology and reproductive medicine to target healthcare providers would help to improve sperm banking rates.

Sperm preservation in children: a prescription for consistency with both child protection and the criminal law

People under the age of 18 with cancer sometimes require treatments that render them infertile. It may therefore be necessary, during the brief interval between diagnosis and the commencement of cancer treatment, to offer them the opportunity to produce sperm, through masturbation, for cryopreservation.

The article provides a framework for justifying this as a clinical activity, and avoiding it being construed as a sexual activity under the terms of the criminal law. Of equal importance, the article puts into place measures to ensure that this clinical activity is entirely consistent with the safeguarding principles of child protection.

Attitudes of physicians and parents towards discussing infertility risks and semen cryopreservation with male adolescents diagnosed with cancer

BACKGROUND

In paediatric oncology, the risk of infertility due to treatment constitutes an important problem. For sexually mature male adolescents, sperm cryopreservation is an option, but discussing the topic is complex because of the sensitive nature and the limited time frame. In this article, we determined attitudes and preferred roles of physicians and parents towards discussing sperm banking with male adolescents.

METHODS

Qualitative multi-centre study, using in-depth semi-structured interviews with 14 physicians and 15 parents of male adolescents undergoing cancer treatment.

RESULTS

Although physicians and parents agreed that infertility would have a major impact on the future quality of life, they sometimes disagreed on whether the topic should be discussed with adolescents. Physicians always wanted a separate discussion with adolescents because of the sensitive nature and the experience that parents sometimes misjudged the stage of maturity of their son. Parents, however, wanted control over whether physicians discussed the topic with their child and what was said. Physicians did not accept this control and, when necessary, were willing to bypass the parents and discuss the topic with the adolescent even when parents refused consent.

CONCLUSIONS

Physicians face the difficult task of balancing between their ideas of what is in the (future) interest of the adolescent and accommodating parental wishes. We argue that, because of the private character of sexuality and the potentially inadequate maturity assessment by parents, semen cryopreservation should be discussed separately with adolescent and parents. In addition, there should be an open communication with parents to address potential discomforts.