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Degraeve A, Roumeguere T, Tilmans G, Marotta ML, Huyghe E, Fournier G, Faix A, Spinoit AF, Decaestecker K, Herve F, Boitrelle F, Lahdensuo K, Tosco L, Van Damme J. The habits of European urologists in the field of cryopreservation before the urological cancers treatment. Andrology 2024; 12:1347-1355. [PMID: 38183375 DOI: 10.1111/andr.13577] [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: 05/16/2023] [Revised: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Treatments against urogenital cancers frequently have fertility side-effects. The strategy to preserve fertility after oncologic treatments is still a matter of debate with a lack of evidence and international guidelines. The aim of this study is to investigate fertility preservation practices before urogenital cancer treatments and to compare national habits. MATERIAL AND METHODS An online anonymous survey was submitted from January to June 2021 to six European urological societies. The 31-items questionnaire included questions about demography, habits of evaluation, and management of fertility preservation in case of urogenital cancer treatments. RESULTS Two hundred twenty-eight urologists from six urological societies in five different countries (Belgium, The Netherlands, Luxembourg, France, Finland) filled out the survey. Three quarter (74%; n = 166) usually propose a cryopreservation before orchidectomy. In case of oligo/azoo-spermia, the technique performed for the sperm extraction during orchidectomy varies among the sample: 70.5% (n = 160) of the responders do not perform a Testicular Sperm Extraction (TESE) nor a Percutaneous Epididymal Sperm Aspiration (PESA). The cryopreservation for prostate cancer treatments is never proposed in 48.17% (n = 105) of responders but conversely it is always proposed in 5.05% (n = 11). The cryopreservation before bladder cancer treatments is not commonly proposed (67.5%, n = 154). CONCLUSION Our study showed variable country specific tendencies in terms of fertility preservation in the period of treatment of urological cancers. These differences seem to be related to national guidelines recommendations. Standardization of international guidelines is urgently needed in the field of fertility for urological cancer patients.
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Affiliation(s)
- Amandine Degraeve
- Department of Urology, Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
- Department of Urology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Thierry Roumeguere
- Department of Urology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Erasme Hospital, Brussels, Belgium
| | - Gilles Tilmans
- Unit of Abdominal Surgery, Saint-Luc University Clinics, Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Laura Marotta
- Department of Andrology, Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | - Eric Huyghe
- Department of Urology-Kidney transplantation-Andrology-Rangueil Hopital, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Department of Reproductive Medicine, Paule de Viguier Hospital, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- UMR 1203 « DEFE » (Development-Embryo-Fertility-Environment) -INSERM-Université de Toulouse-Université de Montpellier, Montpellier, France
| | | | - Antoine Faix
- Department of Urology, Clinique Beau Soleil, Montpellier, France
| | | | | | - François Herve
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Kanerva Lahdensuo
- Department of Urology and Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lorenzo Tosco
- Department of Urology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Erasme Hospital, Brussels, Belgium
| | - Julien Van Damme
- Department of Urology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
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Tverye A, Nangia A, Fantus RJ. Testicular Cancer Survivorship and Fertility Preservation. Urol Clin North Am 2024; 51:429-438. [PMID: 38925745 DOI: 10.1016/j.ucl.2024.03.011] [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] [Indexed: 06/28/2024]
Abstract
Testicular cancer disproportionally affects men of reproductive age making fertility an important aspect of testicular cancer survivorship. Men with testicular cancer have more semen parameter abnormalities and a higher incidence of infertility compared to the general population. All treatment options for testicular cancer negatively affect fertility with recovery rates varying by treatment. For these reasons, clinicians should offer sperm cryopreservation, ideally before orchiectomy to maximize the possibility of biologic paternity, if desired. Several innovations have positively impacted this space including direct-to-consumer cryopreservation and bench research demonstrating the feasibility of reintroducing testicular cells post-therapy.
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Affiliation(s)
- Aaron Tverye
- Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Ajay Nangia
- Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Richard J Fantus
- Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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3
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Hu Y, Fu X, Jiang X, Jiang M, Zheng X, Lu H, Xu M. The experience of fertility concerns in patients with testicular cancer: a qualitative study. Support Care Cancer 2024; 32:529. [PMID: 39028382 PMCID: PMC11271369 DOI: 10.1007/s00520-024-08720-y] [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: 02/28/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Testicular cancer usually occurs in young adult men between the ages of 20 and 40 years, which largely coincides with the age of men's reproductive intentions. However, a serious side effect of testicular cancer therapy could reduce the fertility of patients. PURPOSE To explore the experience of fertility concerns in patients with testicular cancer. METHODS A phenomenological research was conducted on 12 patients with testicular cancer. Data collection was from May 2023 to August 2023, and Colaizzi analysis method was used to analyze the data. RESULTS Four themes were found: (1) multiple worries and negative emotions, (2) fertility decision-making faces many challenges, (3) self-coping strategies for facing fertility concerns, (4) unmet supportive care needs. CONCLUSION Medical staff should pay attention to the fertility needs of patients with testicular cancer and provide relevant interventions and support to reduce their fertility concerns.
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Affiliation(s)
- Ya Hu
- Department of Urology, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P.R. China
- State Key Laboratory of Oncology in Southern China, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, P.R. China
| | - Xue Fu
- Department of Urology, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P.R. China
- State Key Laboratory of Oncology in Southern China, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, P.R. China
| | - Xiaoya Jiang
- International Medical Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, P.R. China
| | - Mengxiao Jiang
- Department of Urology, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P.R. China
- State Key Laboratory of Oncology in Southern China, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, P.R. China
| | - Xia Zheng
- Department of Urology, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P.R. China.
- State Key Laboratory of Oncology in Southern China, Guangzhou, 510060, P.R. China.
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, P.R. China.
| | - Huiming Lu
- Department of Urology, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P.R. China.
- State Key Laboratory of Oncology in Southern China, Guangzhou, 510060, P.R. China.
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, P.R. China.
| | - Man Xu
- Department of Urology, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P.R. China.
- State Key Laboratory of Oncology in Southern China, Guangzhou, 510060, P.R. China.
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, P.R. China.
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4
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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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Kanthabalan A, Emmanuel A, Alexander C, Bhatt N, Chan V, Kalejaiye O, Narahari K, Kasivisvanathan V, Shabbir M. An international survey of contemporary practices towards fertility assessment and preservation in patients undergoing radical inguinal orchidectomy for testicular cancer. BJUI COMPASS 2024; 5:445-453. [PMID: 38751948 PMCID: PMC11090774 DOI: 10.1002/bco2.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 05/18/2024] Open
Abstract
Objective The study aims to assess current international clinician attitudes, practices and barriers towards fertility assessment and preservation in patients undergoing radical inguinal orchidectomy (RIO) for testicular cancer. Materials and methods An international online survey of urologists and urologists in training who perform RIO for testicular cancer was developed by the British Association of Urological Surgeons (BAUS) Sections of Andrology and Oncology and the British Urology Researchers in Surgical Training (BURST). The recruitment process used social media and the emailing lists of national urological societies. Responses were collected between 10/02/2021 and 31/05/2021 and stored using password-protected Research Electronic Data Capture (REDCap) database software. The primary outcome was the proportion of urologists who routinely offer semen cryopreservation prior to RIO. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys platform. Results A total of 393 respondents took part in the online survey; of these, the majority were from the United Kingdom (65.9%), with the remaining international respondents (34.1%) from six different continents, which included 45 different countries. Of the respondents, 57.1% reported that they would routinely offer semen cryopreservation to all patients undergoing RIO for testicular cancer. In addition, 36.0% of urologists routinely performed pre-operative semen analysis, and 22.1% routinely performed pre-operative testicular serum hormone profile. Of the respondents, 14.4% performed expedited RIO within 48 h; 31.2% of respondents reported that they considered no delay to RIO to allow for semen cryopreservation to be acceptable. Conclusions A significant proportion of international urologists do not offer pre-operative fertility assessment and preservation in men undergoing RIO for testicular cancer. Surgery is performed in an expedited fashion within 1 week in the majority of patients. Urologists perceive there to be a lack of access and availability to fertility services, and that delay to RIO to allow for fertility preservation is often not acceptable.
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Affiliation(s)
- Abi Kanthabalan
- Department of UrologyWorcestershire Royal HospitalWorcesterUK
| | | | | | - Nikita Bhatt
- Department of UrologyNorfolk and Norwich University HospitalNorwichUK
| | - Vinson Chan
- School of Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Odunayo Kalejaiye
- Department of UrologyUniversity Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Krishna Narahari
- Department of UrologyCardiff and Vale University Health BoardCardiffUK
| | - Veeru Kasivisvanathan
- Department of UrologyUniversity Hospitals Bristol and Weston NHS Foundation TrustBristolUK
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
| | - Majid Shabbir
- Department of UrologyGuy's & St. Thomas' HospitalLondonUK
- Faculty of Life Sciences & MedicineKing's CollegeLondon
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Qasemi M, Sur VP, Simonik O, Postlerova P, Skrobanek P, Hradec T, Boublikova L, Zamecnik L, Buchler T, Neuzil J, Komrskova K. Sperm mitochondria dysfunction in response to testicular cancer. Eur J Clin Invest 2024; 54:e14146. [PMID: 38069497 DOI: 10.1111/eci.14146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 03/13/2024]
Abstract
Testicular cancer is the most common form of cancer in young men of reproductive age and its incidence is increasing globally. With the currently successful treatment and 95% survival rate, there is a need for deeper understanding of testicular cancer-related infertility. Most patients with testicular cancer experience semen abnormalities prior to cancer therapy. However, the exact mechanism of the effect of testicular cancer on sperm anomalies is not known. Mitochondria are organelles that play a crucial role in both tumorigenesis and spermatogenesis and their malfunction may be an important factor resulting in sperm abnormalities in testicular cancer patients. Within the scope of this review, we will discuss current knowledge of testicular cancer-related alterations in the ATP production pathway, a possible pathophysiological switch from oxidative phosphorylation (OXPHOS) to glycolysis, as well as the role of oxidative stress promoting sperm dysfunction. In this regard, the review provides a summary of the impact of testicular cancer on sperm quality as a possible consequence of impaired mitochondrial function including the energy metabolic pathways that are known to be altered in the sperm of testicular cancer patients.
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Affiliation(s)
- Maryam Qasemi
- Laboratory of Reproductive Biology, Institute of Biotechnology of the Czech Academy of Sciences, BIOCEV, Vestec, Czech Republic
| | - Vishma Pratap Sur
- Laboratory of Reproductive Biology, Institute of Biotechnology of the Czech Academy of Sciences, BIOCEV, Vestec, Czech Republic
| | - Ondrej Simonik
- Laboratory of Reproductive Biology, Institute of Biotechnology of the Czech Academy of Sciences, BIOCEV, Vestec, Czech Republic
| | - Pavla Postlerova
- Laboratory of Reproductive Biology, Institute of Biotechnology of the Czech Academy of Sciences, BIOCEV, Vestec, Czech Republic
- Department of Veterinary Sciences, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, Praha, Czech Republic
| | - Pavel Skrobanek
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Tomas Hradec
- Department of Urology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ludmila Boublikova
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Libor Zamecnik
- Department of Urology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Buchler
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
- Department of Oncology, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Jiri Neuzil
- Laboratory of Molecular Therapy, Institute of Biotechnology of the Czech Academy of Sciences, BIOCEV, Vestec, Czech Republic
- School of Pharmacy and Medical Science, Griffith University, Southport, Queensland, Australia
| | - Katerina Komrskova
- Laboratory of Reproductive Biology, Institute of Biotechnology of the Czech Academy of Sciences, BIOCEV, Vestec, Czech Republic
- Department of Zoology, Faculty of Science, Charles University, Prague, Czech Republic
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Raffo M, Di Naro A, Napolitano L, Aveta A, Cilio S, Pandolfo SD, Manfredi C, Lonati C, Suardi NR. Testicular Cancer Treatments and Sexuality: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:586. [PMID: 38674232 PMCID: PMC11051825 DOI: 10.3390/medicina60040586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
The incidence of testicular cancer (TC) has been rapidly increasing over the past years. Diagnosis and early treatment have shown good oncological control, guaranteeing the patient different treatment approaches according to histology and tumor stage. Currently, physicians usually prioritize oncological outcomes over sexual outcomes and quality of life, considering as a first aim the overall survival of the patients; however, differently from other neoplasms, quality of life is still strongly affected among TC patients, and sexual outcomes are frequently compromised after each TC treatment. Several studies have suggested that each treatment approach may be associated with sexual dysfunctions, including erectile dysfunction, ejaculatory disorders, fertility issues, and hormonal changes. Since testicular cancer patients are more frequently young men, the subject of this work is substantial and should be analyzed in detail to help specialists in the management of this disease. The aim of the current narrative review is to generally describe every treatment for TC, including surgery, chemotherapy, radiotherapy, and retroperitoneal lymph node dissection, and to establish which sexual dysfunction may be specifically associated with each therapy.
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Affiliation(s)
- Massimiliano Raffo
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Angelo Di Naro
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Achille Aveta
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Simone Cilio
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University, 80138 Naples, Italy;
| | - Chiara Lonati
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
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8
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Zheng Y, Li DM, Li FP, Jiang XH, Yang L, Qu R, Bai HZ, Zhao GC, Tian K. Case report: remedial microdissection testicular sperm extraction after onco-microdissection testicular sperm extraction failure. Medicine (Baltimore) 2024; 103:e37201. [PMID: 38394502 PMCID: PMC11309596 DOI: 10.1097/md.0000000000037201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Testicular cancer (TC) mostly occurs in men aged 14 to 44. Studies have shown that TC seriously damages male fertility, and 6% to 24% of patients with TC were even found to suffer from azoospermia when they are diagnosed. At present, some studies have pointed out that onco-microdissection testicular sperm extraction (mTESE) can extract sperm from tumor testicles. However, there are almost no reports on remedial measures after onco-mTESE failure. Given the valuable opportunity for fertility preservation in patients with TC and azoospermia, it is necessary to provide effective remedial methods for patients with failed onco-mTESE. METHODS Two young men, who were diagnosed with TC and also found to have azoospermia, tried onco-mTESE while undergoing radical orchiectomy for fertility preservation. However, sperm extraction failed in both patients. Subsequently, the isolated testicular tissue of the patient in case 1 suffered from TC again, and the patient in case 2 was scheduled to receive multiple cycles of gonadotoxic chemotherapy. Because both had a plan to have a birth in the future, we performed remedial mTESE. RESULTS Sperm was successfully extracted from both patients. The patient recovered well, without complications. The patient couple in case 1 underwent 1 intracytoplasmic sperm injection (ICSI) cycle but did not achieve clinical pregnancy. CONCLUSIONS There is still an opportunity to extract sperm successfully using onco-mTESE, despite the difficulty of fertility preservation in TC patients with azoospermia. If sperm extraction from the tumor testis fails, implementing remedial mTESE as early as possible would likely preserve the last chance of fertility for these patients.
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Affiliation(s)
- Yi Zheng
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Ding-Ming Li
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Fu-Ping Li
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Xiao-Hui Jiang
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Luo Yang
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| | - Rui Qu
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| | - Heng-Zhou Bai
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Gui-Cheng Zhao
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Kun Tian
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
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9
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Mendes G, Teixeira B, Madanelo M, Rocha A, Mesquita S, Vital J, Monteiro M, Fraga A, Louro N. Semen parameters in testicular tumor patients before orchiectomy: What is the impact of testicular tumor stage and histology? Arch Ital Urol Androl 2024; 96:12238. [PMID: 38389451 DOI: 10.4081/aiua.2024.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE To evaluate the influence of testicular cancer histology and stage on sperm parameters in cryopreserved samples collected prior to orchiectomy. MATERIALS AND METHODS We conducted a retrospective analysis of tumor histology, stage and sperm parameters of patients who underwent pre-orchiectomy sperm cryopreservation for testicular cancer between March 2010 and March 2023. The World Health Organization (WHO) 2010 sperm reference values were used to identify patients with subnormal semen parameters and to further categorize patients by sperm alteration. Localized disease was classified as Stage I, while metastatic disease encompassed Stages II and III. Continuous variables were compared using t-test or Mann Whitney U test, and categorical variables using Chi-square and Fishers exact test. RESULTS A total of 64 patients was identified, 48 (75%) classified as stage I and 16 (25%) classified as stage II/III. No difference was found in semen parameters between patients with seminoma and patients with non-seminoma germ cell tumor (NSGCT). Patients with stage II/III disease had significantly lower percentages of progressive motility (36% vs 53%, p=0.021) and total motility (60% vs 69%, p=0.015) than stage I patients. When categorizing by sperm alterations according to WHO 2010 reference values, patients with stage II/III disease had significantly higher proportions of asthenozoospermia (38% vs 15%, p=0.048) and teratozoospermia (63% vs 31%, p=0.027) than stage I patients. Elevated tumor markers were not associated with sperm abnormalities. CONCLUSIONS Patients with metastatic testicular cancer present with worse sperm quality than patients with localized disease. Sperm cryopreservation should be offered to all patients with testicular cancer, and especially emphasized in patients with metastatic disease.
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Affiliation(s)
- Gonçalo Mendes
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Bernardo Teixeira
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Mariana Madanelo
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Alexandra Rocha
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Sofia Mesquita
- Department of Urology, Santo António University Hospital Center, Porto.
| | - João Vital
- Department of Urology, Hospital of Funchal.
| | - Miguel Monteiro
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Avelino Fraga
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Nuno Louro
- Department of Urology, Santo António University Hospital Center, Porto.
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10
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Conduit C, Hutchinson AD, Leonard M, O 'Haire S, Moody M, Thomas B, Sim I, Hong W, Ahmad G, Lawrentschuk N, Lewin J, Tran B, Dhillon HM. An exploration of testicular cancer survivors' experience of ejaculatory dysfunction following retroperitoneal lymph node dissection-a sub-study of the PREPARE clinical trial. J Cancer Surviv 2023:10.1007/s11764-023-01489-9. [PMID: 37981616 DOI: 10.1007/s11764-023-01489-9] [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: 08/29/2023] [Accepted: 10/20/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Ejaculatory dysfunction secondary to retrograde ejaculation or anejaculation is a complication of retroperitoneal lymph node dissection (RPLND) for survivors of testicular cancer. We explored survivors' experiences of ejaculatory dysfunction following RPLND. METHODS In a sub-study of a single-arm phase 2 clinical trial (ACTRN12622000537752/12622000542796), participants reporting ejaculatory dysfunction ≥ 6 months following RPLND were invited to complete semi-structured interviews. Purposive sampling was used. Interviews continued until thematic saturation occurred, and codebook thematic analysis of interviews was performed. RESULTS Of 58 individuals recruited to the trial, 33 (57%) reported ejaculatory dysfunction. Of these, 32 (97%) agreed to interview and 15 participated. Participants interviewed had median age 34 years (range 24-66), 12 (80%) in a long-term relationship with median time from surgery 36 months (range 11-112). Three overarching themes were identified. The first reflected the value of RPLND despite ejaculatory dysfunction. The second illuminated the impact(s) of ejaculatory dysfunction closely mapped to life stage, with flow-on impacts to fertility, sex, psychological wellbeing and communication. The third reflected information needs. Fertility was a substantial source of concern for some participants. Ejaculatory dysfunction had no effect on sex for some, whilst for others, sex was less pleasurable. Some reported benefits. Few reported ejaculatory dysfunction challenged masculinity, confidence, or self-esteem. CONCLUSIONS Future research should examine interventions to reduce distress related to fertility, challenged masculinity and body image. IMPLICATIONS FOR CANCER SURVIVORS Whilst most participants considered ejaculatory dysfunction to have little impact on their sexual function and relationships, some reported significant difficulties varying by life stage and relationship status.
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Affiliation(s)
- C Conduit
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - A D Hutchinson
- Justice & Society, Behaviour-Brain-Body Research Centre, University of South Australia, Magill, Australia
| | - M Leonard
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, Australia
| | - S O 'Haire
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - M Moody
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - B Thomas
- Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - I Sim
- Endocrinology, Monash Health and Eastern Health, Clayton, VIC, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - W Hong
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - G Ahmad
- Andrology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - N Lawrentschuk
- Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
- Urology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Lewin
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Melbourne, VIC, Australia
| | - B Tran
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia.
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
| | - H M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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11
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Eisenberg ML, Esteves SC, Lamb DJ, Hotaling JM, Giwercman A, Hwang K, Cheng YS. Male infertility. Nat Rev Dis Primers 2023; 9:49. [PMID: 37709866 DOI: 10.1038/s41572-023-00459-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Clinical infertility is the inability of a couple to conceive after 12 months of trying. Male factors are estimated to contribute to 30-50% of cases of infertility. Infertility or reduced fertility can result from testicular dysfunction, endocrinopathies, lifestyle factors (such as tobacco and obesity), congenital anatomical factors, gonadotoxic exposures and ageing, among others. The evaluation of male infertility includes detailed history taking, focused physical examination and selective laboratory testing, including semen analysis. Treatments include lifestyle optimization, empirical or targeted medical therapy as well as surgical therapies that lead to measurable improvement in fertility. Although male infertility is recognized as a disease with effects on quality of life for both members of the infertile couple, fewer data exist on specific quantification and impact compared with other health-related conditions.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sandro C Esteves
- ANDROFERT Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Dolores J Lamb
- Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Kathleen Hwang
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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12
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Harris CJ, Rowell EE, Jayasinghe Y, Cost C, Childress KJ, Frederick NN, McNally O, Appiah L, Anazodo A. Pediatric, adolescent, and young adult breast and reproductive tumors. Pediatr Blood Cancer 2023; 70 Suppl 5:e29422. [PMID: 36458682 DOI: 10.1002/pbc.29422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 12/04/2022]
Abstract
Tumors of the breast and reproductive organs that occur in children, adolescents, and young adults (AYA) have different biological features and can present special challenges. Although prognosis for these tumors is generally favorable, the long-term effects of treatment can be debilitating. Treatments are often multimodal and may include surgery as well as chemotherapy and/or radiation, which can cause considerable distress and anxiety related to loss of femininity or masculinity, concern over future fertility, or sexual dysfunction. Thus, tumors of the reproductive organs in pediatric/AYA patients require special consideration of the treatment effects beyond the intended oncologic outcome. Multidisciplinary teams should be involved in their care and address issues of fertility, sexual dysfunction, and psychosexual concerns before treatment begins. This review addresses histology, risk factors, prognosis, staging and treatment of gynecologic, breast and testicular cancers in pediatric and AYA patients.
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Affiliation(s)
- Courtney J Harris
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Erin E Rowell
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Yasmin Jayasinghe
- Royal Women's Hospital, Parkville, Victoria, Australia
- Royal Children's Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Carrye Cost
- Children's Hospital Colorado, Aurora, Colorado
| | - Krista J Childress
- Children's Healthcare of Atlanta, Atlanta, Georgia
- Emory University, Atlanta, Georgia
| | - Natasha N Frederick
- Department of Pediatrics and the Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Orla McNally
- Royal Women's Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | | | - Antoinette Anazodo
- Sydney Children's Hospital, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's, University of New South Wales, High St Kensington, New South Wales, Australia
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13
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Kimelman D, Torrens A, Bonelli C, Sapiro R. Fertility preservation in male cancer patients. Counseling and reproductive outcomes. Front Cell Dev Biol 2023; 11:1240152. [PMID: 37664467 PMCID: PMC10468982 DOI: 10.3389/fcell.2023.1240152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction: Advances in cancer treatments have determined an increase in survival rates. However, these lifesaving therapies may have a negative impact on reproductive health. To diminish the infertility risk; different fertility preservation strategies have been designed. Sperm freezing is the gold standard fertility preservation method in the case of post-pubertal men. The main objective of this study is to evaluate the fertility status of Uruguayan male cancer survivors who have gone through sperm freezing, as well as to assess oncofertility counseling received by these patients. Methods: This is a descriptive, cross-sectional, observational, and transversal study. A survey was conducted on male cancer survivors who cryopreserved sperm between 1985 and 2021 in "Reprovita Lab and Biobank" which is the only sperm bank in this country. Results: One hundred thirty-five participants answered the survey. At the time of diagnosis, the mean age of patients was 28.8 ± 6.4 years old. Testicular was the most frequent type of cancer (64%). Only, 12% (n = 15) already had children at the time of diagnosis. Among the interviewed survivors, 50% (n = 62) attempted to conceive after cancer treatment, and 68% (n = 42) achieved natural pregnancy. Patients who did not achieve spontaneous conception (n = 11), used their cryopreserved samples, and 45.4% achieved pregnancy. About 86% (n = 107) of survivors believed that the timing of oncofertility referrals was appropriate and 97% considered that having the possibility of protecting their fertility was very important. Eighty percent (n = 101), were advised by their attending physicians, 14% (n = 18) sought advice from family members or friends, and 4% (n = 5) from oncofertility specialists. Discussion: To our knowledge, this is the first study evaluating the reproductive outcomes of male cancer survivors in our country and the region. Most of the interviewed survivors considered fertility preservation as a positive initiative, independent of their reproductive outcomes, reflecting the importance of fertility preservation counseling as one of the most important aspects for futurequality of life of young cancer patients.
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Affiliation(s)
- Dana Kimelman
- Oncofertility Program, Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado (ASSE), Montevideo, Uruguay
- Reprovita Lab and Biobank, Montevideo, Uruguay
- Clínica Ginecotocológica “B”, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | | | | | - Rossana Sapiro
- Unidad Académica Histologia y Embriologia, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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14
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Cirigliano L, Falcone M, Gül M, Preto M, Ceruti C, Plamadeala N, Peretti F, Ferro I, Scavone M, Gontero P. Onco-TESE (Testicular Sperm Extraction): Insights from a Tertiary Center and Comprehensive Literature Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1226. [PMID: 37512038 PMCID: PMC10386487 DOI: 10.3390/medicina59071226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The peak of incidence of testicular cancer (TC) occurs among individuals in their reproductive age, emphasizing the importance of fertility preservation as an integral aspect of disease management. Sperm cryopreservation performed before orchiectomy is ineffective in azoospermic men, necessitating alternative approaches such as microdissection testicular sperm extraction (mTESE) at the time of orchiectomy (onco-mTESE) to obtain viable sperm. This study presents the findings from our institution's experience with onco-mTESE and critically discusses our results in light of the existing body of literature. Materials and Methods: This is a tertiary center retrospective analysis of onco-mTESE procedures performed at a single center between December 2011 and July 2022. The included patients were post-puberal men with testicular tumors requiring orchiectomy, along with concomitant severe oligozoospermia or azoospermia. Bilateral mTESE was performed in all cases. Surgical outcomes, sperm retrieval rates, the usage of preserved viable sperm, assistive reproductive techniques' results, and post-operative serum testosterone were recorded. Results: A total of nine patients were included, with a median age of 34 (IQR 29-36) years. All patients had germ cell tumors (GCTs), with seminomatous and non-seminomatous GCTs accounting for 44.4% (n = 4) and 55.6% (n = 5) of patients, respectively. Sperm retrieval occurred in three (33%) patients: one patient in the ipsilateral testis, one in the contralateral testis, and one in both testes. No complications were reported during the procedure, and no post-operative hypogonadism was observed. Among the three patients with successful sperm retrieval, an intracytoplasmic sperm injection (ICSI) was performed in two patients, resulting in two pregnancies, leading to one healthy live birth and one miscarriage. Conclusions: In the context of TC, it is essential to conduct a thorough evaluation of testicular function, including a semen analysis and cryopreservation. Onco-mTESE has proven its safety in preserving fertility in azoospermic cases while ensuring the efficacy of oncological treatment.
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Affiliation(s)
- Lorenzo Cirigliano
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Marco Falcone
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
- Neurourology Clinic-A.O.U. "Città della Salute e della Scienza"-Unità Spinale Unipolare, 10100 Turin, Italy
| | - Murat Gül
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
- Department of Urology, School of Medicine, Selcuk University, Konya 42005, Turkey
| | - Mirko Preto
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Carlo Ceruti
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Natalia Plamadeala
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Federica Peretti
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Ilaria Ferro
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Martina Scavone
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Paolo Gontero
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
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15
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Badia RR, Patel A, Chertack N, Howard JM, Bagrodia A, Bakare T. Impact of testicular cancer stage on semen parameters in patients before orchiectomy. Urol Oncol 2023; 41:151.e11-151.e15. [PMID: 36697315 DOI: 10.1016/j.urolonc.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To study the impact of testicular cancer composite stage and histology with semen parameters in preorchiectomy cryopreservation samples. METHODS We retrospectively collected semen parameter data, composite stage, and tumor histology for patients who cryopreserved sperm prior to orchiectomy for testicular cancer between 2006 and 2018. Stage I was considered localized disease, and Stages II and III were considered metastatic disease. The World Health Organization (WHO) 2010 semen parameter criteria was used to characterize lab values as normal or subnormal. Categorical and continuous variables were compared using Fisher's exact and Mann Whitney U tests, respectively. RESULTS Thirty eight patients with testicular cancer underwent preorchiectomy cryopreservation. The median age (IQR) of our cohort was 27 (23-32). Four patients (11%) had azoospermia. No significant differences were found in these semen parameters between Stage I and Stage II/III patients or between seminoma and NSGCT patients. Per WHO 2010 criteria, 7 patients (18%) had abnormal (below reference range) semen volume, 18 patients (47%) had abnormal total sperm counts, and 9 patients (24%) had abnormal motility percentage. Abnormal semen parameters were not significantly associated with tumor histology or stage. CONCLUSION To our knowledge, this is the first study to show that semen parameters are similar across all stages of testicular cancer. Prior studies have shown that delaying orchiectomy to cryopreserving sperm does not negative affect oncological outcomes. As a result, regardless of staging or histology, sperm banking should be recommended for patients with both localized and metastatic testicular cancer.
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Affiliation(s)
- Rohit R Badia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Akshat Patel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nathan Chertack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey M Howard
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego Health, San Diego, CA
| | - Tolulope Bakare
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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16
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Fertility preservation in uro-oncology. Curr Opin Support Palliat Care 2022; 16:230-233. [PMID: 36349382 DOI: 10.1097/spc.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight the demand for fertility preservation among cancer survivors and to draw attention to areas where healthcare workers need to improve. As technology advances, maximizing cryopreservation rates will be paramount to increase the ability individuals to conceive after cancer treatment. RECENT FINDINGS Guidelines recommending discussion of fertility for those diagnosed with cancer have been shown to increase patient satisfaction and overall quality of life. Our review demonstrated that increasing counseling rates remains an ongoing challenge and should remain an area of improvement for all healthcare professionals working in the oncology field. Formal programs to improve patient and provider education and access to fertility preservation increase uptake of fertility preservation. For men, many options exist to cryopreserve sperm; a slight delay to achieve fertility preservation has not been shown to lead to worse outcomes. Cryopreservation strategies differ based on puberty status and remain an active area of clinical research. SUMMARY Improving fertility outcomes for cancer survivors is possible with appropriate counseling techniques at the time of cancer diagnosis. Clinicians should challenge current barriers for patient access to fertility preservation surrounding cancer treatments.
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17
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Tang W, Deng C, Gao J, Tian S, Wei N, Li B, Song J, Zhang L, Wu H, Jiang H. An evaluation of the population characteristics, semen quality, and utilization status of autologous sperm cryopreservation and fertility preservation in for 662 patients: a 6-year monocentric retrospective study. Basic Clin Androl 2022; 32:18. [PMID: 36324079 PMCID: PMC9629882 DOI: 10.1186/s12610-022-00169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Sperm cryopreservation is an effective method of fertility preservation for disease-related and social sperm freezing. In total, 662 subjects (range: 15–65 years-of-age; mean: 33.49 ± 8.79 years-of-age) were included in this study to investigate the population characteristics, semen quality, and usage of autologous sperm preservation patients in Beijing. Of these, 351 were cancer patients (53.02%, 31.14 ± 7.32 years-of-age) and 311 were non-cancer patients (46.98%, 36.14 ± 9.54 years-of-age). Results We found that the number of preservation cases increased steadily from 2015 to 2019; 89.73% of these had a bachelor's degree or above; 54.83%, 41.54%, and 3.63% were single, married, and divorced, respectively. The cases of cancers and oligozoospermia accounted for 71.30% of all patients; therefore, most patients required fertility preservation due to disease. The cancer group had a significantly lower sperm concentration, rate of progressive sperm after the frozen-thawed test, total progressive motility sperm count after the frozen-thawed test, and recovery rate of progressive motile sperm (RRPM) than the non-cancer group (all P < 0.05). Sperm count-related parameters were significantly affected by testicular cancer, while sperm motility-related parameters and RRPM were significantly affected by leukemia. The utilization rate of preserved sperm was 6.34% after 6 to 78 months of follow-up. In terms of fresh or frozen embryo transfer, the clinical pregnancy rate was 56.76% or 50.00%, and the live birth rate was 24.32% or 21.43%, respectively. Conclusion The need for autologous sperm preservation was dominated by patients with diseases, followed by the need for social sperm freezing. Tumors had a major negative impact on semen quality, and the usage rates of stored semen were at lower level compared to the number of sperm cryopreservation. Medical staff and patients should pay attention to both cognition-action consistency and cost-effectiveness in fertility preservation.
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18
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Rives N, Courbière B, Almont T, Kassab D, Berger C, Grynberg M, Papaxanthos A, Decanter C, Elefant E, Dhedin N, Barraud-Lange V, Béranger MC, Demoor-Goldschmidt C, Frédérique N, Bergère M, Gabrel L, Duperray M, Vermel C, Hoog-Labouret N, Pibarot M, Provansal M, Quéro L, Lejeune H, Methorst C, Saias J, Véronique-Baudin J, Giscard d'Estaing S, Farsi F, Poirot C, Huyghe É. What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines. Eur J Cancer 2022; 173:146-166. [PMID: 35932626 DOI: 10.1016/j.ejca.2022.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
AIM To provide practice guidelines about fertility preservation (FP) in oncology. METHODS We selected 400 articles after a PubMed review of the literature (1987-2019). RECOMMENDATIONS Any child, adolescent and adult of reproductive age should be informed about the risk of treatment gonadotoxicity. In women, systematically proposed FP counselling between 15 and 38 years of age in case of treatment including bifunctional alkylating agents, above 6 g/m2 cyclophosphamide equivalent dose (CED), and for radiation doses on the ovaries ≥3 Gy. For postmenarchal patients, oocyte cryopreservation after ovarian stimulation is the first-line FP technique. Ovarian tissue cryopreservation should be discussed as a first-line approach in case of treatment with a high gonadotoxic risk, when chemotherapy has already started and in urgent cases. Ovarian transposition is to be discussed prior to pelvic radiotherapy involving a high risk of premature ovarian failure. For prepubertal girls, ovarian tissue cryopreservation should be proposed in the case of treatment with a high gonadotoxic risk. In pubertal males, sperm cryopreservation must be systematically offered to any male who is to undergo cancer treatment, regardless of toxicity. Testicular tissue cryopreservation must be proposed in males unable to cryopreserve sperm who are to undergo a treatment with intermediate or severe risk of gonadotoxicity. In prepubertal boys, testicular tissue preservation is: - recommended for chemotherapy with a CED ≥7500 mg/m2 or radiotherapy ≥3 Gy on both testicles. - proposed for chemotherapy with a CED ≥5.000 mg/m2 or radiotherapy ≥2 Gy. If several possible strategies, the ultimate choice is made by the patient.
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Affiliation(s)
- Nathalie Rives
- Normandie Univ, UNIROUEN, Team "Adrenal and Gonadal Physiopathology" Inserm U1239 Nordic, Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, France
| | - Blandine Courbière
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Thierry Almont
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Diana Kassab
- Methodology Unit, Association Française d'Urologie, Paris, Ile-de-France, France
| | - Claire Berger
- Department of Pediatric Hematology and Oncology, University-Hospital of Saint-Etienne, Hospital, Nord Saint-Etienne cedex 02, France 42055; Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, 15 rue Ambroise Paré, Saint-Etienne cedex 02, France 42023
| | - Michaël Grynberg
- Reproductive Medicine and Fertility Department, Hôpital Antoine-Beclère, Clamart, Île-de-France, France
| | - Aline Papaxanthos
- Reproductive Medicine and Biology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Christine Decanter
- Medically Assisted Procreation and Fertility Preservation Department, Centre Hospitalier Régional Universitaire de Lille, Lille, Hauts-de-France, France
| | - Elisabeth Elefant
- Reference Center for Teratogenic Agents, Hôpital Armand-Trousseau Centre de Référence sur les Agents Tératogènes, Paris, Île-de-France, France
| | - Nathalie Dhedin
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Virginie Barraud-Lange
- Reproductive Medicine and Biology Department, Hôpital Cochin, Paris, Île-de-France, France
| | | | | | - Nicollet Frédérique
- Information and Promotion Department, Association Laurette Fugain, Paris, France
| | - Marianne Bergère
- Human Reproduction, Embryology and Genetics Directorate, Agence de la biomédecine, La Plaine Saint-Denis, France
| | - Lydie Gabrel
- Good Practices Unit - Guidelines and Medicines Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Marianne Duperray
- Guidelines and Drug Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Christine Vermel
- Expertise Quality and Compliance Mission - Communication and Information Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Natalie Hoog-Labouret
- Research and Innovation, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Michèle Pibarot
- OncoPaca-Corse Regional Cancer Network, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Magali Provansal
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Laurent Quéro
- Cancerology and Radiotherapy Department, Hôpital Saint Louis, AP-HP, Paris, France
| | - Hervé Lejeune
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Charlotte Methorst
- Reproductive Medicine and Biology Department, Centre Hospitalier des Quatre Villes - Site de Saint-Cloud, Saint-Cloud, France
| | - Jacqueline Saias
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Jacqueline Véronique-Baudin
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Sandrine Giscard d'Estaing
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Fadila Farsi
- Regional Cancer Network, Réseau Espace Santé Cancer, Lyon, Rhône-Alpes, France
| | - Catherine Poirot
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Éric Huyghe
- Urology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, Université Toulouse 3 Paul Sabatier, Toulouse, France.
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19
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Shrem NS, Wood L, Hamilton RJ, Kuhathaas K, Czaykowski P, Roberts M, Matthew A, Izard JP, Chung P, Nappi L, Jones J, Soulières D, Aprikian A, Power N, Canil C. Testicular cancer survivorship: Long-term toxicity and management. Can Urol Assoc J 2022; 16:257-272. [PMID: 35905486 PMCID: PMC9343164 DOI: 10.5489/cuaj.8009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Noa Shani Shrem
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kopika Kuhathaas
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason P. Izard
- Departments of Urology and Oncology, Queen’s University, Kingston, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Health Network, University of Toronto, Toronto, ON, Canada
| | - Lucia Nappi
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Le Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Armen Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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20
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Khan N, Yap T, Kopeika J, Shabbir M. Clomid after failed Onco-microsurgical testicular sperm extraction: A case for delaying contralateral surgical sperm retrieval. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221081315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background & Objectives: Onco-microsurgical testicular sperm extraction (Onco-microTESE) allows the microsurgical extraction of testicular sperm from the unaffected regions of the tumour-bearing testis at the time of radical orchidectomy. We report the case of a 36-year-old hypogonadotropic male with a testicular tumour and non-obstructive azoospermia. Method: A left radical orchidectomy was performed with simultaneous onco-microTESE. Although some sperm were found during the procedure, these were unsuitable for cryopreservation due to abnormal morphology. Given his low testosterone level (4.1 nmol/L), contralateral surgical sperm retrieval at the same sitting was not performed. Histology of the affected testicle demonstrated a classical seminoma and ‘Sertoli cell only’ appearance. He was subsequently started on clomiphene citrate. Results: After 9 months of clomiphene citrate, repeat semen analysis showed a total of 2.8 million sperm (1 million/mL), with 80% motility. Four vials of semen were cryopreserved, and this ejaculated sperm was used for in vitro-fertilisation (IVF) with intracytoplasmic sperm injection (ICSI). All six harvested eggs were fertilised. By day 5, there were two top grade blastocysts available, one of which was transferred and another frozen. After 9 months, the couple welcomed the birth of a healthy male infant. Conclusion: To our knowledge, this case is the first to demonstrate the benefit of clomiphene citrate in a patient with testis cancer resulting in a reversal of azoospermia and a subsequent live birth with assisted conception. Level of evidence: Not applicable
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Affiliation(s)
- Nawal Khan
- Department of Urology, Guy’s Hospital, UK
| | - Tet Yap
- Department of Urology, Guy’s Hospital, UK
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21
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Liu X, Liu B, Liu S, Xian Y, Zhao W, Jiang M, Zhou B, Li F. The effect of gonadal and extragonadal malignant cancers on sperm quality. Transl Cancer Res 2022; 10:5183-5190. [PMID: 35116368 PMCID: PMC8797935 DOI: 10.21037/tcr-21-1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/10/2021] [Indexed: 11/12/2022]
Abstract
Background Many studies have reported that testicular germ cell tumours (TGCTs) give rise to a decrease in sperm production and may further lead to infertility. However, little is known regarding sperm production in extragonadal germ cell tumours (EGCTs). We have studied the differences in the characteristics and sperm quality of patients with testicular cancer and patients with EGCTs. Methods We collected and analysed demographic factors, semen parameters, and the disposition of banked sperm. Results TGCTs accounted for the majority of malignant cancers compared with EGCTs (83.9% vs. 16.1%, respectively). There were no statistically significant differences in semen volume, pre-freeze concentration, pre-freeze motility, post-thaw concentration, post-thaw motility or recovery rate between patients with TGCTs and those with EGCTs. Both patients with TGCTs and EGCTs showed low pre-freeze and post-thaw sperm concentrations. Men with a seminoma had a higher median level of thaw-sperm motility in their ejaculate than men with non-seminomas. TGCT (67%) and EGCT (72%) patients chose to keep their specimens in storage. Conclusions Our study provides evidence that both patients with TGCTs and EGCTs have a high risk for impaired semen quality and gonadal dysfunction. This suggests that oncologists and patients should consider the effects of both TGCTs and EGCTs on fertility among males.
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Affiliation(s)
- Xiao Liu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Bo Liu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shasha Liu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yang Xian
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wenrui Zhao
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Min Jiang
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Bin Zhou
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Clinical Research Center for Birth Defects of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Fuping Li
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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22
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Blecher GA, Chung E, Katz D, Kim SHK, Bailie J. Onco-Testicular Sperm Extraction (oncoTESE): A Contemporary Concept Review and Report of Australian Sperm Retrieval Rates and Fertility Outcomes. Urology 2021; 160:109-116. [PMID: 34813838 DOI: 10.1016/j.urology.2021.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess sperm retrieval rates of Onco-Testicular Sperm Extraction (oncoTESE) in men with testicular tumors and coexisting severe spermatogenic impairment. METHODS Multi-centre Australian wide retrospective review of oncoTESE procedures performed within the last 10 years. Patients were postpubertal adults having a testicular tumor requiring orchidectomy, with severe oligozoospermia or nonobstructive azoospermia. Ipsilateral testicular sperm extraction was performed following radical inguinal orchidectomy. A contralateral micro-testicular sperm extraction was performed if no sperm or insufficient amounts were initially achieved. Surgical sperm retrieval rates, live birth rates and post operative serum testosterone were recorded. RESULTS Four surgeons compiled a total 13 patients. The mean age was 34.9 years. Seven of 13 were germ cell tumor (GCT), 4 of 13 had non-GCT and 2 of 13 contained benign lesions. Twelve of 13 patients were azoospermic and 1 was severely oligozoospermic. Sperm was found in 6 of 7 GCT patients; 3 of 7 were found in the ipsilateral testis whilst the remaining 4 underwent contralateral micro-testicular sperm extraction; sperm was retrieved in 3 of 4. The respective mean pre and post orchidectomy testosterone was 12.0 vs 14.1nmol/L (GCT cohort). Cryopreserved sperm has been used in assisted reproduction in 2 of 13 patients, with median follow up of 38.7 months. Including use of both cryopreserved and fresh sperm, 6 pregnancies were achieved, including 5 healthy live births and 1 miscarriage. CONCLUSION OncoTESE appears feasible, with acceptable sperm retrieval and subsequent live birth rates, following assisted reproduction. Despite significant underutilisation in the Australian population, oncoTESE should be considered in the management for TC patients with severe oligozoospermia, or nonobstructive azoospermia.
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Affiliation(s)
- Gideon Adam Blecher
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia; Department of Urology, Alfred Health, Melbourne, Victoria, Australia; Department of Urology, Monash Health, Melbourne, Victoria, Australia.
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia; AndroUrology Centre, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
| | - Darren Katz
- Department of Urology, Western Health, Melbourne, Victoria, Australia; Men's Health, Melbourne, Victoria, Australia
| | - Shannon Hee Kyung Kim
- IVF Australia, Sydney, New South Wales, Australia; Macquaire University, Macquarie school of medicine, Sydney, New South Wales, Australia
| | - John Bailie
- Department of Urology, Monash Health, Melbourne, Victoria, Australia
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23
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Eini F, Kutenaei MA, Shirzeyli MH, Dastjerdi ZS, Omidi M, Novin MG. Normal seminal plasma could preserve human spermatozoa against cryopreservation damages in Oligozoospermic patients. BMC Mol Cell Biol 2021; 22:50. [PMID: 34610788 PMCID: PMC8491377 DOI: 10.1186/s12860-021-00390-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/24/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cryopreservation of human spermatozoa has been identified as an efficient procedure to preserve fertility in men before any cancer therapy or surgical infertility treatment. Despite the benefits of the procedure, the deleterious effects of cryopreservation have been proven on sperm structure and function. This study aimed to evaluate seminal plasma effects on human sperm characteristics after cryopreservation, and compare the addition of normozoospermic and oligozoospermic seminal plasma in the prepared oligozoospermic samples. Semen samples were collected from fifty-five oligozoospermic men and the twenty fertile individuals who referred to the infertility center. At first, a semen analysis was carried out on each neat ejaculate, and then some were cryopreserved. The remainder of the semen was divided into two, one for seminal plasma removal and the other for sperm preparation. Then, the prepared spermatozoa were cryopreserved in three groups: one with, and another without the addition of oligozoospermic seminal plasma, and still another with the addition of normal seminal plasma. After thawing, sperm DNA integrity, viability, motility, and morphology were determined. RESULTS The percentages of all parameters were significantly lower after cryopreservation in all groups compared to the fresh sample. However, this reduction was lower in the oligozoospermic samples cryopreserved with normal seminal plasma. CONCLUSION The results indicated that seminal plasma in oligozoospermic patients could not support sperm against cryo-injuries, an indication likely due to insufficient antioxidants and other protective components in oligozoospermic patients. However, normal seminal plasma could slightly preserve sperm characteristics after cryopreservation in oligozoospermic patients.
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Affiliation(s)
- Fatemeh Eini
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Maryam Azizi Kutenaei
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Maryam Hosseinzadeh Shirzeyli
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mahmoud Omidi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Marefat Ghaffari Novin
- Men's health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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24
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Shabbir M, Fanshawe J. A Patient-centred Approach to Fertility Management for Testicular Cancer Patients. Eur Urol Focus 2021; 7:916-919. [PMID: 34556456 DOI: 10.1016/j.euf.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Subfertility in testicular cancer is common and often overlooked. Baseline fertility assessments are essential before intervention to allow implementation of a patient-centred pathway to maximise fertility preservation without delaying oncological treatment and to significantly improve a patient's quality of life.
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Affiliation(s)
- Majid Shabbir
- Department of Urology, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Jack Fanshawe
- Department of Urology, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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25
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Liu X, Liu B, Liu S, Xian Y, Zhao W, Zhou B, Xiao X, Wang L, Zhu X, Shu B, Jiang M, Li F. Male cancer patient sperm cryopreservation for fertility preservation: 10-year monocentric experience. Basic Clin Androl 2021; 31:24. [PMID: 34525944 PMCID: PMC8444387 DOI: 10.1186/s12610-021-00140-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/22/2021] [Indexed: 02/01/2023] Open
Abstract
Background Sperm cryopreservation, an effective method for preserving male fertility, is very advantageous for men suffering from cancer. Unfortunately, as both physicians and cancer patients are unaware of the possibilities for sperm cryopreservation, the data on evaluation of semen parameters and disposition of cryopreserved samples among Chinese cancer patients are scarce. Results Male tumours were classified into six major types, germ cell tumours (26 %), haematological neoplasms (28 %), head and neck cancers (19 %), thoracic tumours (4 %), abdominal tumours (10 %), and others (13 %). Haematological neoplasm was the most prevalent cancer among our cohort of patients who opted for sperm banking, followed by germ cell tumours. Patients with germ cell tumours had the lowest pre-thaw and post-thaw seminal sperm concentrations. We separately compared patients with testicular tumours, lymphoma, and leukaemia, and found that leukaemia patients had the lowest pre-thaw sperm concentrations. Most cancer patients (58 %) chose to keep their specimens stored, while 31 % chose to discard the specimens. Over the years, only 13 patients (4 %) returned to use their spermatozoa by assisted reproductive technology. Of the stored samples, patients with germ cell tumours constituted the highest proportion (29.3 %). Moreover, the percentage of haematological neoplasm patients who had no spermatozoa frozen was the highest (46.2 %). Conclusions The present data confirm the deleterious impact of various cancers on semen quality. Leukaemia was associated with the worst semen quality and the highest number of semen samples that could not be frozen. We suggest that sperm quality may have decreased even before anti-neoplastic treatment and that sperm banking before treatment should be strongly recommended for cancer patients. A sperm banking programme before gonadotoxic therapy requires close cooperation between assisted reproduction centres and cancer clinics.
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Affiliation(s)
- Xiao Liu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Bo Liu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Shasha Liu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Yang Xian
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Wenrui Zhao
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Bin Zhou
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Clinical Research Center for Birth Defects of Sichuan Province, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Chengdu, Sichuan, P.R. China
| | - Xiao Xiao
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Li Wang
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Xiaofang Zhu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Bizhen Shu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Min Jiang
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China
| | - Fuping Li
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Ministry of Education, Sichuan University, 610041, Sichuan, P.R. China. .,Human Sperm Bank, West China Second University Hospital, Sichuan University, No. 1416, Section 1, Chenglong Avenue, Chengdu, China.
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26
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Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, Cocci A, Corona G, Dimitropoulos K, Gül M, Hatzichristodoulou G, Jones TH, Kadioglu A, Martínez Salamanca JI, Milenkovic U, Modgil V, Russo GI, Serefoglu EC, Tharakan T, Verze P, Salonia A. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol 2021; 80:603-620. [PMID: 34511305 DOI: 10.1016/j.eururo.2021.08.014] [Citation(s) in RCA: 239] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021. OBJECTIVE To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health, including advances and areas of controversy in male infertility. EVIDENCE ACQUISITION The panel performed a comprehensive literature review of novel data up to January 2021. The guidelines were updated and a strength rating for each recommendation was included that was based either on a systematic review of the literature or consensus opinion from the expert panel, where applicable. EVIDENCE SYNTHESIS The male partner in infertile couples should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors causing fertility impairment. Infertile men are at a higher risk of harbouring and developing other diseases including malignancy and cardiovascular disease and should be screened for potential modifiable risk factors, such as hypogonadism. Sperm DNA fragmentation testing has emerged as a novel biomarker that can identify infertile men and provide information on the outcomes from assisted reproductive techniques. The role of hormone stimulation therapy in hypergonadotropic hypogonadal or eugonadal patients is controversial and is not recommended outside of clinical trials. Furthermore, there is insufficient evidence to support the widespread use of other empirical treatments and surgical interventions in clinical practice (such as antioxidants and surgical sperm retrieval in men without azoospermia). There is low-quality evidence to support the routine use of testicular fine-needle mapping as an alternative diagnostic and predictive tool before testicular sperm extraction (TESE) in men with nonobstructive azoospermia (NOA), and either conventional or microdissection TESE remains the surgical modality of choice for men with NOA. CONCLUSIONS All infertile men should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors. Increasing data indicate that infertile men are at higher risk of cardiovascular mortality and of developing cancers and should be screened and counselled accordingly. There is low-quality evidence supporting the use of empirical treatments and interventions currently used in clinical practice; the efficacy of these therapies needs to be validated in large-scale randomised controlled trials. PATIENT SUMMARY Approximately 50% of infertility will be due to problems with the male partner. Therefore, all infertile men should be assessed by a specialist with the expertise to not only help optimise their fertility but also because they are at higher risk of developing cardiovascular disease and cancer long term and therefore require appropriate counselling and management. There are many treatments and interventions for male infertility that have not been validated in high-quality studies and caution should be applied to their use in routine clinical practice.
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Affiliation(s)
- Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | | | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Joana Carvalho
- CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal
| | - Nusret Can Cilesiz
- Department of Urology, Taksim Training & Research Hospital, Istanbul, Turkey
| | - Andrea Cocci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Konstantinos Dimitropoulos
- Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Murat Gül
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | | | - Thomas Hugh Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK
| | - Ates Kadioglu
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | | | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, UK
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Tharu Tharakan
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
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Emmanuel A, Kanthabalan A, Alexander C, Bhatt N, Chan V, Kasivisvanathan V, Shabbir M. Expedited Radical Orchidectomy for Testicular Cancer: Compromising Fertility Outcomes Without Oncological Benefit? Eur Urol 2021; 80:766-767. [PMID: 34503880 DOI: 10.1016/j.eururo.2021.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Anthony Emmanuel
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Abi Kanthabalan
- Department of Urology, Worcestershire Royal Hospital, Worcester, UK
| | | | - Nikita Bhatt
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Vinson Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
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Abou Heidar N. Incidental discovery of azoospermia on work-up of testicular tumour: a practice changing discovery. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211024044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Testicular tumours are increasing in incidence, especially in developed countries. This incidence increases specifically in the subpopulation of infertile men. This case highlights a young man incidentally diagnosed with a subcentimetric testicular lesion, who was discovered to have concomitant azoospermia. The authors review management strategies in this challenging case, as treatment options for men with infertility and concomitant testicular tumours vary from men who are fertile. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Nassib Abou Heidar
- Department of Surgery, American University of Beirut Medical Center, Lebanon
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Scott C, Omar K, Alnajjar HM, Alifrangis C, Ahmed K, Muneer A. A patient-centric pathway for testicular cancer - A multicentre study investigating the uptake of semen cryopreservation and impact on treatment. Andrology 2021; 9:823-828. [PMID: 33527714 DOI: 10.1111/andr.12984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/15/2020] [Accepted: 01/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The option of semen cryopreservation following a diagnosis of testicular cancer shows a variable uptake with the option to cryopreserve before surgery often dependent on the preference of the treating clinician and the fertility laboratory resources available. OBJECTIVES To assess whether the introduction of a patient-centric pathway for managing suspected testicular cancer increases the uptake of semen cryopreservation and the impact of this on surgical waiting times. MATERIALS AND METHODS A multicentre retrospective analysis of patients treated as part of a patient-centric pathway was conducted for suspected testicular cancer at two specialist centres within a one-stop testicular clinic. Clinical information, including semen cryopreservation acceptance rate, time intervals to surgery and CT scan, TNM stage, histology and age, was recorded from an institutional database. RESULTS Eighty nine patients (median age: 34 years (range: 14-89)) underwent orchidectomy for suspected testicular cancer over a 15-month period after the introduction of a patient-centric testicular cancer pathway at two UK centres. The overall uptake of semen cryopreservation was 68.5% (n = 61) with all men under the age of 33 years accepting this option. A microdissection oncoTESE was performed in 9/61 (14.8%) patients who attempted cryopreservation but were found to be azoospermic. Pre-operative CT imaging was completed for 85.4% of patients, and the median time from initial outpatient consultation to orchidectomy was 9 days. DISCUSSION AND CONCLUSIONS A patient-centric pathway ensures that the uptake of semen cryopreservation remains high particularly for those men within the common age for paternity. It also identifies men who may benefit from microdissection oncoTESE for complex cases such as tumours in solitary testicles, bilateral tumours or an atrophic contralateral testicle as well as those diagnosed with de novo azoospermia. The additional time taken for semen cryopreservation to be performed did not significantly delay orchidectomy or influence the decisions for adjuvant treatment.
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Affiliation(s)
- Charles Scott
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Kawa Omar
- Department of Urology, King's College Hospital, London, UK
| | | | | | - Kamran Ahmed
- Department of Urology, King's College Hospital, London, UK.,MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.,King's Fertility, London, UK
| | - Asif Muneer
- Institute of Andrology, University College London Hospital, London, UK.,NIHR Biomedical Research Centre, University College London Hospital, London, UK.,Department of Surgery and Interventional Science, University College London, London, UK
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30
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Hagiuda J, Nakagawa K, Oya M. Frequent azoospermia in patients with testicular germ cell cancer and a history of cryptorchidism: a report of nine cases and review of the literature. Syst Biol Reprod Med 2021; 67:189-192. [PMID: 33630670 DOI: 10.1080/19396368.2020.1867666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study analyzed semen parameters in patients with testicular germ cell cancer and a history of cryptorchidism. Among testicular cancer patients referred for sperm cryopreservation, the semen of 9 patients with a history of cryptorchidism, including three cases of bilateral cryptorchidism and one case of cryptorchidism with bilateral metachronous tumor, was analyzed. Eight patients underwent orchidopexy during childhood. The tumor was observed on the contralateral side of the undescended testis, except in the bilateral metachronous tumor and cryptorchidism cases. Five patients, including the one who developed a metachronous testicular tumor on the undescended testis, showed azoospermia even though in three of them, semen was collected before undergoing orchiectomy. Clinical urologists should recognize that spermatogenesis is severely impaired in these patients and consider cryopreservation before orchiectomy or onco-TESE.
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Affiliation(s)
- Jun Hagiuda
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital
| | - Ken Nakagawa
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital
| | - Mototsugu Oya
- School of Medicine, Department of Urology, Keio University, Tokyo, Japan
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Krouwel EM, Jansen TG, Nicolai MPJ, Dieben SWM, Luelmo SAC, Putter H, Pelger RCM, Elzevier HW. Identifying the Need to Discuss Infertility Concerns Affecting Testicular Cancer Patients: An Evaluation (INDICATE Study). Cancers (Basel) 2021; 13:cancers13030553. [PMID: 33535586 PMCID: PMC7867120 DOI: 10.3390/cancers13030553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Testicular cancer is the most common malignancy in young males affecting the ability to father children. It’s important that effects on fertility are discussed before starting treatment so patients are aware of the risks and their options. The objective of our study was to evaluate the manner in which men with testicular cancer are counselled about implications on fertility and the possibility of semen preservation. Furthermore, we aimed to evaluate satisfaction with provided information and to identify reproductive concerns. In a sample of 201 patients, one out of ten patients reported not to be informed about the risk of subfertility. Sperm banking was performed by 41.3%, of which 13 men made use of preserved sperm, resulting in paternity for 7 men. The subjects fertility and semen preservation need to be broached promptly after diagnosis of testicular cancer because they cause dissatisfaction with care and grief if fertility problems occur afterwards. Abstract Men with testicular cancer (TC) risk impaired fertility. Fertility is a major concern for TC patients due to diagnosis in almost always reproductive ages and high overall survival. This study assessed counselling in regards to the risk of impaired fertility and sperm cryopreservation. A cross-sectional survey was performed on 566 TC patients diagnosed between 1995–2015. Of the 566 survivors, 201 questionnaires were completed (35.5%). Eighty-eight percent was informed about possible impaired fertility, 9.5% was not informed. The majority (47.3%) preferred the urologist to provide information. Collecting sperm was troublesome but successful for 25.6%, 4.8% did not succeed in collecting sperm. The reasons were high pressure due to disease, pain after surgery and uncomfortable setting. Due to impaired fertility, 19% of the respondents reported grief and 9.3% stated as being less satisfied in life. Sperm cryopreservation was performed by 41.3% (n = 83). One third (n = 63, 31.3%) had children after treatment, of which 11.1% made use of preserved sperm (n = 7). The results of this survey indicate the importance of timely discussion of fertility issues with TC patients. While being discussed with most men, dissatisfaction and grief may occur as a result of impaired fertility and a lack of counselling. Overall, 6.5% made use of cryopreserved sperm (n = 13). Men prefer their urologist providing counselling on fertility.
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Affiliation(s)
- Esmée M. Krouwel
- Department of Urology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.G.J.); (R.C.M.P.); (H.W.E.)
- Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence: ; Tel.: +31-71-526-2304
| | - Thijs G. Jansen
- Department of Urology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.G.J.); (R.C.M.P.); (H.W.E.)
- Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Melianthe P. J. Nicolai
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Sandra W. M. Dieben
- Department of Gynaecology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Saskia A. C. Luelmo
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Rob C. M. Pelger
- Department of Urology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.G.J.); (R.C.M.P.); (H.W.E.)
- Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Henk W. Elzevier
- Department of Urology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.G.J.); (R.C.M.P.); (H.W.E.)
- Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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32
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Fung C, Dinh PC, Fossa SD, Travis LB. Testicular Cancer Survivorship. J Natl Compr Canc Netw 2020; 17:1557-1568. [PMID: 31805527 DOI: 10.6004/jnccn.2019.7369] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022]
Abstract
Testicular cancer (TC) is the most common cancer among men aged 18 to 39 years. It is highly curable, with a 10-year relative survival approaching 95% due to effective cisplatin-based chemotherapy. Given the increasing incidence of TC and improved survival, TC survivors (TCS) now account for approximately 4% of all US male cancer survivors. They have also become a valuable cohort for adult-onset cancer survivorship research, given their prolonged survival. Commensurately, long-term treatment-related complications have emerged as important survivorship issues. These late effects include life-threatening conditions, such as second malignant neoplasms and cardiovascular disease. Moreover, TCS can also experience hearing loss, tinnitus, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, infertility, anxiety, depression, cognitive impairment, and chronic cancer-related fatigue. Characterization of the number and severity of long-term adverse health outcomes among TCS remains critical to develop risk-stratified, evidence-based follow-up guidelines and to inform the development of preventive measures and interventions. In addition, an improved understanding of the long-term effects of TC treatment on mortality due to noncancer causes and second malignant neoplasms remains paramount. Future research should focus on the continued development of large, well-characterized clinical cohorts of TCS for lifelong follow-up. These systematic, comprehensive approaches can provide the needed infrastructure for further investigation of long-term latency patterns of various medical and psychosocial morbidities and for more in-depth studies investigating associated etiopathogenetic pathways. Studies examining premature physiologic aging may also serve as new frontiers in TC survivorship research.
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Affiliation(s)
- Chunkit Fung
- aUniversity of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul C Dinh
- bIndiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.,cDepartment of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana; and
| | | | - Lois B Travis
- bIndiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
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A QUESTIONNAIRE SURVEY ON AWARENESS OF REPRODUCTIVE PROTECTION AND AUTOLOGOUS SPERM PRESERVATION AMONG CANCER PATIENTS. JOURNAL OF MEN'S HEALTH 2020. [DOI: 10.15586/jomh.v16i3.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ito K, Ichioka K, Dahal S, Matsui Y, Nakayama T, Hatayama H, Ogawa O, Negoro H. Barriers for sperm cryopreservation in advanced germ cell tumor patients: a 20-year experience. Int J Clin Oncol 2020; 25:906-911. [PMID: 31894434 DOI: 10.1007/s10147-019-01607-7] [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: 09/05/2019] [Accepted: 12/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to investigate barriers to sperm cryopreservation for patients with advanced germ cell tumors. METHODS We reviewed data collected from patients who underwent chemotherapy for advanced germ cell tumors in our institutions from 1996 to 2016. We divided sperm cryopreservation procedures into three steps: offering information about sperm cryopreservation, patients' decision making and sperm collection, and investigating the barriers in each step. RESULTS Of the 91 patients, 43 (47%) successfully completed sperm cryopreservation. Thirty (33%) patients were not offered information about sperm cryopreservation from the doctors. Nine patients (9.9%) were offered but declined preservation. Nine patients (9.9%) were not able to provide sperm because of azoospermia (5) and anejaculation (4). Among 43 patients who successfully provided sperm, 10 (23%) had their cryopreserved sperm used for 21 cycles of in vitro fertilization. Ten pregnancies and 7 fatherhoods were achieved. Thirteen patients (30%) had their cryopreserved sperm discarded without use, whereas 20 (47%) continued preserving their sperm for a median 12.5 years. CONCLUSIONS Not only offering proper information about sperm cryopreservation, but also shared decision making prior to chemotherapy, and considering fertility preservation before orchiectomy are imperative. The rate of use of preserved sperm was relatively high, but decision making for sperm disposal should also be supported.
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Affiliation(s)
- Katsuhiro Ito
- Department of Urology, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
- Ichioka Urological Clinic, Symphonia-Oike 1F, Higashinotoin-Nijo sagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Kentaro Ichioka
- Ichioka Urological Clinic, Symphonia-Oike 1F, Higashinotoin-Nijo sagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Sachiko Dahal
- Center For Reproductive Endocrinology and Infertility, Adachi Hospital, Higashinotoin-Nijosagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Yoshiyuki Matsui
- Department of Urology, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
- Ichioka Urological Clinic, Symphonia-Oike 1F, Higashinotoin-Nijo sagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Takahiro Nakayama
- Center For Reproductive Endocrinology and Infertility, Adachi Hospital, Higashinotoin-Nijosagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Hiroshi Hatayama
- Center For Reproductive Endocrinology and Infertility, Adachi Hospital, Higashinotoin-Nijosagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
| | - Hiromitsu Negoro
- Department of Urology, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan.
- Ichioka Urological Clinic, Symphonia-Oike 1F, Higashinotoin-Nijo sagaru, Nakagyo-ku, Kyoto, 6040837, Japan.
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35
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Uçar MA, Arikan F, Coşkun HŞ, Kondak Y, Tatlı AM, Göksu SS. Fertility in testicular cancer patients: a single-centre study in Turkey. Int J Clin Oncol 2019; 25:495-500. [DOI: 10.1007/s10147-019-01534-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022]
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