Efficient pathway for men fertility preservation in testicular cancer or lymphoma: a cross-sectional study of national 2018 data

BACKGROUND

In 15-49 years-old men, the main cancers are testicular cancer (TC) and lymphomas (L): freezing of ejaculated sperm is primarily used for male fertility preservation (FP) before cancer treatment. Our objective was to analyze the French FP rate in 15-49 years-old men diagnosed with TC or L in 2018. We designed a national descriptive cross-sectional study of sperm banking rate in men with a diagnosis of TC, Hodgkin L (HL) or non-Hodgkin L (NHL). From the French National Cancer Institute (INCa) 2018 data, we extracted the estimated incidence of TC and L in metropolitan France. From the 2018 activity report of CECOS network (Centers for Study and Banking of Eggs and Sperm), we extracted the number of men with TC or L who banked ejaculated sperm. We estimated the proportion of 15-49 years-old men diagnosed with TC or L who banked sperm.

RESULTS

Among 15-49 years-old men, INCa estimated 38,048 new cancer diagnoses in metropolitan France in 2018: 2,630 TC and 3,913 L (943 HL and 2,970 NHL). The CECOS network provided data from 26/27 metropolitan centers (96% response rate): 1,079 sperm banking for men with TC, 375 for HL and 211 for NHL. We estimated that the 2018 sperm banking rate in France was 41% for TC, 40% for HL, and 7% for NHL.

CONCLUSIONS

To our knowledge, our paper is the first cross-sectional study with multicenter and national data analyzing FP rate in cancer men: it suggests an efficient pathway for men to FP before cancer treatment, compared to previously published studies. Although sperm banking rate in 15-49 years-old men could definitely be improved, further studies should evaluate the information given to patients before gonadotoxic treatments, the factors associated with the absence of sperm banking and whether this lack of referral induces a loss of chance for these men.

European countries with delayed childbearing are not those with lower fertility

At the individual level, a very strong negative relationship is observed between age at first birth and total number of children. However, at the country level, it is possible that no relationship exists between factors that reduce fertility at younger ages and stimulate it at older ages. Hence, across countries, the size of the decline in youth fertility is potentially unrelated to the size of the increase in fertility at older ages or the decline in total fertility. We study the fertility of women and their age at childbirth, with particular attention to their evolution over the last 40 years in countries across Europe. Comparing these countries, the increase in births after age 30 has occurred relatively independently of the decline at younger ages according to both period and cohort, and we find no positive relationship between the delay of first birth and decline in total fertility. On the contrary, an inverse relationship evidently exists at the country level, as longer delays generally correspond to smaller declines in total fertility. Context effects largely dominate individual constraints and play an important role in the occurrence of later births.

Decision-Making Capacity Among Elderly People: A Mapping of Health Professionals' and Laypeople's Views

The views of laypeople and professionals (nurses, occupational therapists, psychologists, and physicians) on the capacity to make informed decisions of elderly people with depression or dementia were examined. Participants were presented with vignettes created by varying the levels of three factors: (a) the type of decision (e.g., agreeing to surgery), (b) the health problem (e.g., slight depression), and (c) the availability of social support. Through cluster analysis, four different positions were found. Seventeen percent of the participants considered that even persons suffering from slight depression were already quite incapacitated. In contrast, 24% considered that only elderly people suffering from moderate or severe dementia were impaired. The majority of participants (59%) expressed positions that can be considered as pragmatic. Level of impairment was viewed as a function of severity of illness or type of illness. No significant differences were found between health professional and laypeople.

Can men be trusted in population-based surveys to report couples' medical care for infertility?

BACKGROUND

Men are usually excluded from surveys on reproductive health as some works have cast doubts on their ability to accurately report information on reproduction. Recent papers challenged this viewpoint, arguing that the quality of men's reports depends strongly on use of an appropriate study design. We aimed to explore the relevance of evaluating couples' use of medical care for infertility based on men's interviews in a population-based survey.

METHODS

The study was based on the last French sexual and reproductive health study (Fecond) conducted by phone interviews among a population-based sample of 2863 men and 4629 women aged 20-49 years.

RESULTS

Among respondents who had ever tried to have a child, the use of infertility medical care by couples (i.e. by the respondents and/or their partners) within the previous 15 years was 16% (95%CI 14 to 18%) based on men's reports and 17% (95%CI 15 to 18%) based on women's reports (p = 0.43). Men's and women's reports were remarkably concordant on most items (infertility duration, treatment). The main discrepancy concerned male medical checkup, which was reported much more often by male respondents than female respondents (86% vs. 57%, p < 0.001 for sperm analysis, 56% vs. 27%, p < 0.001 for male genital examination).

CONCLUSIONS

It is time to trust men to report couples' infertility medical care in reproductive surveys, as they provide information remarkably concordant with that provided by women. Conversely, women may poorly report the infertility checkups of their male partner.

Increased incidence of congenital hypothyroidism in France from 1982 to 2012: a nationwide multicenter analysis

PURPOSE

Recent studies have shown an increased incidence of congenital hypothyroidism over the past 2 or 3 decades. The etiology of this change is unknown, but it has been related by several authors to lowering of cutoffs. We sought to determine whether the incidence of congenital hypothyroidism (CH) in France has changed.

METHODS

We analyzed data from the nationwide neonatal screening program for CH during the period 1982-2012. We included all children having thyroid-stimulating hormone values above the threshold and for whom diagnosis of CH confirmed by the pediatrician. We estimated multicentric temporal trends in the annual incidence rates adjusted for screening methods for thyroid dysgenesis and eutopic gland.

RESULTS

We found 6622 cases of CH (28.0 per 100,000 newborns); 1895 had a eutopic gland, and 4727 had thyroid dysgenesis. The incidence of eutopic glands showed a significant annual average increase of (5.1%; 95% confidence interval: 4.3-5.9) regardless of the screening method or screening center. This increase was confirmed in severe cases (thyroid-stimulating hormone ≥ 50: 2.1%; 95% confidence interval, 1.4-2.9). The incidence of dysgenesis remained constant.

CONCLUSIONS

The incidence of eutopic glands increased in France, not only in mild forms but also in severe cases.