Clinical Application of Sperm Chromatin Structure Assessment in Andrology Patients

Infertility, defined as the inability to conceive spontaneously within one year, is a common medical problem. Traditionally, fertility investigations initially focus on the evaluation of ovulation and tubal patency in females, and on assessment of sperm quantity and quality in males. In about one third of couples with infertility abnormalities in classic semen parameters are found, like sperm concentration, motility and morphology. In another one third of patients a combination of infertility-related female and male factors are seen (WHO 1999). Although sperm quality parameters derived from classic semen analysis are frequently used to categorise male infertile patients, the prognostic and diagnostic information they provide is limited with a predictive power that is highest at the lower ranges of the spectrum (Barratt et al. 2010)

Testiculaire sperma-extractie (TESE): een update

Dit artikel geeft een overzicht van de historie van TESE en TESE-ICSI, de Nederlandse context, de fysiologie/pathofysiologie en histologie van het ziektebeeld niet-obstructieve azoöspermie (NOA) en de uitkomst van ICSI met testiculaire zaadcellen. Ook worden de operatietechniek en de work-up van TESE besproken, en de mogelijke complicaties, langetermijngevolgen en controversiële voorbehandelingen. Tot slot komen innovatieve ontwikkelingen op het gebied van diagnostiek en behandeling aan bod

20 jaar semencryopreservatie: haalbaarheid en verwijspatronen

Treatment of cancer can affect spermatogenesis resulting in infertility. Semen cryopreservation prior to gonadotoxic treatment can be offered to secure future fertility in male cancer patients. During 20 years 1,018 patients referred for semen cryopreservation in fertile age with Hodgkin disease (n = 194), non-Hodgkin lymphoma (n = 110), leukemia (n = 126) and testicular germ cell tumor (n = 588) were followed up. Incidence of these cancers and incidence of regional semen cryopreservation was used to calculate a referral rate. Semen cryopreservation was successful in 856 of 1,018 patients (84.1%). Median yearly referral rate was respectively 17% and 31% in hematological malignancies and testicular germ cell tumor. Regional referral rate in hematological malignancies dropped dramatically after 2005 to a minimum of 2% in 2009. The incidence of TGCT and referral rate for fertility preservation in these patients increased over time. Our result show that referral of for semen cryopreservation in patients with hematological malignancies in fertile age is suboptimal.Behandeling van kanker kan de spermatogenese aantasten, met infertiliteit tot gevolg. Semencryopreservatie voorafgaand aan gonadotoxische behandeling kan de vruchtbaarheid van mannelijke kankerpatiënten veiligstellen. Gedurende 20 jaar zijn 1.018 patiënten tussen 12 en 50 jaar oud, met Hodgkin-lymfoom (n= 194), non-Hodgkin lymfoom (n=110), leukemie (n= 126) of testiculaire kiemceltumoren (n= 588) verwezen naar één centrum voor semencryopreservatie. De incidentie van deze kankertypen in het adherentiegebied en de incidentie van regionale semencryopreservatie werd gebruikt om een verwijsratio te berekenen. Semencryopreservatie was succesvol bij 856 van de 1.018 patiënten (84,1%). De mediane jaarlijkse verwijsratio bij hematologische maligniteiten en testiculaire stamceltumoren was respectievelijk 17% en 31%. De regionale verwijzing bij hematologische maligniteiten daalde na 2005 fors, tot een minimum van 2% in 2009, terwijl deze toenam bij testiculaire kiemceltumoren. Onze resultaten tonen aan dat verwijzing voor semencryopreservatie bij patiënten met een hematologische maligniteit in de fertiele leeftijd suboptimaal is

Pre-treatment fertility preservation and post-treatment reproduction in long-term survivors of adolescent and young adult (AYA) cancer

Purpose: To describe recall of fertility-related consultations and cryopreservation and to examine reproductive goals and reproduction post-treatment in long-term survivors of adolescent and young adult (AYA) (age, 18–39 years) cancer. Methods: This study included n = 1457 male and n = 2112 female long-term survivors (M age = 43–45 years; 5–22 years from diagnosis) who provided self-report. Clinical data were supplied by the Netherlands Cancer Registry.Results: Most male survivors (72.7%) recalled fertility-related consultations and 22.6% completed sperm cryopreservation. Younger age (OR = 2.8; 95%CI [2.2–3.6]), not having children (OR = 5.0; 95%CI [3.2–7.7]), testicular cancer or lymphoma/leukemia (OR = 2.8/2.5 relative to “others”), and more intense treatments (OR = 1.5; 95%CI [1.1–2.0]) were associated with higher cryopreservation rates. Time since diagnosis had no effect. Of men who cryopreserved, 12.1% utilized assisted reproductive technologies (ART). Most men (88.5%) felt their diagnosis did not affect their reproductive goals, but 7.6% wanted no (additional) children due to cancer. Half of female survivors (55.4%; n = 1171) recalled fertility-related consultations. Rates of cryopreservation were very low (3.6%), but increased after 2013 when oocyte cryopreservation became non-experimental. Of women who cryopreserved, 13.2% successfully utilized ART. Most women (74.8%) experienced no effects of cancer on reproductive goals, but 17.8% wanted no (additional) children due to cancer. Conclusions: Cryopreservation in men varied by patient/clinical factors and was very low in women, but data of more recently treated females are needed. Utilizing cryopreserved material through ART was rare, which questions its cost-effectiveness, but it may enhance survivors’ well-being. Implications for Cancer Survivors: The extent to which cryopreservation positively affects survivors’ well-being remains to be tested. Moreover, effects of cancer on reproductive goals require further attention, especially in women who refrain from having children due to cancer.</p

Pre-treatment fertility preservation and post-treatment reproduction in long-term survivors of adolescent and young adult (AYA) cancer

Purpose: To describe recall of fertility-related consultations and cryopreservation and to examine reproductive goals and reproduction post-treatment in long-term survivors of adolescent and young adult (AYA) (age, 18–39 years) cancer. Methods: This study included n = 1457 male and n = 2112 female long-term survivors (M age = 43–45 years; 5–22 years from diagnosis) who provided self-report. Clinical data were supplied by the Netherlands Cancer Registry.Results: Most male survivors (72.7%) recalled fertility-related consultations and 22.6% completed sperm cryopreservation. Younger age (OR = 2.8; 95%CI [2.2–3.6]), not having children (OR = 5.0; 95%CI [3.2–7.7]), testicular cancer or lymphoma/leukemia (OR = 2.8/2.5 relative to “others”), and more intense treatments (OR = 1.5; 95%CI [1.1–2.0]) were associated with higher cryopreservation rates. Time since diagnosis had no effect. Of men who cryopreserved, 12.1% utilized assisted reproductive technologies (ART). Most men (88.5%) felt their diagnosis did not affect their reproductive goals, but 7.6% wanted no (additional) children due to cancer. Half of female survivors (55.4%; n = 1171) recalled fertility-related consultations. Rates of cryopreservation were very low (3.6%), but increased after 2013 when oocyte cryopreservation became non-experimental. Of women who cryopreserved, 13.2% successfully utilized ART. Most women (74.8%) experienced no effects of cancer on reproductive goals, but 17.8% wanted no (additional) children due to cancer. Conclusions: Cryopreservation in men varied by patient/clinical factors and was very low in women, but data of more recently treated females are needed. Utilizing cryopreserved material through ART was rare, which questions its cost-effectiveness, but it may enhance survivors’ well-being. Implications for Cancer Survivors: The extent to which cryopreservation positively affects survivors’ well-being remains to be tested. Moreover, effects of cancer on reproductive goals require further attention, especially in women who refrain from having children due to cancer.</p

Fertility preservation for male patients with childhood, adolescent, and young adult cancer:recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group

Item does not contain fulltextMale patients with childhood, adolescent, and young adult cancer are at an increased risk for infertility if their treatment adversely affects reproductive organ function. Future fertility is a primary concern of patients and their families. Variations in clinical practice are barriers to the timely implementation of interventions that preserve fertility. As part of the PanCareLIFE Consortium, in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in male patients who are diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. Recognising the need for global consensus, this clinical practice guideline used existing evidence and international expertise to rigorously develop transparent recommendations that are easy to use to facilitate the care of male patients with childhood, adolescent, and young adult cancer who are at high risk of fertility impairment and to enhance their quality of life