Fertility preservation in males with cancer: 16-year monocentric experience of sperm banking and post-thaw reproductive outcomes

Abstract STUDY QUESTION What is the reproductive potential following combinations of ovarian stimulation, IVM and ovarian tissue cryopreservation (OTC) in female patients seeking fertility preservation (FP)? SUMMARY ANSWER In selected patients, combining different FP procedures is a feasible approach and reproductive outcomes after FP in patients who return to attempt pregnancy are promising. WHAT IS KNOWN ALREADY FP is increasingly performed in fertility clinics but an algorithm to select the most suitable FP procedure according to patient characteristics and available timeframe is currently lacking. Vitrification of mature oocytes (OV) and OTC are most commonly performed, although in some clinical scenarios a combination of procedures including IVM, to spread the sources of gametes, may be considered in order to enhance reproductive options for the future. STUDY DESIGN, SIZE, DURATION Retrospective, observational study in a university-based, tertiary fertility centre involving all female patients who underwent urgent medical FP between January 2012 and December 2018. Descriptive analysis of various FP procedures, either stand-alone or combined, was performed, and reproductive outcomes of patients who attempted pregnancy in the follow-up period were recorded. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 207 patients underwent medical FP. Patient-tailored strategies and procedures were selected after multidisciplinary discussion. When deemed feasible, FP procedures were combined to cryopreserve different types of reproductive tissue for future use. The main primary outcome measure was the number of mature oocytes. Live birth rates were evaluated in patients who returned for reproductive treatment. MAIN RESULTS AND THE ROLE OF CHANCE Among patients seeking FP, 95/207 (46%) had breast cancer, 43/207 (21%) had haematological malignancies and 31/207 (15%) had a gynaecological tumour. Mean ± SD age was 27.0 ± 8.3 years. Eighty-five (41.1%) patients underwent controlled ovarian stimulation (COS), resulting in 10.8 ± 7.1 metaphase II (MII) oocytes for vitrification. Eleven (5.3%) patients had multiple COS cycles. Transvaginal oocyte retrieval for IVM was performed in 17 (8.2%) patients, yielding 9.2 ± 10.1 MII oocytes. Thirty-four (16.4%) patients underwent OTC combined with IVM of oocytes retrieved from ovarian tissue ‘ex vivo’ (OTO-IVM), yielding 4.0 ± 4.3 MII oocytes in addition to ovarian fragments. Seventeen (8.2%) patients had OTC combined with OTO-IVM and transvaginal retrieval of oocytes for IVM from the contralateral ovary, resulting in 13.5 ± 9.7 MII oocytes. In 13 (6.3%) patients, OTC with OTO-IVM was followed by controlled stimulation of the contralateral ovary, yielding 11.3 ± 6.6 MII oocytes in total. During the timeframe of the study, 31/207 (15%) patients have returned to the fertility clinic with a desire for pregnancy. Of those, 12 (38.7%) patients had preserved ovarian function and underwent ART treatment with fresh oocytes, resulting in nine (75%) livebirth. The remaining 19 (61.3%) patients requested warming of their cryopreserved material because of ovarian insufficiency. Of those, eight (42.1%) patients had a livebirth, of whom three after OTO-IVM. To date, 5/207 patients (2.4%) achieved an ongoing pregnancy or livebirth after spontaneous conception. LIMITATIONS, REASONS FOR CAUTION Our FP programme is based on a patient-tailored approach rather than based on an efficiency-driven algorithm. The data presented are descriptive, which precludes firm conclusions. WIDER IMPLICATIONS OF THE FINDINGS Combining different FP procedures is likely to enhance the reproductive fitness of patients undergoing gonadotoxic treatment but further follow-up studies are needed to confirm this. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study and the authors have no competing interests. TRIAL REGISTRATION NUMBER N/A.

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Fertility preservation cost and use: Results from the LIVESTRONG survey.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.59 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 59-59 ◽

Cited By ~ 1

Author(s):

Ruth Rechis ◽

Stephanie Nutt ◽

Carla Bann

Keyword(s):

Fertility Preservation ◽

Online Survey ◽

Survey Methods ◽

Sperm Banking ◽

Current State ◽

Lack Of Information ◽

Important Quality ◽

Embryo Banking ◽

Median Amount

59 Background: Each year nearly 70,000 adolescents and young adults (AYAs) are diagnosed with cancer. Recently, steps have been taken to address infertility, which is an important issue experienced by AYAs. For example, ASCO QOPI includes fertility standards and Walgreens and the LIVESTRONG Foundation provide financial assistance for fertility preservation medications. To better understand the current state of fertility preservation, eight questions on this topic were included on the LIVESTRONG Survey. Methods: From June to December 2012, LIVESTRONG conducted an online survey (N = 6,313). Analysis here includes the 1,333 AYA respondents who were diagnosed since 2002. Results: Only 24% of respondents (42% of males, 12% of females) indicated they took steps to preserve their fertility before beginning treatment. Top reasons for not preserving their fertility were not receiving information about options (19%) and/or information about the risks to their fertility (14%). For the AYAs who did preserve their fertility, the median amount spent on fertility expenses was between $1,000 and $2,499 (Table) with males spending significantly less than females (p < 0.001). Mostly commonly, males used sperm banking (97%) while females used egg and embryo banking (each 35%). The majority all who attempted to become pregnant were successful (58% and 68% respectively). Conclusions: Results from this analysis indicate that few survivors took steps to preserve their fertility before starting treatment. Yet for those who were interested in preserving their fertility and starting a family, the majority of individuals were successful. Many individuals reported not preserving their fertility due to a lack of information or resources. While a relatively small number of survivors will have fertility concerns, this is an important quality of life issue for those who do. [Table: see text]

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Professionals' views on the issues and challenges arising from providing a fertility preservation service through sperm banking to teenage males with cancer

Human Fertility ◽

10.1080/1464727042000198087 ◽

2004 ◽

Vol 7 (1) ◽

pp. 23-30 ◽

Cited By ~ 29

Author(s):

Marilyn Crawshaw ◽

Adam Glaser ◽

Juliet Hale ◽

Patricia Sloper

Keyword(s):

Fertility Preservation ◽

Sperm Banking

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Sperm cryopreservation of male cancer patients for fertility preservation : 10-year monocentric experience

10.21203/rs.3.rs-212790/v1 ◽

2021 ◽

Author(s):

Xiao Liu ◽

Bo Liu ◽

shasha liu ◽

yang xian ◽

wenrui zhao ◽

...

Keyword(s):

Germ Cell ◽

Cancer Patients ◽

Fertility Preservation ◽

Sperm Quality ◽

Germ Cell Tumors ◽

Semen Parameters ◽

Sperm Cryopreservation ◽

Sperm Banking ◽

Hematological Neoplasms ◽

Body Regions

Abstract Background: Semen cryopreservation is an effective method to preserve fertility, which is very important for male cancer patients. Unfortunately, due to unaware of the opportunities for sperm cryopreservation for both physicians and cancer patients, not a lot of data on evaluating the semen parameters and dispositions of the cryopreserved samples of Chinese cancer population are available in the literature. Methods: We retrospectively reviewed semen parameters as well as the clinical outcomes of assisted reproductive treatments (ART) of 339 male cancer patients of Chinese population who were referred to our center from 2010 to 2019 for fertility preservation. Results: We first classify the male tumors into six major types according to body regions. The most prevalent cancer patients who came from our cohort for sperm banking were hematological neoplasms patients, and the second cancers were germ cell tumors. Patients with germ cell tumors had the lowest pre- thaw and post-thaw concentration among the six major cancer types. However, we separately compared among testicular tumors, lymphoma and leukemia, it turned out that leukemia had the lowest pre-thaw concentration. Most cancer patients (58%) chose to go on keeping their specimens in storage. The second proportion selected to discard their specimens electively (31%). Over the years, there were only 13 patients (4%) returned to use their sperm by ART. In the storage samples, germ cell tumors were the most proportion ones (29.3%). Moreover, in the unfrozen samples, the percentage of hematological neoplasms were the most (45.5%).Conclusions: To our knowledge, we had owned the most numbers of male cancers who came to sperm bank for fertility conservation in the southwest of China. In our study we suggested that sperm quality could decrease even before antineoplastic treatment and sperm banking prior to treatment should be strongly recommended for male cancer patients.

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Prevalence and Predictors of Sperm Banking in Adolescents Newly Diagnosed With Cancer: Examination of Adolescent, Parent, and Provider Factors Influencing Fertility Preservation Outcomes

Journal of Clinical Oncology ◽

10.1200/jco.2016.70.4767 ◽

2017 ◽

Vol 35 (34) ◽

pp. 3830-3836 ◽

Cited By ~ 38

Author(s):

James L. Klosky ◽

Fang Wang ◽

Kathryn M. Russell ◽

Hui Zhang ◽

Jessica S. Flynn ◽

...

Keyword(s):

Fertility Preservation ◽

Psychological Health ◽

Tanner Stage ◽

The United States ◽

Adolescent Males ◽

Self Report ◽

Newly Diagnosed ◽

Sperm Banking ◽

Factors Associated ◽

Adolescent Parent

Purpose To estimate the prevalence of sperm banking among adolescent males newly diagnosed with cancer and to identify factors associated with banking outcomes. Patients and Methods A prospective, single-group, observational study design was used to test the contribution of sociodemographic, medical, psychological/health belief, communication, and developmental factors to fertility preservation outcomes. At-risk adolescent males (N = 146; age 13.00 to 21.99 years; Tanner stage ≥ 3), their parents, and medical providers from eight leading pediatric oncology centers across the United States and Canada completed self-report questionnaires within 1 week of treatment initiation. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% CIs for specified banking outcomes (collection attempt v no attempt and successful completion of banking v no banking). Results Among adolescents (mean age, 16.49 years; standard deviation, 2.02 years), 53.4% (78 of 146) made a collection attempt, with 43.8% (64 of 146) successfully banking sperm (82.1% of attempters). The overall attempt model revealed adolescent consultation with a fertility specialist (OR, 29.96; 95% CI, 2.48 to 361.41; P = .007), parent recommendation to bank (OR, 12.30; 95% CI, 2.01 to 75.94; P = .007), and higher Tanner stage (OR, 5.42; 95% CI, 1.75 to 16.78; P = .003) were associated with an increased likelihood of a collection attempt. Adolescent history of masturbation (OR, 5.99; 95% CI, 1.25 to 28.50; P = .025), banking self-efficacy (OR, 1.23; 95% CI, 1.05 to 1.45; P = .012), and parent (OR, 4.62; 95% CI, 1.46 to 14.73; P = .010) or medical team (OR, 4.26; 95% CI, 1.45 to 12.43; P = .008) recommendation to bank were associated with increased likelihood of sperm banking completion. Conclusion Although findings suggest that banking is underutilized, modifiable adolescent, parent, and provider factors associated with banking outcomes were identified and should be targeted in future intervention efforts.

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Fertility Preservation in Pediatric Patients Undergoing Stem Cell Transplantation: Sperm Banking Before or After Chemotherapy

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2011.12.220 ◽

2012 ◽

Vol 18 (2) ◽

pp. S283-S284

Author(s):

K.R. Sheth ◽

V. Sharma ◽

B.A. Lockart ◽

R.E. Brannigan ◽

Y.C. Gosiengfiao

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Fertility Preservation ◽

Cell Transplantation ◽

Pediatric Patients ◽

Sperm Banking

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Who should be offered sperm banking for fertility preservation? A survey of UK oncologists and haematologists

Annals of Oncology ◽

10.1093/annonc/mdq579 ◽

2011 ◽

Vol 22 (5) ◽

pp. 1209-1214 ◽

Cited By ~ 37

Author(s):

E. Gilbert ◽

A. Adams ◽

H. Mehanna ◽

B. Harrison ◽

G.M. Hartshorne

Keyword(s):

Fertility Preservation ◽

Sperm Banking

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Improving Male Reproductive Health After Childhood, Adolescent, and Young Adult Cancer: Progress and Future Directions for Survivorship Research

Journal of Clinical Oncology ◽

10.1200/jco.2017.76.3839 ◽

2018 ◽

Vol 36 (21) ◽

pp. 2160-2168 ◽

Cited By ~ 17

Author(s):

Lisa B. Kenney ◽

Zoltan Antal ◽

Jill P. Ginsberg ◽

Bradford S. Hoppe ◽

Sharon L. Bober ◽

...

Keyword(s):

Young Adult ◽

Sexual Dysfunction ◽

Reproductive Health ◽

Fertility Preservation ◽

Reproductive Function ◽

Adolescent And Young Adult ◽

Reproductive Outcomes ◽

Male Survivors ◽

Young Adult Cancer ◽

Male Reproductive Health

Reproductive health is a common concern and often a source of distress for male childhood, adolescent, and young adult cancer survivors. Clinical and epidemiologic research in survivor populations has identified alkylating agent chemotherapy, testicular radiation, and surgery or radiation to the genitourinary organs, lower spine, or the hypothalamic-pituitary region as risk factors for adverse reproductive outcomes, including impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Much of the research on male survivors has focused on the outcome of fertility, using spermatogenesis, serum gonadotropins, and paternity as the measures. However, these studies often fail to account for the clinically relevant but difficult-to-quantify aspects of fertility such as sexual function, cancer-related delayed psychosocial development, medical comorbidities, and socioeconomic concerns. Clinical and basic science research has made significant contributions to improving reproductive outcomes for survivors, with recent advancements in the areas of fertility preservation, clinical assessment of reproductive function, and treatment of adverse reproductive outcomes. Furthermore, there is an emerging qualitative literature addressing the psychosexual aspects of male reproductive health, the clinical application of which will improve quality of life for survivors. This review summarizes the current survivorship literature on reproductive health outcomes for male survivors, including the epidemiology of impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction; clinical and laboratory assessment of reproductive function; and established and investigational interventions to preserve reproductive function for patients newly diagnosed and survivors. Although survivorship research has made significant contributions to improving reproductive outcomes, additional scientific progress is needed in the areas of fertility preservation, risk assessment, and psychosexual support with the aim of optimizing reproductive health for current and future survivors.

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