Fertility concerns in men with genitourinary malignancies: Treatment dilemmas, fertility options, and medicolegal considerations

Polland, Allison; Berookhim, Boback M.

doi:10.1016/j.urolonc.2016.05.007

Cited by 15 publications

(14 citation statements)

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“…Counseling these patients on their risk of future infertility, and on their options for fertility preservation, is considered standard of care but continues to be an area of needed improvement (Hotaling et al, 2013;Williams, 2013;Hamano et al, 2017). For instance, only a small percentage of men diagnosed with cancer choose to bank spermatozoa, with reported rates ranging from less than 5% to approximately 25%; this deficiency has been attributed in part to inadequate patient education and awareness (Chung et al, 2004;Polland & Berookhim, 2016;Hamano et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Genitourinary cancer patients have worse baseline semen parameters than healthy sperm bankers

Centola

Tanrikut

2019

Andrology

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Background: While the spermatotoxic properties of cancer treatments such as chemotherapy and radiation therapy are widely recognized, the effect of malignancy itself on male fertility is not clearly understood. Objectives: To determine whether malignancy is associated with diminished semen quality prior to spermatotoxic treatment among sperm bankers. Materials and Methods: Retrospective database review of de-identified records was obtained for all episodes of sperm banking performed at a cryobank from January 2004 to May 2017 for one of the following reasons: 'future use' (e.g., military deployment and gender reassignment); infertility; benign disease; and malignancy, further categorized as testicular, other genitourinary (GU), solid non-GU, hematologic, or unspecified. Dependent variables of interest were ejaculatory volume, sperm concentration, % motility, and total motile sperm count (TMSC), as well as post-thaw TMSC. Results: A total of 1558 patients met the inclusion criteria. Multivariable regression analysis on log-transformed data controlling for age demonstrated decreased ejaculatory volume and sperm concentration, % motility, and TMSC in the infertility group as compared to the 'future use' group (p < 0.001). Testicular cancer was associated with decreased sperm concentration, TMSC, and postthaw TMSC (p < 0.001); other GU malignancy was associated with decreased ejaculatory volume (p < 0.001). Benign disease, solid non-GU malignancy, hematologic malignancy, and unspecified malignancy were not associated with decreased parameters. Discussion: In addition to sperm bankers with known fertility issues, sperm bankers with testicular and other GU malignancy had worse baseline semen parameters as compared to individuals pursuing banking for future use. These findings can inform patient counseling and consent prior to sperm banking and disease treatment. Conclusion: Individuals with testicular and other GU malignancy who banked spermatozoa before undergoing spermatotoxic therapy demonstrated worse baseline semen parameters as compared to individuals banking spermatozoa for non-medical reasons.

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Section: Discussionmentioning

confidence: 99%

Genitourinary cancer patients have worse baseline semen parameters than healthy sperm bankers

Centola

Tanrikut

2019

Andrology

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“…Consequently, it is widely used in both humans and farm animals [2,3,4]. Once frozen, the spermatozoa are usually stored immersed in liquid nitrogen (LN2).…”

Section: Introductionmentioning

confidence: 99%

Post-thaw boar sperm motility is affected by prolonged storage of sperm in liquid nitrogen. A retrospective study

Parrilla

Ortega

et al. 2018

Cryobiology

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Owing to the quick genetic turnover of the pig industry, most AI-boar sires live 2-3 yr, a period during which for 1-2 yr their semen is extended and used in liquid form for AI. Despite showing low cryosurvival, affecting fertility after AI, boar semen is frozen for easiness of transport overseas and reposition of valuable genetics. For the latter, semen is stored in liquid nitrogen (LN, cryostorage) for many years, a controversial practice. Here we studied how length of cryostorage could affect sperm quality. Straws (0.5 mL) frozen using the same cryopreservation protocol at one specific location from AI- sires of proven fertility were stored in LN for up to 8 yr. Post-thaw sperm quality was evaluated after 2, 4 or 8 yr of cryostorage, always compared to early thawing (15 d after freezing). Sperm motility and kinematics were evaluated post-thaw using CASA and sperm viability was cytometrically evaluated using specific fluorophores. Sperm viability was not affected by length of cryostorage, but total and progressive sperm motility were lower (p < 0.01) in sperm samples cryostored for 4 or 8 yr compared to those thawed 15 d after freezing. Cryostorage time affected sperm kinetics, but with greater intensity in the samples cryostored for 4 yr (p < 0.001) than in those for 2 yr (p < 0.01). The fact that the major phenotypic characteristic of boar spermatozoa, motility, is constrained by time of cryostorage should be considered when building cryobanks of pig semen. Attention should be placed on the finding that >2 yr of cryostorage time can be particularly detrimental for the post-thaw motility of some sires, which might require increasing sperm numbers for AI.

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“…In the testes, the spermatogonial cells are vulnerable to cytotoxic agents and may be depleted [13]. Thus, cryopreservation, sperm retrieval techniques and spermatogonial stem cell transplantation (SSCT) have been tested to preserve testicular function and fertility [7,14,15].…”

Section: Introductionmentioning

confidence: 99%

“…The recovery of spermatogenesis after cytotoxic therapy depends on the survival and mitotic activity of SSC [8]. SSCT is a promising strategy to restore fertility, even in sterile childhood cancer survivors [14,15]. However, few SSC are normally found in the small testicular biopsy from the pubertal testis, and a successful clinical SSCT in these patients depends on the proliferation capacity of human SSC in culture before transplantation [15].…”

Section: Introductionmentioning

confidence: 99%

The antineoplastic busulphan impairs peritubular and Leydig cells, and vitamin B12 stimulates spermatogonia proliferation and prevents busulphan-induced germ cell death

Sasso-Cerri

Oliveira

Santi

et al. 2017

Biomedicine & Pharmacotherapy

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Busulphan (Bu), an alkylating agent used for bone marrow and spermatogonial stem cell transplantation (SSCT), impairs Sertoli (SC) cells, which are necessary for the spermatogonial stem cell (SSC) homing during transplantation. As Leydig (LC) and peritubular myoid (PMC) cells are essential for SC support and maintenance of spermatogonial niche, we evaluated the impact of Bu on the LC and PMC structural integrity. Vitamin B (B) has demonstrated beneficial effects against drug-induced testicular changes; thus, we also examined whether this vitamin is able to stimulate spermatogonia mitotic activity and prevent Bu-induced germ cell death. Rats received 10mg/kg of Bu in the 1st and 4th days, and daily B supplementation during Bu treatment and for 6days after the last injection of Bu (Bu-6d), totaling 10days of treatment. Other animals received the same treatment as Bu-6d, and B supplementation (Bu+7dB) or saline (Bu+7dS) for 7 more days, totaling 17days of treatment. Serum testosterone levels were measured. In the historesin-embedded testis sections, the seminiferous tubule and epithelial areas were measured, and the number of spermatogonia and PMC was quantified. Actin and 17β-HSD6 immunofluorescence was detected, and the number of TUNEL-positive LC and germ cells was computed. In Bu-6d, PMC number reduced, and a weak actin immunoexpression and death in these cells was observed. The testosterone levels reduced, and the interstitial tissue showed a weak 17β-HSD6 immunoexpression and increased number of TUNEL-positive LC. In Bu+7dB, the number of spermatogonia was higher than in Bu-6d and Bu+7dS, and the number of TUNEL-positive germ cells was significantly lower than in Bu+7dS. Bu exerts a harmful impact on PMC and LC, reducing the testosterone levels. Vitamin B prevents significantly Bu-induced germ cell death and stimulates spermatogonia proliferation, being a useful strategy for the enrichment of SSC in vitro and an adjuvant therapy for spermatogenesis recovery in oncologic patients.

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Fertility concerns in men with genitourinary malignancies: Treatment dilemmas, fertility options, and medicolegal considerations

Cited by 15 publications

References 50 publications

Genitourinary cancer patients have worse baseline semen parameters than healthy sperm bankers

Genitourinary cancer patients have worse baseline semen parameters than healthy sperm bankers

Post-thaw boar sperm motility is affected by prolonged storage of sperm in liquid nitrogen. A retrospective study

The antineoplastic busulphan impairs peritubular and Leydig cells, and vitamin B12 stimulates spermatogonia proliferation and prevents busulphan-induced germ cell death

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