Documentation of Infertility Risk Discussion in Cancer Patients Receiving Cancer-Directed Therapy: The UC Davis Cancer Center Experience.

Purpose: A complication of cancer-directed therapy that often goes undiscussed is infertility. Although guidelines recommend addressing the possibility of infertility and fertility preservation approaches before initiating treatment, an internal review at our institution showed only 49% of female patients had infertility risk counseling documented. As a result, a fertility assessment communication was added into all oncology treatment plans to improve rates of fertility discussion and documentation. Methods: This retrospective observational study included newly diagnosed patients of childbearing potential who initiated cancer-directed therapy between January 1, 2020, and October 31, 2021. Patients who were no longer of childbearing potential due to age or surgery were excluded. Patients were divided into pre- and post-implementation groups to assess the impact of the fertility assessment communication implemented on November 1, 2020. Results: A total of 152 patients met inclusion criteria, with 80 patients in the pre-implementation group and 72 patients in the post-implementation group. The primary outcome of documentation of infertility risk discussion was 47.5% in the pre-implementation group and 86.1% in the post-implementation group (p < 0.0001). Discussion of fertility preservation options was documented in 28.7% of the pre-implementation group and 43.1% in the post-implementation group (p = 0.13). In the pre-implementation group, 5% underwent fertility preservation versus 27.8% in the post-implementation group (p = 0.0001). Of the 27 patients who received fertility preservation, 13 received hormonal therapy, 11 sperm banking, and 3 egg harvesting. Conclusion: This intervention significantly increased rates of infertility risk discussion and fertility preservation approaches received. There are opportunities to help patients receive fertility preservation, especially sperm banking and egg harvesting.

Cryopreservation of Semen in Domestic Animals: A Review of Current Challenges, Applications, and Prospective Strategies.

Cryopreservation is a way to preserve germplasm with applications in agriculture, biotechnology, and conservation of endangered animals. Cryopreservation has been available for over a century, yet, using current methods, only around 50% of spermatozoa retain their viability after cryopreservation. This loss is associated with damage to different sperm components including the plasma membrane, nucleus, mitochondria, proteins, mRNAs, and microRNAs. To mitigate this damage, conventional strategies use chemical additives that include classical cryoprotectants such as glycerol, as well as antioxidants, fatty acids, sugars, amino acids, and membrane stabilizers. However, clearly current protocols do not prevent all damage. This may be due to the imperfect function of antioxidants and the probable conversion of media components to more toxic forms during cryopreservation.

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.

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.

RéSUMé: CONTEXTE: La cryoconservation des spermatozoïdes est une méthode efficace de préservation de la fertilité pour la congélation des spermatozoïdes liée à des causes médicales et aux demandes sociétales. Au total, 662 hommes (entre 15 et 65 ans; moyenne: 33,5 ± 8,8 ans) ont été inclus dans cette étude pour évaluer les caractéristiques de la population, la qualité du sperme et l'utilisation de la préservation autologue de spermatozoïdes réalisée par des patients à Beijing. Parmi ceux-ci, 351 étaient des patients atteints de cancer (53%; 31,1 ± 7,3 ans) et 311 des patients non atteints de cancer (47%; 36,1 ± 9,5 ans). RéSULTATS: Nous avons constaté que le nombre de cas de conservation a augmenté régulièrement de 2015 à 2019; 89,7% d'entre eux avaient un baccalauréat ou plus; 54,8%, 41,5% et 3,6% étaient respectivement célibataires, mariés, ou divorcés. Les cas de cancer et ceux d'oligozoospermie représentaient 71,3% de tous les patients; par conséquent, la plupart des patients avaient besoin d'une préservation de la fertilité pour raison de maladie. Le groupe des hommes atteints de cancer avait significativement une plus faible concentration de spermatozoïdes, un plus faible taux de spermatozoïdes progressifs après le test de congelation-décongelation, un plus faible nombre total de spermatozoïdes de motilité progressive après le test de congelation-décongelation, et un plus faible taux de récupération de spermatozoïdes mobiles progressifs (TRMP) que le groupe de patients non atteints de cancer (tous p < 0,05). Les paramètres liés au nombre de spermatozoïdes ont été significativement affectés par le cancer du testicule, tandis que les paramètres liés à la mobilité des spermatozoïdes et le taux de récupération de spermatozoïdes mobiles progressifs ont été significativement affectés par la leucémie. Le taux d'utilisation des spermatozoïdes conservés était de 6,3% après 6 à 78 mois de suivi. En ce qui concerne le transfert d'embryons frais et congelés, le taux de grossesse clinique était respectivement de 56,8% et 50,0%, et le taux de naissances vivantes respectivement de 24,3% et 21,4%. CONCLUSIONS: Le besoin de conservation autologue des spermatozoïdes était dominé par les patients atteints de maladies, suivi par le besoin social de congélation des spermatozoïdes. Les tumeurs ont eu un impact négatif majeur sur la qualité du sperme, et le taux d'utilisation des spermatozoïdes stockés était à un niveau inférieur à celui du nombre de cryoconservation des spermatozoïdes. Le personnel médical et les patients doivent prêter attention à la fois à la cohérence cognition-action et à la rentabilité de la préservation de la fertilité.

What can we learn about posthumous sperm retrieval after extra long-term follow-up?

PURPOSE: To describe spermatozoa extraction rate by testicular sperm extraction (TESE) for posthumous sperm retrieval (PMSR) and examine harvest time impact on sperm motility; to compare long-term sperm usage between married vs. single deceased men. METHODS: This retrospective study included all PMSR cases in Shamir Medical Center during 2003-2021. We evaluated sperm cryopreservation according to latency time after death. Then, we assessed sperm usage according to Israeli PMSR regulations. RESULTS: The study included 69 (35 married and 34 singles) deceased men with average age of 30.3 ± 7.8 years. Sperm was cryopreserved in 65 cases (94.2%) after maximum and average harvest time of 40 and 16.5 ± 8.1 h, respectively. Motile sperm extraction was associated with significantly shorter harvest time compared with non-motile sperm (13.8 ± 7.3 vs. 18.7 ± 8.1 h, p = 0.046). Sperm usage among married deceased was significantly higher than single (15.6% vs. 0%, p = 0.05). Disposal requests were lower among single compared to married men relatives without reaching statistical difference. Eventually, single men had significantly higher rate of non-used cryopreserved samples (93.8% vs 69.6%, p = 0.01). CONCLUSION: This large long-term cohort study demonstrates high efficacy of PMSR. We found significant harvest latency time difference between motile and non-motile preserved sperm. Clinical sperm usage rate justifies the efforts for PMSR among married deceased. However, contradicting policy on the topic of single men (which implies liberal sperm preservation but rigid prevention of usage) results with high non-used sperm rate and relatives' extremely sophisticated emotional burden.

Fertility preservation in male cancer patients: A mixed methods assessment of experiences and needs.

INTRODUCTION: As fertility may be impaired due to gonadotoxic cancer treatment, fertility preservation should be offered to young cancer patients. Despite affirmative guidelines, sperm cryopreservation rates are still unsatisfying. OBJECTIVE: To examine how male cancer patients experience the current practice of counseling regarding fertility preservation and the needs they have for additional online support tools. METHODS: A cross-sectional mixed methods study of men above 18 years old with a cancer diagnosis within the last 10 years. The quantitative part was a retrospective questionnaire-based online survey; the qualitative part used focus-group methodology. The mean age of participants (n=72) was 32.94 years (SD 8.38) and the predominant cancer types were testicular cancer (55.6%), lymphomas (16.7%), and leukemias (13.9%). RESULTS: Participants rated the significance of the counseling as high (M=4.2, SD=1.05) and experienced professionals as supportive (M=4.37, SD=0.66). A majority of participants (70.8%) stated that they would use an additional support tool designed for male cancer patients. The tool should contain not only information about fertility preservation, but also about sexuality, virility, consequences for partners, and experience reports from other patients. CONCLUSIONS: Cancer patients undergoing gonadotoxic therapies should be counseled about fertility preservation. Professional, individualized information and a well-organized fertility preservation process improve the subjective experience of cancer patients. An online support tool that provides information about fertility preservation and general reproductive health was considered as a helpful, low-threshold offer that would be appreciated.

Semen Cryopreservation in Adolescents and Young Adults with Hematologic Diseases: from Bed to Benchside.

Purpose: Infertility in adolescents and young adult (AYA) survivors of malignant disease remains a major long-term adverse effect, but semen collection for fertility preservation in fertility centers is not always feasible and makes AYAs uncomfortable. We evaluated the feasibility of collecting sperm samples on the ward versus in fertility centers. Methods: Consecutive hospitalized AYA-aged male patients in the Hematology AYA unit (Saint-Louis Hospital, France) between August 2010 and June 2016 with hematological disease and indication of semen collection (n = 95) were included in this retrospective study. Semen quality was analyzed according to World Health Organization guidelines and was compared according to semen collection place: on the ward (n = 46) or in fertility center (n = 49). Results: The median age was median age 19.1 years (range: 13.7-33.3; interquartile range: 17.1-22.8) and 85 patients successfully collected semen. Sperm collection failure was ∼11% and was comparable between the two modalities as were main sperm quality characteristics (semen volume, sperm concentration, total sperm count, progressive motility and vitality, sperm morphology, and multiple anomalies index). Oligospermia was significantly higher in the samples obtained in fertility center (47.7%) than on the ward (26.8%), p = 0.047. Average frozen straws were comparable, 12.2 ± 6.4 on the ward versus 11.9 ± 6.3 in fertility center. Conclusion: Semen collection on the ward is feasible and would be particularly interesting for AYA male patients without altering semen quality characteristics.

Satisfaction with Fertility Preservation Decisions among Adolescent Males with Cancer: A Mixed Methods Study.

Half of male childhood cancer survivors experience treatment-related fertility impairment, which can lead to distress. Survivors often regret forgoing fertility preservation (FP), and decisional dissatisfaction is associated with a lower quality of life. This mixed methods study examined short-term FP decisional satisfaction among families of male adolescents newly diagnosed with cancer who received an initial fertility consult and completed an FP values clarification tool. One-two months after the FP decision, thirty-nine families completed the Brief Subjective Decision Quality measure. Decisional satisfaction was compared for participants (mothers, fathers, adolescents) who did and did not attempt to bank. Semi-structured interviews included the following question: How do you/your family feel about the banking decision now/in the future? Decisional quality scores were moderate-high (M = 5.74-6.33 out of 7), with no significant differences between non-attempter (n = 15) and attempter (n = 24) families (adolescents: p = 0.83, d = 0.08; mothers: p = 0.18, d = 0.45; fathers: p = 0.32, d = 0.44). Three qualitative themes emerged among non-attempter families: (1) satisfaction with decision (50% of participants), (2) acceptance of decision (60%), and (3) potential for future regret (40%). Satisfaction with decision was the only theme identified in attempter families (93%). Quantitively, short-term decisional satisfaction was high regardless of the banking attempt. However, the qualitative findings suggest that the experiences of families who did not bank may be more nuanced, as several participants discussed a potential for future regret, highlighting the importance of ongoing support.

Cryopreservation of sperm before gonadotoxic treatment at the University Hospital Brno in the years 1995-2020

OBJECTIVE: Sperm cryopreservation before gonadotoxic treatment is the basic and mos teffective method of preserving reproduction, which can be used during adolescence. The communication summarizes 26 years of experience in the operation of an oncological sperm bank, analyzes spermiograms of oncological patients, assesses the relationship between sperm pathology and diagnosis, and determines the number of deaths and the use of frozen sperm. METHODS: During the existence of CAR 01 (assisted reproduction center), more than 50,000 spermiograms were performed. From January 1995 to December 2020, a total of 24,729 men were examined within the sperm bank, of which 1,448 (5.9%) had an oncological diagnosis. The spermiograms were evaluated according to current WHO (World Health Organization) manuals. Cryopreservation of sperm has undergone a major development. The rules for the storage of frozen cells have been laid down by Act No. 296/2008 Coll. since 2008. In 2019, the methodology "Cryopreservation of reproductive cells and tissues in patients before cancer treatment" was updated. In all cases, the standard thawing technique was used. The sperms were processed by the swim-up method. As part of the treatment with assisted reproduction methods, oocytes were fertilized by the ICSI (intracytoplasmatic sperm injection) micromanipulation technique. RESULTS: Out of 1,448 examined spermiograms in men with oncological diagnoses, testicular cancer was present in 43.7% of patients and malignant diseases of lymphatic and hematopoietic tissue were found in 24.1%, of which 70,1% included Hodgkin's lymphomas and 29,9% were non-Hodgkin's lymphomas. Leukemia was found in 7.9%, bone and cartilage cancers in 6.8%. The age of the clients of the whole group ranged from 13 to 64 years (27.2 ± 6.8 years). A total of 38.3% of men had normozoospermia, 54.2% of spermiograms showed pathological findings in 1 to 3 evaluated parameters and 7.5% of patients had azoospermia. Severe asthenozoospermia (mobility ≤ 10%) was detected in 57.2% of men and severe oligozoospermia (concentration ≤ 1 × 106 mm3) in 22.3% of patients. The lowest values of the spermiogram were found in men with testicular cancer; the best values were seen in CNS (central nervous system) cancers. The cryopreservation of sperm was performed in 1,340 cases (92.5%). So far, a total of 160 men (11.9%) have used frozen sperm, of which 6.2% in our center. In these 83 cases, the ICSI technique was always used, 38 clinical pregnancies (45.8%) and 32 births were achieved. We have registered 424 completed storages of semen (31.6%), of which 148 (11.0% of all oncology patients) were made due to death and the others at patients' request. Using the sperm of the dead is a specific issue. CONCLUSION: In cancer patients, sperm pathologies occur in high percentage. The lowest spermiogram values were found in men with testicular cancer. It is necessary to take into account long-term storage and fertilization by micromanipulation methods. The number of men who die is significantly higher than the number of those who use sperm to treat infertility. Cryopreservation of sperm should be offered to each patient prior to the therapy leading to the destruction of spermatogenesis.

Family communication about fertility preservation in adolescent males newly diagnosed with cancer.

BACKGROUND: Approximately half of male childhood cancer survivors experience fertility impairment, which can cause psychological distress. Sperm banking remains underutilized among adolescent males with cancer. Parent recommendation influences banking decisions, yet multi-informant studies have not been conducted to examine fertility preservation (FP) communication and decision making in this population. This study explored FP communication among mothers, fathers, and their male adolescents newly diagnosed with cancer. PROCEDURE: Thirty-three male adolescents, 32 mothers, and 22 fathers completed semi-structured interviews 1-2 months after cancer diagnosis addressing this question: Tell me more about conversations you had about fertility preservation/sperm banking with your health care providers, parents/son, other family members, or anyone else. Interviews were audio-recorded and transcribed verbatim for thematic content analysis. RESULTS: Five process themes emerged: (1) reliance on health care team and social support networks to facilitate FP decisions (only parents); (2) withholding parental opinion and deferring the decision to the adolescent; (3) ease of communication (primarily adolescents); (4) communication barriers/facilitators; (5) not being present or not remembering details of FP conversations with health care providers (primarily fathers and adolescents). Four content themes included: (1) preference for biological (grand)parenthood; (2) consideration of adolescent's future partner's desire for biological parenthood (primarily parents); (3) banking while it is a viable option; (4) openness to alternative parenthood options (e.g., adoption/fostering, primary parents). CONCLUSIONS: Understanding variation in what family members discuss and consider relevant when making FP decisions is an important step toward improving pediatric oncofertility care. Interventions are needed to facilitate family FP-related conversations and optimize decisional satisfaction over time.

SARS-CoV-2 pandemic and repercussions for male infertility patients: A proposal for the individualized provision of andrological services.

The prolonged lockdown of health facilities providing non-urgent gamete cryopreservation-as currently recommended by many reproductive medicine entities and regulatory authorities due to the SARS-CoV-2 pandemic will be detrimental for subgroups of male infertility patients. We believe the existing recommendations should be promptly modified and propose that the same permissive approach for sperm banking granted for men with cancer is expanded to other groups of vulnerable patients. These groups include infertility patients (eg, azoospermic and cryptozoospermic) undergoing medical or surgical treatment to improve sperm quantity and quality, as well as males of reproductive age affected by inflammatory and systemic auto-immune diseases who are about to start treatment with gonadotoxic drugs or who are under remission. In both scenarios, the "fertility window" may be transitory; postponing diagnostic semen analysis and sperm banking in these men could compromise the prospects of biological parenthood. Moreover, we provide recommendations on how to continue the provision of andrological services in a considered manner and a safe environment. Our opinion is timely and relevant given the fact that fertility services are currently rated as of low priority in most countries.

Male fertility preservation-Methods, indications and challenges.

Male fertility preservation has been steadily increasing over the past two decades. Significant improvements have been achieved in the treatment modalities of cancer and other severe chronic medical conditions, leading to an increase in patient survivorship and the resulting demand for future parenthood. Recognition and proper patient counselling before commencing therapies with a potential gonadotoxic effect are of paramount importance. Similarly, nonmedically indicated fertility preservation is on the rise. Social sperm banking, gender dysphoria prior to affirmation procedures and posthumous reproduction preservation are becoming more common. When timing and logistics are appropriate, sperm cryopreservation is considered the gold standard for fertility preservation. Testicular tissue and spermatogonial stem cell autotransplantation is considered experimental and represents a promising alternative for pre-pubertal patients. The current paper aims to review the recent trends in male fertility preservation, the common indications for sperm cryopreservation, techniques for sperm retrieval and experimental frontiers.

A prospective study on the long-term outcome of prepubertal and pubertal boys undergoing testicular biopsy for fertility preservation prior to hematologic stem cell transplantation.

BACKGROUND: Few studies have reported the long-term outcomes of prepubertal and pubertal boys undergoing testicular biopsy for fertility preservation (FP). PROCEDURE: This prospective longitudinal study examined 21 boys (aged 1.5-14.5 years) who underwent testicular biopsy for FP prior to allogeneic (n = 20) or autologous (n = 1) hematological stem cell transplantation (HSCT) between 2003 and 2010. During counseling, pubertal boys were encouraged to produce a sperm sample by masturbation , while prepubertal boys were presented with surgical testicular tissue retrieval as an option for experimental FP. Clinical outcomes included postoperative complications, pubertal development, and sex-hormone levels. Survivors approaching adulthood were encouraged to provide semen samples. RESULTS: Twenty boys, including 14 in prepuberty and six in early puberty (Tanner stage 2-3), underwent open testicular biopsies. Two pubertal biopsies contained mature sperms, which were cryopreserved. Testicular tissue was vitrified in the remaining 18 cases. One pubertal boy (Tanner stage 4) underwent percutaneous testicular sperm aspiration and sperms obtained were cryopreserved. Postoperative complications (hematoma or infection) were rare. Overall, 14 boys survived >5 years (mean follow-up after HSCT, 7.2 years) and 11 showed advanced puberty. Semen samples were provided by five boys and obtained sperm were cryopreserved from two. Individuals at adulthood had normal testosterone levels but subnormal testicular size, high follicle stimulating hormone, and low inhibin B and anti-Müllerian hormone levels. CONCLUSION: No long-term risks were detected during continuous clinical follow-up. Experimental testicular biopsies for FP were well accepted by the patients and families, despite the absence of methods to use prepubertal tissue for fertility treatment.

Fertility considerations in men with testicular cancer.

The modern approach to cancer management has evolved into a multidisciplinary initiative focused not only on cancer specific and overall survival, but also patient quality of life and survivorship. Future fertility is often a major concern for young patients undergoing cancer therapy. Fertility preservation has emerged as a viable but significantly underutilized option. Patients and families should be aware of the varying effects of antineoplastic therapy on their future fertility to allow for an informed decision regarding their fertility preservation options. In this review we discuss the epidemiology, pathophysiology, and management of fertility in the setting of testicular cancer diagnosis and treatment.

Fertility counseling and sperm banking among adolescents and adults treated for cancer with curative intent in a developing country.

PURPOSE: In developing countries, a higher percentage of patients develop cancer at a younger age. Cancer survival rates have significantly improved, highlighting the importance of survivorship programs that address late complications related to cancer itself or its treatment. The purpose of this study is to estimate the prevalence of fertility counseling and sperm banking and related factors among at-risk males newly diagnosed with cancer and planning to receive a potentially curative anticancer therapy. METHODS: Medical records and hospital database of young male patients with newly diagnosed cancers and planned to start chemotherapy were reviewed for fertility counseling and sperm cryopreservation. Additionally, a self-administered questionnaire was utilized. RESULTS: A total of 186 patients, mean age 32.9 (range: 18-53) years, were included. Non-Hodgkin's lymphoma 59 (31.7%), leukemia 48 (25.8%), and Hodgkin's lymphoma 26 (14.0%) were the most common tumors encountered. A total of 129 (75.0%) respondents received fertility counseling prior to their treatment, and this rate was higher among patients with early-stage disease (82.4% vs. 58.1%, p = 0.038). However, sperm banking was performed by 33.1% of the whole study group but was significantly higher among single patients (53.4% vs. 17.7%, p < 0.001), those who had no children (51.8% vs. 14.3%, p < 0.001), and among highly educated patients (47.6% vs. 17.1%, p = 0.001). Patients failed to do sperm banking because they were not informed about the risk of infertility (26.2%) or service availability (25.4%). Fear of treatment delay was a reason in 20.0%. CONCLUSIONS: Fertility counseling and sperm banking among cancer patients are not optimal. Many patients failed to do sperm banking because of avoidable reasons. Better communication and patients' education will probably improve the utilization of this vital service.

Does supplementation of sperm freezing/thawing media with Ceratonia siliqua improve detrimental effect of cryopreservation on sperm parameters and chromatin quality in normozoospermic specimens?

Human sperm banking is an important procedure in the assisted reproductive technique centers. It entails sperm damage. The aim of this study was to investigate beneficial effect of Ceratonia siliqua (C. siliqua) supplement in freezing/thawing media on post thaw sperm parameters and sperm chromatin quality in normozoospermic samples. Forty normozoospermic specimens were included in this prospective study. Each sample was divided into ten groups. In groups one to five, 0 (as control group) 5, 10, 20 and 30 µg/ml C. siliqua were added to freezing medium and in groups six to ten, similar concentration of C. siliqua were added to thawing medium for 30 min incubation. Sperm concentration, progressive motility, normal morphology, viability, aniline blue (AB), toluidine blue (TB) and sperm chromatin dispersion (SCD) staining tests were evaluated before vitrification and after thawing. The results showed that 10 and 20 µg/ml supplementation of C. siliqua in freezing/thawing media significantly increased progressive motility, normal morphology and viability of sperm (p < 0.05) as well as decreased AB, TB and SCD (p < 0.05). Also, 20 µg/ml had significantly higher improvement compared to 10 µg/ml C. siliqua (p < 0.05). The present study showed that C. siliqua supplemented freezing/thawing media can improve sperm quality of normozoospermic samples after freezing/thawing.

Maternal, infant and childhood risks associated with advanced paternal age: The need for comprehensive counseling for men.

The increasing maternal age at first birth is well recognized, but much less discussed are the fact that the prevalence of advanced paternal age (APA) is also increasing and the societal implications of this trend. Over the past 40 years in the United States, the proportion of infants born to fathers of APA, which has been variably defined as above 35 or above 45, increased from ˜4% to 10% (Khandwala et al., 2017, 2018) While there has been extensive research regarding infertility and comorbidities in the aging mother, relatively few studies have explored similar reproductive factors in aging men. However, evidence does suggest a decrease in fertility and an increase in pregnancy complications such as gestational diabetes, intrauterine growth restriction and preterm birth. Additionally, the offspring of fathers of APA have increased risks of chromosomal and non-chromosomal birth defects and an increased incidence of childhood autism and cancers. This review explores the data, with the intent that key counseling points, including the suggestion of sperm banking, can be highlighted when advising the midlife and older man who is considering paternity.

Corrected cholesterol, a novel marker for predicting semen post-thaw quality: a pilot study.

Semen cryopreservation is the recommended method for protecting the fertility of men before they undergo iatrogenic treatments. However, post-thaw sperm quality is highly variable between and within individuals. Thus, prediction of post-thaw quality has not been achieved with great certainty. Men (n = 101) attending our andrology clinic each produced a single ejaculate for semen analysis and semen cryopreservation. Post-thaw semen quality was examined for associations with traditional and novel semen and seminal plasma parameters. This current research demonstrates that the cholesterol concentration of human sperm is associated with ejaculate tolerance to cryopreservation. Corrected cholesterol, calculated as the difference between the cholesterol of semen and the cholesterol of cell free seminal plasma, is predictive of post-thaw motility. This may have potential as a method to guide the number of ejaculates stored for individual patients before iatrogenic treatment and/or for the appropriate selection of ART with frozen/thawed semen.

Patient and Physician Perspective on Sperm Banking to Overcome Post-Treatment Infertility in Young Cancer Patients in Pakistan.

BACKGROUND: Cancer survivor rates have increased over the past few decades leading to a growing interest in research related to quality of life (QoL). We attempted to explore the unique barriers that might prevent adult male cancer patients from accessing sperm cryopreservation in Pakistan. METHODS: Semi-structured interviews of male cancer patients aged 18-45 years were audio-recorded in Urdu and translated to English and were transcribed ad verbatim. The topics included information regarding risk of infertility following chemotherapy, future reproductive choices, and barriers to sperm cryopreservation. Questionnaire to physicians containing four content domains of knowledge, attitude, practice, and barriers to sperm banking was also delivered. Data were entered and analyzed on SPSS. RESULTS: Of the 25 patients interviewed, there were 10 cases of leukemia, 3 cases of lymphoma, 2 cases each of colorectal carcinoma and multiple myeloma, 1 case each of neuroblastoma and osteosarcoma, and solitary cases involving the lung, breast, thymus, brain, jaw, and testis. Four patients knew about the risk of infertility. All patients were aware of the option of sperm cryopreservation. Two patients had their sperm preserved before the initiation of chemotherapy. Perceived treatment-related expenses appeared to be the major barrier to sperm cryopreservation in nine patients. This was followed by lack of information, which was cited by eight patients, and religious reasons (n = 2 patients). Other barriers were female gender of the doctor and patient's preferences. Four patients stated no barriers. Nine physicians responded to the questionnaire. Seventy-eight percent of physicians agreed that cancer treatment increases the risk of infertility. 33.3% strongly agreed and 55.6% agreed that infertility can have an adverse impact on QoL. CONCLUSIONS: There is a significant lack of awareness among male cancer patients regarding infertility following cancer treatment. It is imperative that physicians inform them of this and discuss treatment options, along with addressing potential barriers.

Interest in Learning About Fertility Status Among Male Adolescent and Young Adult Survivors of Childhood Cancer.

PURPOSE: As many as two-thirds of male childhood cancer survivors are at risk for fertility impairment as a consequence of treatment. Despite this, survivorship guidelines lack concrete recommendations as to when fertility status conversations should happen between patients and providers and what should be discussed. Thus, conversations may be inconsistent, or do not occur at all in survivorship. To inform recommendations for fertility-related conversations in survivorship, this pilot study aimed to better understand background (e.g., age, diagnosis and treatment intensity) and psychosocial factors (i.e., perceived barriers and perceived susceptibility) associated with survivor interest in learning about fertility status. METHODS: Male survivors (N = 45) 15-25 years of age were recruited within 1-8 years of completing treatment. Survivors completed questionnaires based on the Health Belief Model (HBM) to assess perception of infertility risk and attitudes toward testing. RESULTS: Most survivors (n = 31; 69%) reported they were informed of their risk for infertility by a healthcare provider before treatment, but only 31% (n = 14) of the sample banked sperm. Nearly two-thirds of survivors (n = 29; 64%) were interested in learning more about their fertility post-treatment. This interest was significantly correlated with greater perceived susceptibility to infertility by survivors, but it was not associated with other psychosocial or background factors. CONCLUSION: Informing survivors of their personal infertility risk may increase interest in pursuing testing. Offering opportunities for fertility testing and family planning alternatives may mitigate potential psychological distress and unplanned pregnancy. While additional research is needed, future survivorship guidelines should encourage regular communication about fertility status and offer fertility testing for male survivors.

A fertility needs assessment survey of male cancer patients.

OBJECTIVE: To describe fertility-related informational needs and practices, and to examine if demographic characteristics are related to these needs and practices. METHODS: A needs assessment survey was conducted at three Canadian cancer centres. RESULTS: 192 male cancer patients (Mage = 33.6) completed the survey. Most patients (70%) recalled having had a discussion with a health care provider regarding their fertility and 44% banked their sperm. Patients reported not getting all the information that they wanted, eg, the risk that a future child may have the same type of cancer (78%), and what was covered by insurance plans (71%). Barriers to sperm preservation were urgency to begin cancer treatment (49%), not planning to have a child in the future (47%) and worries that cancer could be passed on to future children (38%). Participants' age and being the parent of a child were significantly associated with having had a discussion about fertility. Participants' age, province, being the parent of a child and the desire for future children were significantly associated with fertility preservation. CONCLUSIONS: Discussions with health care providers were more frequent, and fertility preservation rates were higher than in past studies, but still not all patients' questions were answered. Misconceptions about passing on cancer to one's child, and that sperm preservation will delay treatment, should be dispelled. Health care providers can ask patients if they have any desire to have children in the future as a way to initiate a discussion of fertility preservation. Key information gaps and psychosocial resource needs are suggested to fully meet male cancer patients' fertility-related concerns.