Department of Andrology, Hammersmith Hospital, London, UK.
Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK.
Clin Endocrinol (Oxf). 2018 Dec;89(6):798-804. doi: 10.1111/cen.13851. Epub 2018 Oct 10.
Sperm cryopreservation (freezing) should be offered to all men with cancer due to risk of infertility. However, many men with cancer already have impaired spermatogenesis prior to sperm cryopreservation. Furthermore, physical ill-health may hinder attendance of freeze visits. Investigating both the distribution of sperm functions and freeze attendance rates in men with newly diagnosed cancer, may identify patients benefiting from targeted reproductive fertility support.
We performed a retrospective study of 2906 male patients undergoing sperm cryopreservation prior to cancer therapy at a single UK tertiary centre between 1989 and 2013; all patients were asked to attend three hospital semen collection visits prior to cancer therapy.
Fifteen per cent (433/2906) of men with newly diagnosed cancer had severely impaired semen quality (i.e., sperm total motile count, TMC < 1 million) during the first semen collection visit. However, patients with severely impaired semen quality had the poorest attendance of subsequent semen collection visits despite being requested to do so (non-attendance in TMC < 1 million: 43.4%; TMC < 1-30 million: 35.7%, P < 0.05 vs. <1 million; TMC > 30 million: 33.2%, P < 0.01 vs. <1 million).
This study expands understanding of the semen quality of men with newly diagnosed cancer, and their ability to adhere to fertility preservation recommendations. Our data suggest that patients with the poorest semen quality paradoxically suffer the poorest attendance rates of sperm cryopreservation appointments prior to commencing cancer therapy. We suggest that additional support may be of clinical benefit to men with newly diagnosed cancer and TMC < 1 million sperm.
由于存在不育风险，应向所有患有癌症的男性提供精子冷冻（冷冻）。然而，许多患有癌症的男性在进行精子冷冻之前已经存在精子发生受损的情况。此外，身体不适可能会妨碍冷冻就诊的进行。研究新诊断癌症男性的精子功能分布和冷冻就诊率，可能会发现需要针对性生殖生育支持的患者。
我们对 1989 年至 2013 年期间在英国一家三级中心接受癌症治疗前进行精子冷冻的 2906 名男性患者进行了回顾性研究；所有患者均被要求在癌症治疗前进行三次医院精液采集就诊。
15%（433/2906）新诊断癌症的男性在第一次精液采集就诊时精液质量严重受损（即精子总活力计数，TMC<100 万）。然而，尽管要求他们这样做，但精子质量严重受损的患者随后的精液采集就诊的出勤率最差（TMC<1 亿：43.4%；TMC<1-3000 万：35.7%，P<0.05 与<1 亿相比；TMC>3000 万：33.2%，P<0.01 与<1 亿相比）。
本研究扩展了对新诊断癌症男性的精液质量及其遵守生育力保留建议能力的理解。我们的数据表明，精子质量最差的患者就诊率最差，与<1 亿相比，他们接受癌症治疗前的精子冷冻预约就诊率最差。我们建议，额外的支持可能对 TMC<1 万精子的新诊断癌症男性具有临床益处。
