Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia.
ANZAC Research Institute, University of Sydney, Sydney, Australia.
Hum Reprod. 2019 May 1;34(5):795-803. doi: 10.1093/humrep/dez026.
What is the natural history of outcomes of sperm cryostorage at an Australian tertiary academic centre?
Cryostorage is feasible in virtually all men facing gonadotoxic therapy but the timing of sperm disposal varies according to the reason for it.
Gonadotoxic treatment for cancer or non-cancer diseases damages spermatogenesis and impairs male fertility. Sperm cryopreservation is an established technique to preserve male fertility prior to gonadotoxic treatment.
STUDY DESIGN, SIZE, DURATION: A retrospective review of clinical, anthropometric, semen analysis and hormonal data from 1978 to 2017 involving 2717 men comprising 2085 men with cancer, 234 non-cancer disease and 398 healthy controls, in a single tertiary academic centre with the same clinic and laboratory staff.
PARTICIPANTS/MATERIALS, SETTING AND METHODS: Sperm output was analysed according to diseases, the feasibility of sperm cryostorage notably for adolescents, regional access to an urban cryostorage facility, the determinants of sperm output and time-dependent disposal of cryostored sperm. Semen samples were assessed by contemporaneous WHO methods.
Of 2085 men with cancer, 904 (43%) had haematological malignancies, 680 (33%) testicular cancers and 136 (6.5%) were adolescents. Most men (89%) and adolescents (80%) could collect sperm. Sperm output for all cancers and non-cancer diseases was lower than controls. Sperm output correlated positively with total testicular volume (r = 0.44, P < 0.0001) and negatively with serum FSH and LH (r = -0.24, -0.12, respectively, both P < 0.0001) but not testosterone. For all stored samples, the median time in cryostorage was 8.5 years, 7% were transferred for use to induce pregnancy (median time 2.5 years) and 62.2% were discarded as no longer needed (return of fertility, 35.9% median 3.5 years; death, 26.3%, median 6.5 years), the high disposal rate reflecting regular annual follow-up to establish ongoing need for continued cryostorage. Cryostorage facilities are not available in remote and rural areas of the State and the proportion of outer regional and remote area residents cryostoring sperm was only about half that compared with urban residents.
LIMITATIONS, REASONS FOR CAUTION: This study does not report the pregnancy outcomes of the patients who used the cryostored sperm, due to recent limitations on health data privacy.
Sperm cryostorage is feasible for virtually all men, including sufficiently mature adolescents, who can collect semen to insure future paternity as well as making positive psychological preparation for the patient's survival. Disposal of cryostored material when no longer required is efficient with regular follow-up. Sperm cryopreservation should be an integral part of comprehensive treatment plan in men receiving gonadotoxic treatment but remains underutilized.
STUDY FUNDING/COMPETING INTEREST(S): There was no external funding for this study and there were no relevant conflicts of interest.
在澳大利亚一家三级学术中心，精子冷冻储存的结果的自然史是什么？
冷冻储存对于面临性腺毒性治疗的几乎所有男性都是可行的，但精子处理的时间取决于其原因。
癌症或非癌症疾病的性腺毒性治疗会损害精子发生并损害男性生育能力。精子冷冻保存是在进行性腺毒性治疗之前保存男性生育能力的一种成熟技术。
研究设计、大小和持续时间：对 1978 年至 2017 年间在一家三级学术中心进行的临床、人体测量、精液分析和激素数据的回顾性分析，涉及 2717 名男性，其中 2085 名男性患有癌症、234 名非癌症疾病和 398 名健康对照，该中心有相同的诊所和实验室工作人员。
参与者/材料、地点和方法：根据疾病分析精子产量，特别是青少年精子冷冻储存的可行性、获得城市冷冻储存设施的区域机会、精子产量的决定因素以及冷冻储存精子的时间依赖性处理。精液样本采用当代世卫组织方法进行评估。
在 2085 名患有癌症的男性中，904 名（43%）患有血液系统恶性肿瘤，680 名（33%）患有睾丸癌，136 名（6.5%）为青少年。大多数男性（89%）和青少年（80%）都可以采集精子。所有癌症和非癌症疾病的精子产量均低于对照组。精子产量与总睾丸体积呈正相关（r = 0.44，P < 0.0001），与血清 FSH 和 LH 呈负相关（r = -0.24，-0.12，均 P < 0.0001），但与睾酮无关。对于所有储存的样本，中位冷冻储存时间为 8.5 年，7%用于转移使用以诱导妊娠（中位时间为 2.5 年），62.2%被丢弃不再需要（恢复生育能力，35.9%，中位时间 3.5 年；死亡，26.3%，中位时间 6.5 年），高处置率反映了定期进行年度随访以确定是否继续需要持续冷冻储存。该州偏远和农村地区没有冷冻储存设施，与城市居民相比，远郊和偏远地区居民冷冻储存精子的比例仅为一半左右。
局限性、谨慎的原因：由于最近对健康数据隐私的限制，本研究并未报告使用冷冻储存精子的患者的妊娠结局。
冷冻储存对于几乎所有男性都是可行的，包括足够成熟的青少年，他们可以收集精液以确保未来的亲权，以及为患者的生存做好积极的心理准备。当不再需要时，有效处理冷冻储存的材料，并定期进行随访。精子冷冻保存应该是接受性腺毒性治疗的男性综合治疗计划的一个组成部分，但仍未得到充分利用。
研究资金/利益冲突：本研究没有外部资金支持，也没有相关利益冲突。
