Ceska Gynekol. 2021;86(3):156-162. doi: 10.48095/cccg2021156.
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.
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.
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.
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.
在性腺毒性治疗前进行精子冷冻保存是保存生殖功能的基本且最有效的方法，可在青春期进行。该通讯总结了在肿瘤精子库运行 26 年的经验，分析了肿瘤患者的精子图，评估了精子病理学与诊断之间的关系，并确定了死亡人数和冷冻精子的使用情况。
在 CAR 01（辅助生殖中心）存在期间，进行了超过 50,000 次精子图检查。从 1995 年 1 月至 2020 年 12 月，共有 24,729 名男性在精子库接受检查，其中 1,448 名（5.9%）患有肿瘤诊断。根据现行的世界卫生组织（WHO）手册评估精子图。精子冷冻保存经历了重大发展。自 2008 年第 296/2008 号法案以来，已经制定了冷冻细胞储存规则。2019 年，更新了“癌症治疗前生殖细胞和组织的冷冻保存”方法。在所有情况下，都使用了标准的解冻技术。精子通过游泳法进行处理。作为辅助生殖方法治疗的一部分，通过 ICSI（胞浆内精子注射）微操作技术使卵子受精。
在 1,448 名患有肿瘤诊断的男性的精子图检查中，睾丸癌患者占 43.7%，淋巴和造血组织恶性疾病占 24.1%，其中 70.1%包括霍奇金淋巴瘤，29.9%为非霍奇金淋巴瘤。白血病占 7.9%，骨和软骨癌占 6.8%。整个组的客户年龄范围从 13 岁到 64 岁（27.2 ± 6.8 岁）。共有 38.3%的男性具有正常精子数，54.2%的精子图在 1 到 3 个评估参数中显示出病理发现，7.5%的患者出现无精子症。在 57.2%的男性中发现严重弱精子症（活动力≤10%），在 22.3%的患者中发现严重少精子症（浓度≤1×106 mm3）。在睾丸癌患者中发现精子图的最低值；在中枢神经系统（CNS）癌症患者中发现了最佳值。对 1,340 例（92.5%）进行了精子冷冻保存。到目前为止，共有 160 名男性（11.9%）使用了冷冻精子，其中 6.2%在我们中心。在这 83 例中，始终使用 ICSI 技术，实现了 38 例临床妊娠（45.8%）和 32 例分娩。我们已经登记了 424 次精液（31.6%）的完成储存，其中 148 次（所有肿瘤患者的 11.0%）是由于死亡，其余是患者的要求。使用死者的精子是一个特殊的问题。
在癌症患者中，精子病理学发生率很高。在睾丸癌患者中发现精子图的最低值。有必要考虑长期储存和通过微操作方法受精。死亡人数明显高于使用精子治疗不育症的人数。在导致精子发生破坏的治疗前，应向每位患者提供精子冷冻保存。
