Bitan Roy, Magnezi Racheli, Kedem Alon, Avraham Sarit, Youngster Michal, Yerushalmi Gil, Kaufman Sarita, Umanski Ana, Hourvitz Ariel, Gat Itai
Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel.
Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Tzrifin, Israel.
Andrology. 2024 Mar;12(3):527-537. doi: 10.1111/andr.13502. Epub 2023 Aug 2.
The wide implementation of sperm freezing presents a growing burden on sperm banks.
To evaluate sperm freezing and usage patterns over 30 years, according to demographic parameters of age at first cryopreservation and number of children, and indication for cryopreservation.
This retrospective, population based, cohort study included all sperm cryopreservation cases performed at a tertiary referral center from October 1993 to December 2021, among patients aged 18 years and older. First, we determined the interval between first sperm sample and use. Then, we examined sperm usage separately for: (1) age, comparing patients grouped into 5-year age cohorts; (2) paternal status according to number of children; (3) indication, comparison among seven indications. Secondary analysis included correlations between main age groups and paternal status versus the four most common indications found.
During the study period 1490 men who cryopreserved sperm met the inclusion criteria. Average age at cryopreservation of the first sample was 33.9 ± 8.1 years. Average age at first sperm use was 37 ± 8.5 years. Cumulative sperm usage was 38.7% after 17.8 years. Increasing age was associated with progressive increase in sperm usage rate and shorter preservation period. Use significantly decreased with increasing number of children. Examination of seven reasons for sperm cryopreservation found the highest cumulative sperm usage was related to azoospermia (67.7%), followed by functional cryopreservation (39.3%), oligoasthenoteratospermia (27.3%), other (26.5%), patient's request (24%), cancer (19%), and systemic disease (7.2%). Secondary analysis defined specific usage patterns mainly related to age and indication, with less of an effect based on the number of children.
After decades of cryopreservation, the paradigm of sperm cryopreservation is mostly related to cancer patients. This should be reevaluated and evolve to include broader patient-targeted factors and perceptions.
精子冷冻技术的广泛应用给精子库带来了日益沉重的负担。
根据首次冷冻保存时的年龄、子女数量等人口统计学参数以及冷冻保存的指征，评估30年来的精子冷冻及使用模式。
这项基于人群的回顾性队列研究纳入了1993年10月至2021年12月在一家三级转诊中心进行的所有18岁及以上患者的精子冷冻保存病例。首先，我们确定了首次精子样本采集与使用之间的间隔时间。然后，我们分别针对以下方面检查精子使用情况：（1）年龄，将患者按5岁年龄组进行分组比较；（2）根据子女数量划分的父亲状况；（3）指征，对七种指征进行比较。二次分析包括主要年龄组和父亲状况与四种最常见指征之间的相关性。
在研究期间，1490名冷冻保存精子的男性符合纳入标准。首次样本冷冻保存时的平均年龄为33.9±8.1岁。首次使用精子时的平均年龄为37±8.5岁。17.8年后的累积精子使用率为38.7%。年龄增长与精子使用率的逐渐增加以及保存期缩短相关。随着子女数量的增加，使用率显著下降。对七种精子冷冻保存原因的检查发现，累积精子使用率最高的是无精子症（67.7%），其次是功能性冷冻保存（39.3%）、少弱畸精子症（27.3%）、其他（26.5%）、患者要求（24%）、癌症（19%）和全身性疾病（7.2%）。二次分析确定了主要与年龄和指征相关的特定使用模式，而基于子女数量的影响较小。
经过数十年的冷冻保存，精子冷冻保存模式主要与癌症患者相关。这应该重新评估并发展，以纳入更广泛的以患者为目标的因素和观念。
