Cryopreservation of semen from pubertal boys with cancer

BACKGROUND: The possibility of cryopreservation of semen from adolescents has until now received only little attention. Therefore, we have investigated the possibility of cryopreservation of semen in adolescent boys with cancer. PROCEDURE: Forty-five boys, aged 13-18 years, admitted because of cancer during the period January 1, 1995 to July 31, 1998 were eligible. Semen was obtained after masturbation in the majority of the cases. In three boys, semen was preserved after penile vibration or electroejaculation in general anaesthesia. The semen samples were analysed for concentration, motility, and morphology according to the WHO guidelines. The sample was transferred into straws prior to cryopreservation at 196 degrees C in liquid nitrogen. RESULTS: Twenty-one boys delivered a semen sample for cryopreservation. Four boys were offered and accepted sperm banking but were not able to produce a sample. In 20 cases time did not allow an attempt of sperm banking, the boy was not assessed to be mature enough to deliver a semen sample, or the procedure was not accepted. The boys delivered 1-3 samples, and the total number of spermatozoa ranged from 0-210 millions. Median percentage of motile sperm was 50% (range 9-86%). Semen quality improved with age; however, a 13- year- old boy produced 75 million spermatozoa with 38% motile cells. CONCLUSIONS: Pubertal maturation should be assessed in all boys admitted for cancer, and the possibility of sperm banking should be discussed with the patient and his parents.     

Cryopreservation of semen from adolescent patients with malignancies

In adult oncological patients semen cryopreservation offers the possibility of preserving fertility prior to aggressive therapy that may lead to infertility. The cryopreserved semen can later be used to induce pregnancies in the partner by techniques of assisted fertilization. In adolescent boys the question of fertility is often beyond consideration when the young patient's life is threatened acutely. However, improved survival rates increasingly prompt the question of quality of life after therapy, including fertility. Semen quality is known to be impaired in patients with malignancies and may be further impaired by the process of cryopreservation. Since normal values for semen in adolescents are not known and spermatogenesis may be impaired by the malignant disease, it was unclear whether semen samples from adolescents with malignancies warrant cryopreservation at all. In order to demonstrate the feasibility of semen cryopreservation in adolescent males, we compared the results from 12 pubertal boys aged 14–17 years with those from 17 young adults aged 18–20 years who had similar malignancies and, additionally, to 210 adults with malignancies (>20 years). Luteinizing hormone serum values were significantly lower in adolescents than in adult patients. Follicle stimulating hormone showed a significant increase with age. Testosterone serum levels and testicular volumes showed similar distribution patterns in adolescent and adult men. Sperm concentrations, sperm motility, and normal sperm morphology in the adolescent patients did not show significant differences compared with adults. Thus cryopreservation of semen should be considered as an option to young male patients whose cancer therapy will include potentially gonadotoxic treatment. © 1996 Wiley-Liss, Inc.     

SPERM CRYOPRESERVATION PRACTICES AMONG ADOLESCENT CANCER PATIENTS AT RISK FOR INFERTILITY

To assess sperm cryopreservation among males newly diagnosed with cancer aged 13 years and older, attending oncologists assigned infertility risk (yes/no) to patients and reported whether their patients engaged in sperm cryopreservation. Only 28.1% of informed at-risk patients banked sperm. Utilization of sperm banking was significantly associated with a diagnosis of central nervous system (CNS) malignancy or non-CNS solid tumor diagnosis, higher socioeconomic status, and not being a member of an Evangelical religious group. These results suggest that sperm banking is underutilized among adolescent males newly diagnosed with cancer, and that strategies to increase the engagement in this fertility preservation method are needed.     

改良快速冷冻载体冻融人类稀少精子的实验研究

目的探讨人类稀少精子冷冻改良快速冷冻载体的实验研究,为重度少弱精子症患者的精子冷冻保存提供参考。方法2018年12月至2019年8月,在联勤保障部队第九〇〇医院生殖中心就诊的男性不育症患者:根据精液质量分为正常精液组和少弱精液组,每个实验样本选取3份精液分别进行充分混合,将混合精液稀释至浓度为(1~2)×10~6/ml,实验共计选取81份正常精液标本混匀稀释形成27个正常精液样本,选取54份少弱精液标本混匀稀释形成18个少弱精子样本。根据不同的冷冻载体各分3组进行精子冷冻:薄片精子冷冻管组(A组),麦管微量体积冷冻组(B组),改良快速冷冻载体组(C组),均采用商品化精子冷冻试剂1∶1混匀,熏蒸法后快速冷冻。比较3种载体冷冻复苏后,精子的活动力、存活率、DNA碎片指数和正常形态变化、精子顶体酶活性等指标变化,以评估改良快速冷冻载体的冷冻效率及安全性。统计学方法采用t检验、ANOVA分析、LSD多重比较。结果正常精液组的3种冷冻方法都会造成精子质量下降。正常精液组的C组的复苏后精子活动力、存活率均高于A组和B组,差异有统计学意义(P<0.05)。正常精液组:C组复苏精子DNA碎片指数略低于A和B组,但差异无统计学意义(P>0.05);A、B、C 3组复苏后精子正常形态率均低于冷冻前,差异有统计学意义(P<0.05)。少弱精液组:A、B两组复苏后精子DNA碎片指数均高于冷冻前,差异有统计学意义(P<0.01);C组精子DNA碎片指数高于冷冻前,但差异无统计学意义(P=0.068),C组复苏精子DNA碎片指数略低于A和B组,但差异无统计学意义(P>0.05),A、B、C 3组冷冻精子复苏后正常形态率均低于冷冻前,差异无统计学意义(P>0.05)。正常精液组:冷冻前精子顶体酶活性为(123.6±12.8)IU/10~6个精子,复苏后A、B、C 3组顶体酶活性均有下降,分别为(74.7±15.6)、(84.7±13.5)、(91.2±16.2)IU/10~6个精子,差异有统计学意义(F=37.896,P<0.001),从对于精子顶体影响看,B、C组优于A组,差异有统计学意义(P=0.043、P=0.001)。结论改良快速冷冻载体对于稀少精子冷冻保存有一定优势,值得进一步探讨研究。     

Male reproductive health after childhood cancer

AIM: Twenty-five male patients were investigated to elucidate the correlation of semen parameters and other related parameters in the assessment of spermatogenesis after childhood cancer treatment. METHODS: Evaluation of given cancer treatment, anthropometric and testicular size measurements, semen analysis, and measurement of gonadotrophins, testosterone, sex hormone-binding globulin (SHBG), and inhibin B were performed according to a protocol. RESULTS: Median (range) sperm concentration (SC) was 35.5 (0-273)x10(6)/mL, and percentage of motile sperm 56 (0-86)%. Testicular size (r=0.73, p<0.001) and the level of inhibin B (r=0.66, p<0.001) correlated strongly to SC. SC correlated negatively to FSH (r=0.46, p=0.03). Only testicular size predicted SC significantly (p=0.03). Inhibin B showed highest area under ROC curve (0.83, 95%CI 0.67-0.99) in showing SC<20x10(6)/mL. Body mass index (BMI) did not correlate with SC, but negative correlation between BMI and SHBG was found (r=-0.41, p=0.04). CONCLUSION: Although semen analysis is a useful instrument for fertility assessment in men, it is often difficult to get these samples from childhood cancer survivors. Thus, indirect methods are needed in prediction of possible sperm count impairment in postpubertal adolescents after cancer treatment. When combined with the data on testicular size and follicle-stimulating hormone (FSH) level, inhibin B gives valuable addition to the estimations of spermatogenesis.     

Mid- and long-term effects on pulmonary perfusion,anatomy and diaphragmatic motility in survivors of congenital diaphragmatic hernia

The aim of the present study was to evaluate the pulmonary sequelae and diaphragmatic motility in infant, adolescent and adult patients (pts) who had undergone the repair of a congenital diaphragmatic hernia. Thirty-one (81.5%) out of 38 survivors after left side CDH repair, without using a patch, were followed-up. They were subdivided in two groups. Group A (mid-term follow-up): 12 pts (39%) (5 males, 7 females) with a mean age of 4.5 years; Group B (long-term follow-up): 19 pts (61%) (9 males, 10 females) with a mean age of 21.0 years. All pts underwent physical examination, chest X-ray, diaphragmatic ultrasonographic (US) examination, pulmonary perfusion scintigraphy. Patients of the group B were also submitted to spirometry. All pts had a normal life-style and no one complained of respiratory symptoms. The chest X-ray revealed pathologic findings in 12 pts (39%). 8 pts (26%) showed chest wall alterations. The profile of the left diaphragmatic dome appeared irregular in 9 pts (29%). In all pts M-mode sonography disclosed a reduced diaphragmatic motility on the treated side. The mean pulmonary perfusion scintigraphy value on the affected side was 39.2±0.7%. The spirometric study showed normal values. We noted that the lung perfusion significantly and rapidly improved after CDH repair even the apparently hypoplastic and small lungs, the diaphragm maintained a good contractility during forced respiration. An erratum to this article can be found at     

Analysis of chromatin integrity and DNA damage of buffalo spermatozoa

This study was conducted to determine chromatin integrity and DNA damage by DNA electrophoresis and comet assays of buffalo fresh and frozen semen. Semen samples were collected from four buffalo bulls and evaluated after freezing for semen motility, viability, sperm abnormalities, chromatin integrity and DNA damage. A significant variation was found in semen parameters after thawing. Highly significant differences (P<0.001) in chromatin integrity were observed between fresh and frozen semen. For the fresh semen, there was no significant difference between the bulls for chromatin integrity; however, a significant variation (P<0.05) was detected in their frozen semen. No DNA fragmentation was observed by agarose gel electrophoresis. The percentage of sperm with damaged DNA detected by comet assay differed significantly between fresh and frozen semen. A significant negative correlation was recorded between motility and DNA damage (r=-0.68, P<0.05). Sperm abnormalities and DNA fragmentation were significantly positively correlated (r=0.59, P<0.05). In conclusion, DNA damage evaluation can provide reassurance about genomic normalcy and guide the development of improved methods of selecting spermatozoa with intact DNA to be used in artificial insemination.Key Words: Buffalo bull, Chromatin integrity, DNA damage, Semen quality     

Evaluation of frozen thawed cauda epididymal sperms and in vitro fertilizing potential of bovine sperm collected from the cauda epididymal

In the present study, the fertilizing potential of semen recovered from slaughtered bulls epididymis was evaluated after cryopreservation, by conventional techniques and flow cytometry methods. The cauda epididymal was dissected and sperm were recovered and evaluated for volume, sperm concentration, and membrane and acrosome integrity using a flow cytometer. Sperm fertility potential was tested by in vitro fertilization (IVF). For each bull, three trials of IVF were performed. Before freezing, on average, the sperm concentration was 216 ± 27.5 × 10⁶ sperm/ml. Sperm viability averaged 86.5 ± 4%. The mean percentage of sperm with intact plasma membrane and acrosome before and after cryopreservation was 90.7 ± 2.9% and 90.8 ± 1.9% (P≥0.05), respectively. The fertilization rate using frozen/thawed epididymal semen averaged 64.1 ± 3.9% fertilization with no significant differences between bulls (P>0.05). For the bull considered as control, the fertilization rate was 72.2 ± 4.5%, differing significantly (P>0.05) from the frozen/thawed epididymal semen’s fertilization rate. In conclusion, it is possible to use in vitro techniques with cryopreserved spermatozoa obtained from bull’s epididymis using a controlled rate freezing method with a predetermined freezing curve, and with assessment of sperm’s viability by conventional techniques and flow cytometry methods, together with the fertilizing ability of cryopreserved epididymal spermatozoa.Key Words: Bovine, Cryopreservation, Epididymis, IVF, Semen     

Evaluation of reproductive functions in male adolescents following renal transplantation

Abstract:  The aim of this study was to analyze the semen variables and hormone profiles in kidney transplanted male adolescents. Eight post-pubertal male patients who underwent successful renal tx during the peripubertal period and who had ESRD during childhood were enrolled in the study. Patients who underwent tx before 14 yr old (group I) and patients who underwent tx after 14 yr old (group II) were evaluated separately. Semen was collected and analyzed. Serum levels of LH, FSH, and testosterone were measured and found to be normal in all patients except one. The mean age at the diagnosis of CKD was six yr and 13 yr in groups I and II, respectively. The mean age at the time of tx was 12 yr in the first and 17.8 yr in the second group. The patients in group I had received prednisone, cyclosporine A and azathioprine with a longer duration of time compared with patients in group II. Sperm counts (15.5 ± 15.7 vs. 82.3 ± 64.2 millions/mL) and sperm motilities (37.8 ± 30.9 vs. 57.8 ± 22.1%) were lower in group I than group II. Only one patient in group II had normal sperm parameters and azospermia was observed in one patient from group I. We conclude that the earlier onset and the longer duration of uremia, the more impairment of reproductive function. Also, it seems that duration of exposure to corticosteroids or cyclosporine combined with azathioprine contribute to sperm dysfunction in peripubertal transplanted boys.     

The Palomo procedure in the treatment of boys with varicocele: a retrospective study of testicular growth and fertility

The Palomo procedure has often been criticized with regard to possible atrophy of the testis. Measuring the testicular volume is mainly used in pre- and postoperative assessment. Evidence concerning fertility remains unclear. The aim of this study was to learn whether now-adult former patients had any disturbance of their testicular growth and/or fertility. Out of 79 patients operated upon with Palomo's procedure between 1979 and 1990, 33 could be evaluated. They all had grade II or III left-sided varicoceles. Investigations consisted of: the patient's history, testicular-volume measurement by means of an orchidometer (OM) (Prader) and ultrasonography (US), and semen analysis (27/33) 6–17 years after surgery. No recurrence of grade II varicoceles was observed. Only 1 of the 33 patients might have had testicular atrophy, yet he had already fathered 3 children! Twenty-three had a normal sperm count and 24/27 showed normal sperm motility. Eight hydroceles were either present at the time of investigation or had been operated upon in the past. Estimations of testicular volume by OM and US showed significant differences between the two methods concerning volume and relation of right to left side. In general, the volume was overestimated by the OM. The study shows that in boys the simple surgical technique proposed by Palomo has – in the long run – no disadvantages for testicular development and sperm production. Fertility should therefore not be compromised. Accepted: 8 April 1998     

Reproductive technologies 1998: options available for the cancer patient.

Recent advances in the field of reproduction have potentially opened opportunities for the preservation of the reproductive potential of young cancer patients with good long-term prognosis for survival. In the postpubertal male, cryopreservation of ejaculated sperm is both feasible and potentially successful. Semen parameters at the time of procurement are of minor significance; intracytoplasmic sperm injection (ICSI) can bypass sperm concentration and motility problems and can lead to successful fertilization. For the prepubertal male there are no clinically applicable options insofar as extraction and cryopreservation of postmeiotic sperm cells (mature spermatozoa or round spermatids) is not feasible. To date, efforts for culture of testicular tissue and in vitro maturation of male germ cells have not been successful. In both pre- and postpubertal females, cryopreservation of ovarian cortical tissue or enzymatically extracted follicles and the in vitro maturation of preantral follicles are of potential clinical use, but, to date, these approaches have been successful only in laboratory animals. An additional option available to the postpubertal female is the stimulation of ovaries with exogenous gonadotropins and retrieval of mature oocytes for cryopreservation. The recent application of ICSI in previously cryopreserved human mature oocytes has improved fertilization rates and has resulted in live births. Unfortunately, a shortcoming of this approach is the limited number of oocytes that can be harvested after stimulation of the ovaries. Further, all these approaches potentially harbor the risk of the cryopreservation of malignant cells with their subsequent reintroduction in the patient at a later date. This is a more realistic concern for patients suffering from hematologic or gonadal tumors. Finally, even though cryopreservation of embryos has been successfully used for many years, this option is not available to the pediatric and adolescent patient. It should not be forgotten that, even if the patients' own gametes are not available in the future, donor sperm and eggs provide the option for offspring and can give the opportunity to the females to carry a pregnancy as long as their uterus has not been affected by the cancer treatment. Given the rapid progress we are witnessing in the field of reproductive medicine, it is probable that in the very near future most of the options described and newer ones will be clinically available.     

Semen analysis in post-pubertal patients with posterior urethral valves: a pilot study

 The issues of sexual function and fertility are becoming relevant in patients with posterior urethral valves (PUV), as more of them reach adulthood. To evaluate the semen of post-pubertal patients with PUV as a determinant of future fertility, all such patients (age >16 years) attending the follow-up urology clinic of our department from 1985 to December 1999 were contacted. Of the nine patients contacted, eight agreed to form the study group. All eight patients were asked to provide a post-masturbation semen sample and urine. Semen was analysed for pH, viscosity, liquefaction time, sperm morphology, sperm count, motility, and agglutination. The patients ages ranged from 16 to 21 years (mean 17.5 years). One patient with chronic renal failure awaiting a renal transplant refused to give a semen sample; two tried but failed to ejaculate on three consecutive visits. Their urine was negative for sperm. Of the five patients who gave semen, the liquefaction time was high in two. pH ranged from 7.2 to 8, sperm counts were 24–80 million. None of the patients had oligospermia. Abnormal sperm agglutination was present in four cases; a higher percentage of immotile sperm was also present in four. Semen abnormalities in the form of increased liquefaction time, abnormal sperm agglutination, and a high percentage of immotile sperm were thus seen in the present study. The bearing of these findings on subsequent sexual function and fertility remains a matter of speculation. Accepted: 18 April 2001     

Attitudes and practices of oncologists toward fertility preservation

Cancer is a life-threatening diagnosis. Fortunately, life-saving treatments are available to increase the chance of survival in many patients. Yet, many of these treatments are damaging to the reproductive organs and the patients' fertility. A cross-sectional study addressing the knowledge and practices of oncologists toward fertility preservation for male and female patients with cancer was conducted in Saudi Arabia. In 3 different regions of the country, oncologists were invited to participate in the study, through a self-administered questionnaire which was handed to them inquiring about their knowledge, attitude, and referral practices for sperm cryopreservation. Only one-half knew about intracytoplasmic sperm injection, oncologists rated their perception of the importance of cryopreservation as 7.8 ± 1.8. Their referral practice was very poor; less than 20% refer their patients to a specialist. Factors that were considered important to start discussion of cryopreservation were type of cancer, age of patient, number of children, marital status, and cost. Religion was not deemed as important as was anticipated. With regards to female fertility preservation, oncologists showed a positive attitude as revealed from their positive perception, however, their referral practices was very poor. Several gaps were present in the knowledge of oncologists, which could influence their attitude and in turn was reflected on their poor practice. Future training session should be organized to the oncologists for increasing their knowledge and enhancing their attitude.     

Suicidality and psychopathology in hospitalized children and adolescents

The present study presents the incidence of suicidality in a group of hospitalized children and adolescents and the relationship between suicidality, forms of psychopathology, and a variety of demographic and family variables. Specific attention is paid to age and gender differences. More than two-thirds of the sample (70%) showed evidence of suicide attempts, threats or ideation. One third attempted suicide at least once prior to or during their admission, and twice as many girls attempted suicide as boys. The majority of suicide attempters were 12 years or older at the time of their first attempt. Drug overdose was the method most frequently used. The suicide attempters and patients without a history of attempts did not differ on demographic and family psychopathology variables. Interestingly, no diagnostic differences were found between suicide attempters and non-suicidal patients. The majority of suicide attempters were diagnosed conduct disorder. Only a third of the attempters were diagnosed as suffering from an affective disorder. We therefore conclude that factors such as impulsivity and anger may contribute significantly to suicidal behavior in children and adolescents.     

C-peptide in the classification of diabetes in children and adolescents

Ludvigsson J, Carlsson A, Forsander G, Ivarsson S, Kockum I, Lernmark Å, Lindblad B, Marcus C, Samuelsson U. C‐peptide in the classification of diabetes in children and adolescents. Aim: To report C‐peptide results in newly diagnosed patients and the relation to clinical diagnosis of diabetes. Methods: A nation‐wide cohort, the Better Diabetes Diagnosis study was used to determine serum C‐peptide at diagnosis in 2734 children and adolescents. Clinical data were collected at diagnosis and follow‐up. C‐peptide was determined in a validated and controlled time‐resolved fluoroimmunoassay. Results: The clinical classification of diabetes, before any information on human leukocyte antigen, islet autoantibodies, or C‐peptide was received, was type 1 diabetes (T1D) in 93%, type 2 diabetes (T2D) in 1.9%, maturity onset diabetes of the young (MODY) in 0.8%, secondary diabetes (0.6%), while 3.3% could not be classified. In a random, non‐fasting serum sample at diagnosis, 56% of the patients had a C‐peptide value >0.2 nmol/L. Children classified as T2D had the highest mean C‐peptide (1.83 + 1.23 nmol/L) followed by MODY (1.04 ± 0.71 nmol/L) and T1D (0.28 ± 0.25 nmol/L). Only 1/1037 children who had C‐peptide <0.2 nmol/L at diagnosis was classified with a type of diabetes other than T1D. Predictive value of C‐peptide >1.0 nmol/L for the classification of either T2D or MODY was 0.46 [confidence interval 0.37–0.58]. Conclusions: More than half of children with newly diagnosed diabetes have clinically important residual beta‐cell function. As the clinical diagnosis is not always straightforward, a random C‐peptide taken at diagnosis may help to classify diabetes. There is an obvious use for C‐peptide determinations to evaluate beta‐cell function in children with diabetes.     

Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution.

AIMS: To determine the prevalence of sleep-disordered breathing (SDB) in a clinical sample of overweight and obese children and adolescents, and to examine the contribution of fat distribution. METHODS: Consecutive subjects without chronic lung disease, neuromuscular disease, laryngomalacia, or any genetic or craniofacial syndrome were recruited. All underwent measurements of neck and waist circumference, waist-to-hip ratio, % fat mass and polysomnography. Obstructive apnoea index > or =1 or obstructive apnoea-hypopnoea index (OAHI) > or =2, further classified as mild (2< or =OAHI<5) or moderate-to-severe (OAHI> or =5), were used as diagnostic criteria for obstructive sleep apnoea (OSA). Central sleep apnoea was diagnosed when central apnoeas/hypopnoeas > or =10 s were present accompanied by >1 age-specific bradytachycardia and/or >1 desaturation <89%. Subjects with desaturation < or =85% after central events of any duration were also diagnosed with central sleep apnoea. Primary snoring was diagnosed when: snoring was detected by microphone and normal obstructive indices and saturation. RESULTS: 27 overweight and 64 obese subjects were included (40 boys; mean (standard deviation (SD)) age 11.2 (2.6) years). Among the obese children, 53% were normal, 11% had primary snoring, 11% had mild OSA, 8% had moderate-to-severe OSA and 17% had central sleep apnoea. Half of the patients with central sleep apnoea had desaturation <85%. Only enlarged tonsils were predictive of moderate-to-severe OSA. On the other hand, higher levels of abdominal obesity and fat mass were associated with central sleep apnoea. CONCLUSION: SDB is very common in this clinical sample of overweight children. OSA is not associated with abdominal obesity. On the contrary, higher levels of abdominal obesity and fat mass are associated with central sleep apnoea.     

Cancer Incidence and Survival (1997–2006) Among Adolescents and Young Adults in the North of Portugal

Cancer is the first cause of natural death among young subjects. Population-based statistics are important to evaluate the burden of disease and the effectiveness of healthcare provision. We aimed to describe cancer incidence and survival among adolescents (15–19 years) and young adults (20–24 years) in the north of Portugal. Data on the cancers diagnosed between 1997 and 2006 were obtained from the Portuguese North Region Cancer Registry, and incidence rates were computed. Vital status was determined until December 2010. Survival was estimated using the Kaplan–Meier survival function. Trends on cancer incidence were assessed using the Joinpoint regression analysis. A total of 1223 cases were diagnosed: 441 among adolescents and 782 among young adults. Overall incidence rate was 198.3 per million adolescents [95% confidence interval (95% CI): 135.7–260.9] and 306.2 per million young adults (95% CI: 262.3–350.0). The most frequent tumors were Hodgkin lymphoma (adolescents: 21.0%; young adults: 14.8%), thyroid carcinoma (adolescents: 11.5%; young adults: 16.2%), and germ cell tumors (adolescents: 11.1%; young adults: 16.3%). Cancer incidence significantly increased among young adults [annual average percent change: 3.6%, (95% CI: 1.7–5.4)], while appears to vary randomly among adolescents. Overall five-year observed survival was 77.2% (95% CI: 72.9%–80.8%) among adolescents and 81.3% (95% CI: 78.4%–83.9%) among young adults, lower in males. In conclusion, cancer incidence among adolescents and young adults is higher in the north of Portugal than in other European countries, especially of thyroid tumors. Between 1997 and 2006, the incidence increased significantly in young adults.     

Sperm banking in adolescent cancer patients.

BACKGROUND: Semen cryopreservation is a widely available method of maintaining fertility in male cancer patients. However this facility is not always used. AIMS: To identify the barriers to successful sperm banking in a group of adolescent and young adult patients. METHODS: Questionnaires were administered to 55 patients aged 13-21 years who had received potentially gonadotoxic therapy between 1997 and 2001 and had been offered sperm banking. RESULTS: Forty five questionnaires were completed; 67% of respondents were able to bank sperm. Those who had been unsuccessful were younger and described higher levels of anxiety at diagnosis and greater difficulty in talking about fertility. They also described less understanding of sperm banking at the time of diagnosis. CONCLUSION: Most adolescent cancer patients who have been offered fertility preservation are able to bank sperm. Younger patients may be helped by the provision of high quality information and more open discussion of the technique.     

Neuroblastoma in adolescents and adults: the Memorial Sloan-Kettering experience

BACKGROUND: We reviewed the utility of different treatment modalities in a large series of adolescents/adults with neuroblastoma (NB). PROCEDURE: The 30 adolescents/adults (median age, 19 years) had stage 2B (n = 1), 3 (n = 2), or 4 (n = 27) NB. Treatments included conventional and myeloablative therapy; local radiotherapy (RT); immunotherapy with anti-G(D2) 3F8 monoclonal antibody +/- granulocyte-macrophage colony-stimulating factor (GM-CSF); and 3F8 alternating with low-dose oral etoposide. RESULTS: Seven patients are in first (n = 4) or second (n = 3) complete/very good partial remission (CR/VGPR) at 9+ to 181+ (median, 45+) months. Among 13 newly diagnosed or minimally prior-treated patients, no major responses were seen in 4/4 treated with N4/N5 chemotherapy, but 6/9 treated with the higher dose N6/N7 regimens and surgery had major responses, and immunotherapy produced CR in BM in three patients. Among 17 patients referred because of resistant NB, favorable responses occurred in 6/12 treated with high-dose cyclophosphamide-based salvage therapy, including one patient who is in CR 170+ months after myeloablative consolidation and five patients who achieved CR/VGPR after 3F8/GM-CSF (n = 4) or 3F8/oral etoposide (n = 1). With a median follow-up of 32+ months post-RT, no local relapses occurred in 10/10 patients who received hyperfractionated 21 Gy RT to prevent regrowth of soft tissue masses that had been resected. CONCLUSIONS: High-dose chemotherapy and surgery can achieve a minimal disease state in >50% of newly diagnosed older NB patients. In that setting, local RT, and the use of agents with recently confirmed anti-NB activity, including anti-G(D2) antibodies, and cis-retinoic acid, may improve the poor prognosis of these patients reported to date.     

Pyospermia in an adult cohort with persistent lower urinary tract symptoms and a history of ablated posterior urethral valve

PurposeTo assess for the presence of lower urinary tract symptoms and abnormal semen parameters in adults with a history of PUV.Materials and MethodsThe study involved 29 male patients, aged 17–51 (mean 21.5 years), with a history of PUV. Ten had more severe symptoms of frequency, urgency and enuresis, and agreed to detailed study. Medical history, urine analysis, ultrasonography and voiding cystourethrogram were completed for all. Magnetic resonance imaging of the bladder, prostate, seminal vesicles and ejaculatory ducts, ultrasonography of the prostate, as well as semen analysis and culture, and measurement of serum levels of follicle-stimulating hormone, luteinizing hormone and testosterone were performed on the 10/29 patients with severe symptoms.ResultsOf the 8/10 patients who provided acceptable semen culture data, 88% (7/8) showed significant bacterial growth and pyospermia. On semen analysis, 3/8 patients had profound decreases in sperm count, 6/8 < 50% motility and 4/8 ≤ 30% normal forms. pH range for semen was 7.2–7.8 (mean 7.45). For all 10 patients, follicle-stimulating and luteinizing hormone values were within normal range. Elongation of the prostate was the only radiologic variant of the sex accessory structures.ConclusionA significant finding of pyospermia and bacterial growth in semen culture is reported in a subpopulation of young men with a history of PUV and severe lower urinary tract symptoms. This may have an impact on fertility.