育龄男性癌症患者生育力保护知识及需求调查

目的了解育龄男性癌症患者对于生育力保护的知识水平及生育力保护需求现况。方法采用自制的育龄男性癌症患者生育力保护知识水平及需求调查问卷对332例育龄男性癌症患者进行横断面调查。结果男性癌症患者生育力保护知识得分(3. 5±0. 7)分。77. 71%患者意识到癌症治疗会损害生育能力,63. 86%和80. 72%患者不知晓生育力保护的常规方法及场所。仅10. 54%患者在肿瘤治疗前选择精子库进行生育力保存,有68. 67%患者在治疗过程中希望进行生育力保存。多因素Logistic回归分析结果显示,家庭月收入、年龄是患者生育力保护知识水平的影响因素(均P 0. 05);年龄、有无子女是患者生育力保护需求的影响因素(均P 0. 05)。结论育龄男性癌症患者对生育力保护的知识水平不高,多数患者在治疗前并未选择生育力保护措施,但是在治疗期间有生育力保护的需求。年轻及家庭月收入≥8 000元的患者具备更多生育力保护知识。年轻及无子女的患者在治疗过程中有生育力保存的需求。医务人员需要在患者进行治疗前充分告知生育力保护的相关信息,全面评估患者对信息的掌握程度,为患者提供切实可行的生育力保护措施和指导。     

男性肿瘤患者生育力保存的研究进展

近年来,随着医疗技术的进步,肿瘤患者尤其是年轻肿瘤患者治疗后生存率极大地提高,5年生存率接近80%。目前患者最主要的担忧是肿瘤治疗方式,如手术、化疗、放疗以及肿瘤本身引起的睾丸生精功能和精液质量下降,会导致生育力不可逆的损伤,甚至不育。因此,对于有生育需求的男性肿瘤患者,生育力保存显得极其重要。在肿瘤开始化疗或放疗之前进行自体精液冻存是最常用、最成熟的技术,睾丸组织冷冻保存也逐渐运用于临床,而干细胞技术也为无精子症患者提供新的选择。本文就肿瘤对男性生育力的影响以及男性肿瘤患者生育力保存方法进行综述,以提供理论依据。     

女性儿童和青少年肿瘤患者生育力保存研究进展

近年来随着儿童和青少年肿瘤远期生存率的不断提高,这些肿瘤患者的生育力保存受到越来越多人关注。化疗和放疗可能会损害儿童和青少年肿瘤患者的生育力,使其在成年后发生卵巢早衰和不孕的风险增大,严重影响了成年幸存者的生活质量。卵子冷冻是青春期后患者保存生育力的标准方案,卵巢组织冷冻是青春期前儿童保存生育力的主要方法。对于移植卵巢组织有肿瘤细胞种植风险的患者,卵泡体外培养和人工卵巢可能是未来生育力保存发展的方向。本文综述女性儿童和青少年肿瘤患者生育力保存的现状和研究进展,为临床工作和进一步研究提供参考。     

尿道下裂与男性生育力

尿道下裂是常见的先天性男性外生殖器畸形,发病率达1/250～1/300,主要表现为尿道异位开口于尿道腹侧阴茎头部至会阴的任何部位,且常合并其他畸形,最常见的是隐睾和腹股沟疝,其他如苗勒氏管囊肿、尿道憩室等.手术治疗是矫正尿道下裂的唯一有效治疗方法,其目的是矫直阴茎,重建尿道,恢复良好的阴茎外观,创建正常的排尿和性功能,已报道的手术方式超过300种.     

妇科肿瘤与生育力保护及保存

15%~20%的妇科肿瘤患者处于育龄期,这些患者中有很多仍有生育要求。然而妇科肿瘤治疗中的手术切除、放疗及化疗等均可对生育力产生严重损害,生育力下降或丧失将严重影响肿瘤幸存者的生活质量。因此如何在保证肿瘤治疗效果的前提下尽可能保护患者的生育力已成为肿瘤治疗中的重要议题。近十年,妇科肿瘤患者生育力保护研究取得了长足进展,保留生育力手术、药物和辅助生殖技术的不断改进和应用,其有效性和安全性也逐步得到临床证据的支持。现就妇科肿瘤中各种生育力保护和保存方法进行概述。     

恶性肿瘤患者生育力保护服务研究进展

从肿瘤治疗对生育力的影响、肿瘤患者生育力保护相关指南、国外肿瘤患者生育力保护服务研究热点和进展等进行综述,旨在基于国外研究成果、局限性及国内现况,为开展肿瘤患者生育力保护相关研究服务及出台肿瘤患者生育力保护共识或指南提供参考。     

妇科恶性肿瘤患者的生育功能保留

患妇科恶性肿瘤的育龄妇女 ,应尽可能保留其生育机能。本文对卵巢癌、宫颈癌、子宫内膜癌从临床期别、组织分类、细胞分化程度、治疗方案、临床预后进行了概述     

育龄期女性癌症患者生育力保存决策的研究进展

对育龄期女性癌症患者生育力保存决策现状及影响因素进行综述。影响因素包括社会人口学因素、信息支持、社会支持、生育力保存风险、经济负担、癌症类型、情绪状态、伦理因素、时间压力、文化宗教等。以期为开展决策支持干预提供依据,缓解患者不良情绪,减少决策冲突。     

Fertility treatment in male cancer survivors

The present study reviews the use of assisted reproductive technology in male cancer survivors and their partners. As antineoplastic treatment with chemotherapy or radiation therapy, has the potential of inducing impairment of spermatogenesis through damage of the germinal epithelium, many male cancer survivors experience difficulties in impregnating their partners after treatment. The impairment can be temporary or permanent. While many cancer survivors regain spermatogenesis months to years after treatment, some become infertile with a-, oligo- or azoospermia. An option to secure the fertility potential of young cancer patients is to cryopreserve semen before cancer treatment for later use. A desired pregnancy may be obtained in couples where the husband has a history of cancer, using assisted reproductive technology with either fresh or cryopreserved/thawed semen. Successful outcomes have been obtained with intrauterine insemination (IUI) as well as in vitro fertilization (IVF) with or without the use of intracytoplasmic sperm injection (ICSI). In conclusion, male cancer survivors and their partners who have failed to obtain a pregnancy naturally within a reasonable time frame after end of treatment should be referred to a fertility clinic.     

Fertility preservation in patients of childbearing age treated for breast cancer: A nationwide cohort study

BackgroundApproximately 7% of breast cancers are diagnosed in women under 40. Question of subsequent fertility has become fundamental. We aimed to evaluate the rate of fertility preservation (FP) by oocyte retrieval (OR) after ovarian stimulation in patients of childbearing age, managed for breast cancer with adjuvant chemotherapy in France, reuse rate of frozen gametes and live births rate (LBR) after treatment.MethodsWe included 15,774 women between 18 and 40 years old, managed by surgery and adjuvant chemotherapy for breast cancer, between January 2011 and December 2020 from a French health registry. Patients with OR after breast surgery and before chemotherapy were considered as FP group; those with no OR as no FP group. To compare LBR with French population independently of age, we calculated Standardized Incidence Rates (SIR) of live births using indirect standardization method.ResultsFP rate increased gradually since 2011, reaching 17% in 2019. A decrease in use was observed in 2020 (13,9%). Among patients with at least 2 years of follow-up, gamete reuse rate was 5,6%. Births after cancer were mostly from spontaneous pregnancies. Among patients with at least 3 years of follow-up, LBR was 19,6% in FP group, 3,9% in second group. SIR of live births was of 1,05 (95% CI = 0.91–1.19) and 0.33 (95% CI = 0.30–0.36) in FP and no FP group respectively.ConclusionOncofertility activity increased until 2019 in France, reaching 17%. Gamete reuse rate was low. Births resulted mainly from spontaneous pregnancies. SIR of live births was lower in no FP group.     

Contemporary and future insights into fertility preservation in male cancer patients

In recent years, survival rates of cancer patients have increased, resulting in a shift of focus from quantity to quality of life. A key aspect of quality of life is fertility potential; patients suffering from iatrogenic infertility often become depressed. Since many cancer therapies—chemotherapy, radiotherapy and/or surgery—and even cancer itself have detrimental effects on the male reproductive system, it is important to preserve fertility before any treatment commences. Currently, the only reliable method of male fertility preservation is sperm banking. For patients who are unable to provide semen samples by the conventional method of masturbation, there are other techniques such as electroejaculation, microsurgical epididymal sperm aspiration and testicular sperm extraction that can be employed. Unfortunately, it is presently impossible to preserve the fertility potential of pre-pubertal patients. Due to the increasing numbers of adolescent cancer patients surviving treatment, extensive research is being conducted into several possible methods such as testicular tissue cryopreservation, xenografting, in vitro gamete maturation and even the creation of artificial gametes. However, in spite of its ease, safety, convenience and many accompanying benefits, sperm banking remains underutilized in cancer patients. There are several barriers involved such as the lack of information and the urgency to begin treatment, but various measures can be put in place to overcome these barriers so that sperm banking can be more widely utilized.     

Oncofertility in urologic oncology: Fertility preservation for women undergoing cancer treatment

Thousands of reproductive age women are treated for urologic malignancies each year in the United States. Treatments for advanced bladder and renal cancers have the potential to affect future fertility in female patients. The American Society of Clinical Oncology and the American Society of Reproductive Medicine recognize the importance of fertility preservation, categorizing it as a necessary part of medical care. Iatrogenic infertility has a tremendous impact on quality of life in survivors' of cancer. Fertility preservation counseling and treatment can improve long-term quality of life, therefore access to such counseling and treatment should be expanded.