Cryopreservation of sperm before gonadotoxic treatment at the University Hospital Brno in the years 1995 - 2020

Abstract

Objective: Sperm cryopreservation before gonadotoxic treatment is the basic and most effective 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, determines the number of deaths and the use of frozen sperm.

Design:  Original paper

Setting: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk university and University Hospital Brno

Methods: During the existence of CAR 01, more than 50,000 spermiograms were performed. From January 1995 to December 2020, 24,729 men were examined within the sperm bank, of which 1448 (5.9%) had an oncological diagnosis. Spermiograms were evaluated according to current WHO manuals. Cryopreservation of sperm has undergone a major development. The rules for the storage of frozen cells have been laid down since 2008 by Act No. 296/2008 Coll. 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. Sperm were processed by the swim-up method. As part of treatment with assisted reproduction methods, oocytes were fertilized with the ICSI micromanipulation technique.

Results: Out of 1448 examined spermiograms in men with oncological diagnosis, testicular cancer was present in 43.7% of patients, malignant disease of lymphatic and hematopoietic tissue in 24.1%, of which Hodgkin's lymphoma 17.8%, non-Hodgkin's lymphoma 7.6 %. 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). 38.3% of men had normozoospermia, 54.2% of spermiograms showed a pathological finding 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 x 106 mm3) in 22.3% of patients. The lowest values ​​of the spermiogram were found in men with testicular cancer, the best values ​​were in CNS cancers. Cryopreservation of sperm was performed in 1340 cases (92.5%). So far, a total of 160 men (11.9%) have used frozen sperm, of which 6.2% in our centre. 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 storage of semen (31.6%), of which 148 due to death, ie. in 11.0% of all oncology patients, the others at their own request. A specific issue is the use of the sperm of the dead.

Conclusion: In cancer patients, sperm pathologies are in a 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 those who use sperm to treat infertility. Cryopreservation of sperm should be offered to each patient prior to therapy leading to destruction of spermatogenesis.