维生素D与男性生殖关系的研究进展

维生素D为人们所熟知的,其生理功能是参与钙磷代谢与骨盐沉积.近年来研究表明,维生素D受体在男性生殖器官中广泛表达,相关研究还证实了维生素D缺乏或不足与男性生育力下降存在相关性.本文主要从维生素D生物和代谢特点及其在男性生殖各方面的作用进行综述,以便加深对维生素D在男性生殖中作用的认识,为男性不育的治疗提供理论依据.     

精子DNA损伤对生殖结局的影响及临床意义

精子DNA易受各种因素影响而被损伤,人类精子DNA损伤的机制,包括在精子生成过程及在生殖道转运过程中的损伤。其损伤机制可能涉及精子发生过程中染色质组装异常,精细管上皮细胞凋亡,精子由生精管到附睾迁移过程中的氧化作用等。目前用于检测精子DNA损伤的方法及决定精子DNA损伤的预测价值在诊断和治疗不孕症中有参考意义。越来越多的研究表明,精子DNA损伤影响受精和胚胎发育,最终导致不孕不育、流产、死产、子代智力低下和染色体疾病。与传统检测方法相比,检测精子DNA的损伤可能更有临床意义。     

辅助生殖技术中胚胎冻存新观念及解冻移植策略的探讨

<正>体外受精-胚胎移植(in vitro fertilization & embryo transfer,IVF-ET)技术作为帮助不孕不育夫妇获得后代的重要治疗手段,已经广泛应用于临床中。近十年,随着临床个体化控制性卵巢刺激(individual controlled ovarian stimulation,iCOS)方案等临床技术的改进、胚胎实验室培养体系的精准提高,使得在新鲜周期中可利用胚胎率提高,因此胚胎冷冻保存技术作为IVF衍生技     

不育症患者精子X,Y及18染色体的荧光原位杂交分析

目的:分析不育症患者精子X,Y,18染色体的荧光原位杂交情况。方法:在男性不育症组中,2例无精子症患者从附睾抽吸获取精子、3例从睾丸获取精子、2例严重少精症患者从射出精液中找到精子。选择5例正常射出精液者作为对照组。应用荧光原位杂交法(FISH)检查精子X,Y以及18号染色体,比较两组精子染色体非整倍体的发生率。结果:不育症组睾丸精子、附睾精子的非整倍体率无差别,但不育症组精子与正常男性组精子比较,非整倍体总发生率、性染色体二体性率及缺对染色体率明显增高(2.8％vs0.58％,0.81％vs 0.19％,2.1％vs0.37％),P<0.001。结论:无精子症与严重少精子症患者的精子比正常精子具有更高的染色体非整倍体率,需要进行大样本的研究,为不育症患者的治疗和遗传咨询提供有效的证据。     

辅助生殖技术助孕患者健康信息需求现状及其影响因素分析

目的了解和评估辅助生殖技术(assisted reproductive technology,ART)助孕患者的健康信息需求现状,并分析其影响因素。方法采用一般资料调查表及ART助孕患者健康信息需求量表,采用便利抽样法,对南阳市中心医院、南阳市第一人民医院和南阳市医专一附院生殖门诊就诊的622例ART助孕患者进行信息需求现况调查。结果 ART助孕患者信息需求总分为(114.87±17.42)分;ART助孕患者生育状态、年龄、不孕年限以及文化程度进入信息需求回归方程,能够解释总变异的49.3%。结论 ART助孕患者信息需求水平较高,是否生育、年龄、不孕年限以及文化程度是影响信息需求的重要因素,医务人员应就其可控影响因素制定具有针对性的信息支持策略,以期提高医患信息交流满意度。     

妇科肿瘤手术血管损伤和出血的预防及处理

文章分析了妇科肿瘤手术血管损伤和出血的主要原因、好发部位.预防血管损伤应熟练掌握盆、腹腔的解剖关系,术前充分评估病情,掌握正确的手术方式和技巧.同时提出了处理各种类型出血的有效方法.     

吉安市男男性行为人群行为学特征及HIV感染状况调查分析

目的:了解吉安市男男性行为(MSM)人群的性病艾滋病感染率情况和相关行为特征,为干预措施和干预效果评价提供信息和依据。方法:用统一设计的调查问卷,在知情同意后对MSM人群进行面对面的调查,并进行采血检查。结果:共调查了148例MSM人群,文化程度为大专以上为主,该人群对艾滋病防治知识知晓率较高,大部分有多个男性性伴,33.78%的MSM能坚持使用每次安全套,最近1a出现性病症状有17.6%,79.7%至少接受一项以上的干预措施。HIV阳性检出率为1.4%。结论:MSM人群对艾滋病防治知识有一定认识,但安全套使用率不高,多性伴使艾滋病感染率偏高并有扩散趋势。加大干预力度,减少不安全性行为,预防控制艾滋病在这类人群中流行和蔓延。     

滋养细胞肿瘤脑转移患者行开颅手术后临床及预后分析

目的 探讨接受开颅手术的滋养细胞肿瘤(GTN)脑转移患者的临床特点、治疗方法及预后.方法 回顾性分析1990年1月至2018年12月北京协和医院初治的行开颅手术后再接受化疗的22例GTN脑转移患者的临床病例资料.结果 22例GTN脑转移患者接受开颅手术,术后均接受多药联合化疗,81.8％(18/22)患者获完全缓解,1...     

骨科手术患者导尿术后尿道损伤的原因分析及预防

导尿术后尿道损伤在临床上并不少见,不但给患者造成很大痛苦,也给治疗护理工作带来很多困难,现经过我们医护人员的共同努力,有效地预防了这一并发症的发生,现报道如下。     

40岁以上妊娠滋养细胞肿瘤患者的临床特征及预后分析

目的:探讨40岁以上妊娠滋养细胞肿瘤(GTN)患者的临床特征、治疗方法及预后情况.方法:回顾分析2008年1月至2019年12月西安交通大学第一附属医院妇科收治的82例年龄≥40岁GTN患者的临床资料,用Kaplan-Meier法绘制无进展生存期(PFS),Cox风险比例回归模型进行PFS的单因素分析和多因素分析.结果...     

Sperm banking for fertility preservation: a 20-year experience

Objective

Sperm banking is an effective method to preserve fertility, but is not universally offered to males facing gonadotoxic treatment in the United States. We compared the disposition and semen parameters of cryopreserved sperm from individuals referred for sperm banking secondary to a cancer diagnosis to those of sperm from men banking for infertility reasons.

Study design

We performed a retrospective cohort study that reviewed 1118 records from males who presented to bank sperm at Washington University between 1991 and 2010. We collected and analyzed demographics, semen parameters, and disposition of banked sperm.

Results

Four hundred and twenty-three men with cancer and 348 banking for infertility reasons attempted sperm cryopreservation in our unit during the specified time period. The most prevalent cancers in our cohort were testicular (32%), lymphoma (25%), and leukemia (11%). Patients with leukemia had the lowest pre-thaw counts and motility. Most cancer patients (57%) who banked elected to use, transfer to another facility, or keep their specimens in storage. The remaining samples were discarded electively (34%) or following death (8%). Overall semen parameters were similar between the cancer and infertility groups, but demographics, ability to bank a sample, azoospermia rates, length of storage, current banking status, and use of banked sperm differed significantly between the two groups.

Conclusions

The majority of cancer patients who banked survived their cancer and chose to continue storage of banked samples. Cancer patients were more likely than infertility patients to use or continue storage of banked samples. Our study provides evidence that sperm banking is a utilized modality of fertility preservation in patients with a myriad of cancer diagnoses and should be offered to all men facing gonadotoxic therapies. Further work is needed to determine where disparities in access to sperm banking exist to improve the potential for future fertility in these males.     

Timing of fertility preservation procedures in a cohort of female patients with cancer

Objective

Comparison of time intervals from diagnosis to chemotherapy between patients opting for embryo cryopreservation or ovarian tissue cryopreservation.

Study design

Retrospective analysis.

Setting

University hospital in the Netherlands.

Patients and methods

Thirty-five female patients undergoing fertility preservation procedures before treatment with chemotherapy for cancer. Embryo cryopreservation was performed in 12 patients and ovarian tissue cryopreservation in 23 patients. We investigated differences in time intervals (from diagnosis to start of chemotherapy) between patients opting for embryo cryopreservation and patients opting for ovarian tissue cryopreservation. We calculated time intervals between the moment of diagnosis, the moment of referral, the moment of consultation, the moment of finishing of the fertility preservation procedure and the start of chemotherapy.

Results

The median time between diagnosis and referral (median = 18 days) and between referral and consultation (median = 5 days) was comparable in both groups. A significant difference was found between ovarian tissue cryopreservation and embryo cryopreservation for the time interval between consultation and cryopreservation (p = 0.001). Ovarian tissue cryopreservation was completed for half of the patients within 6 days after consultation with the gynecologist, and the hormonal stimulation for embryo cryopreservation was completed for all patients within four weeks (median = 18 days), with a median of 11 days of hormonal stimulation. A significant difference was found between ovarian tissue cryopreservation and embryo cryopreservation in the time interval between fertility preservation and start of chemotherapy (median = 7 vs 19 days, p = 0.019). In sum, the total duration between diagnosis and chemotherapy was significantly shorter for ovarian tissue cryopreservation patients than for embryo cryopreservation patients (median = 47 vs 69 days, p = 0.042).

Conclusion

Embryo cryopreservation can be performed within the standard timeframe of cancer care in patients with breast cancer receiving adjuvant chemotherapy, but if delay of the start of chemotherapy is harmful, ovarian tissue cryopreservation can be done within one week.     

Integration and safety of fertility preservation in a breast cancer program

Young women diagnosed with breast cancer typically face systemic treatments that may delay childbearing or permanently impair their fertility. These concerns add to the stress experienced by young cancer survivors. Timely counseling and providing fertility preservation through cryopreservation of eggs or embryos have become an important quality of life issue. We analyzed the impact of fertility preservation procedures on the initiation of treatment for breast cancer and discuss critical aspects of the process.     

Fertility preservation in male patients with cancer

Advances in the treatment of cancer in young patients have led to great improvements in life expectancy, which currently approaches 80% 5-year survival rate. As a result, fertility preservation and desire for paternity have become a significant issue in this group. However, a major concern is the negative impact of chemotherapy, radiotherapy, and the malignancy itself on fertility. Thus, men about to have treatment for malignant conditions may have sperm cryopreserved before commencing chemotherapy or radiotherapy. Ejaculated sperm cryopreservation is the most common technique used. Some patients with cancer may present initially with oligospermia or azoospermia. In cases when a sample is not produced due to medical, social, or religious reasons, sperm can be retrieved using penile vibratory stimulation, electroejaculation, or testicular sperm extraction. Fertility preservation in prepubertal boys presents a great challenge, as sperm banking is not possible. Alternative strategies have been developed, but all are currently experimental.     

Experiences in fertility preservation: lessons learned to ensure that fertility and reproductive autonomy remain options for cancer survivors

Purpose

Assess fertility preservation (FP) measures chosen by patients newly diagnosed with malignancy and their outcomes.

Methods

Reproductive-age patients referred for FP underwent counseling and elected cryopreservation vs. no treatment. Outcome measures included ovarian stimulation, FP choice, oocytes/zygotes retrieved/cryopreserved and pregnancy outcome.

Results

From 2005 to 2012, 136 patients were counseled with 124 electing treatment: 83 oocyte-only, 21 oocyte + zygote and 20 zygote-only cryopreservation. Age, partnership and financial status factored into FP choice. Treatment was completed in 12 ± 2 days with 14 ± 11 metaphase-II oocytes harvested and cryopreserved/cycle. Eight patients returned to attempt pregnancy; three succeeded.

Conclusions

Our data demonstrate that oocyte and/or zygote banking are feasible FP options for women with malignancy; given the choice, the majority elected oocyte cryopreservation, highlighting desire for reproductive autonomy. Continued growth and research, combined with interdisciplinary communication, will ensure that appropriate candidates are offered FP and the potential for future parenthood, an important quality-of-life marker for survivors.     

A review of fertility preservation in patients with breast cancer

Breast cancer remains the most common cancer diagnosed in women and causes more lost disability-adjusted life years (DALYs) than any other cancer worldwide; however, improvements in therapies have led to increased survival and therefore a new focus on quality of life following treatment. Fertility is an important concern among cancer survivors of reproductive age. The purpose of this article is to contextualize the importance of oncofertility services for women with breast cancer and review options for fertility preservation, including oocyte/embryo cryopreservation, GnRH agonist therapy, and ovarian tissue cryopreservation. We also discuss special considerations for preimplantation genetic testing for women with germline pathogenic mutations associated with breast cancer, as well as issues related to endocrine therapy. Finally, we review barriers to accessing fertility preservation services, including cost of treatment and lack of referral to reproductive care providers or fertility preservation programs.     

Cryopreservation of ovarian tissue for fertility preservation: no evidence of malignant cell contamination in ovarian tissue from patients with breast cancer

Cryopreserved ovarian cortical biopsies from 51 patients with breast cancer were examined by histologic and immunohistochemical analysis and showed no sign of metastases. Autotransplantation of ovarian cortex to patients with low-stage breast cancer disease appears safe, but confirmatory studies are required, including xenotransplantation studies.     

Recommendations for fertility preservation in patients with lymphomas

Purpose

This guideline aims to serve as a reference for fertility specialists and other specialists working with young patients at risk of premature ovarian insufficiency (POI) or testicular dysfunction (TD) due to treatment of Hodgkin or Non-Hodgkin lymphoma.

Methods

PubMed search of articles addressing risk of POI and TD according to different treatment protocols used in lymphoma patients. PubMed search of articles presenting different options for fertility treatment in cancer patients.

Results

The risk of POI/TD depends on the protocol used with the highest risk in patients treated with haematopoietic stem cell transplantation/bone marrow transplantation (HSCT/BMT) and the lowest risk in patients treated with ABVD (Adriamycin, Bleomycin, Vincristine and Decarbazine). The different options of fertility preservation are discussed and their relevance according to treatment protocol, age of the patient and urgency to start treatment.

Conclusion

Fertility issues should be discussed with all women of fertile age. Fertility preservation should be offered to young women when relevant. Children should be informed together with their parents. All men should be offered semen cryopreservation regardless of protocol used. At present, there are no established methods of fertility preservation in pre-pubertal boys. This guideline offers suggestions to the most preferred methods of fertility preservation according to treatment protocol, age of the patient, and urgency to start treatment.     

Effects of letrozole or tamoxifen coadministered with a standard stimulation protocol on fertility preservation among breast cancer patients

PurposeTo assess the effects of letrozole or tamoxifen coadministration on fertility preservation treatment outcomes.MethodsRetrospective cohort study of 118 breast cancer patients undergoing fertility preservation treatment between 2008 and 2018. Patients who received letrozole (n = 36) or tamoxifen (n = 30) were compared to controls (n = 52) who underwent standard ovarian stimulation protocols. The primary outcome measures included the number of retrieved oocytes, mature oocytes (MII), fertilization, and top-quality embryo rates. The secondary outcome measures included duration of stimulation, gonadotropin dose and peak estradiol level.ResultsThe number of oocytes retrieved, MII oocytes, fertilization rate, duration of stimulation, or gonadotropin dose were similar in the letrozole and tamoxifen groups, compared to controls. Top-quality embryo rate was lower in the tamoxifen group compared to controls (25% vs 39.4%, respectively, P = 0.034). The abnormal fertilization rate was higher in the letrozole group compared to controls (7.8% vs 3.60%, respectively, P = 0.015). A stepwise logistic regression analysis revealed that letrozole and peak estradiol were significantly associated with abnormal fertilization (OR 11.94; 95% CI 2.35–60.4, P = 0.003 for letrozole and OR 1.075; 95% CI 1.024–1.12, P = 0.004 per 100 unit change in estradiol).ConclusionsThere may be a negative effect of letrozole or tamoxifen on fertilization and embryo quality, in fertility preservation cycles. Further studies are needed to confirm these findings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-020-02030-y.     

A nationwide UK survey of female fertility preservation prior to cancer treatment

This survey examined the provision of fertility preservation for female oncology patients prior to cancer treatments, given their well-established gonadotoxic effects. Questionnaires were sent to all assisted conception units in the UK enquiring about the provision of oocyte or embryo cryopreservation, as well as funding for female oncology patients. In addition, data were obtained from the Human Fertilisation and Embryology Authority (HFEA) on the number of cryopreservation cycles in 2013–2014. Of the 60 responding units, 53 (88%) offered fertility preservation. However, only 6 (11%) units performed more than 25 oocyte or embryo cryopreservation cycles per year, with 33 units (62%) treating fewer than 10 women per year. A total of 44 (90%) reported some National Health Service (NHS) funding, but only 12 (23%) had funding granted automatically and only 26 (49%) could offer NHS funded treatment exempt from their local eligibility criteria for in vitro fertilisation (IVF). The HFEA data reported 154 NHS funded oocyte cryopreservation cycles in 2014. We conclude that the provision of fertility preservation is lacking and improvements can be made in the number of referrals from oncology, the provision of cryopreservation and the provision of NHS funding. Developing a national fertility preservation network and close liaison with oncology and Clinical Commissioning Groups are recommended.