ESPE Abstracts (2015) 84 P-1-157

How do Adolescent Minors Banking Sperm Before Cancer Therapy Subsequently use the Fertility Service? A Post Banking Re-Evaluation

James Pigota, Maria Michaelidoub, Elizabeth Williamsonc, Alison Webbd, Hoong-Wei Gane & Helen Spoudeasd,e

aUCL Medical School, London, UK; bSchool of Medicine, The University of Manchester, Manchester, UK; cDepartment of Reproductive Medicine, University College London Hospitals NHS Foundation Trust, London, UK; dDepartment of Adolescent Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK; eDepartment of Developmental Molecular Genetics, Institute of Child Health, London, UK

Background: Gonadotoxic cancer therapy may cause adult male infertility. We previously reported that, of 2/3rds of underage males agreeing to pre-treatment sperm cryopreservation before cancer treatment, 2/3rds succeeded.

Objective and hypotheses: i) To evaluate how many patients banking sperm successfully (GP1) returned for post treatment re-evaluation compared with those who attempted but failed (GP2). ii) To compare intergroup survival and fertility rates by prior gonadotoxicity risk.

Method: Retrospective collection of post treatment survival, semenalysis (sperm count and volume), biochemical (LH/FSH/testosterone) and clinical (testicular volumes) parameters in 93 patients attempting to bank sperm between 2000 and 2010. ‘Infertility’ was defined as FSH >15 IU/l, azoospermia or adult testicular volume <10 ml.

Results: Of 75 GP1 patients aged 15.11 (13.04–22.08) years, 68 banked sperm at cancer diagnosis (GP1A) and seven during 2nd remission (GP1B). 18/75 patients (17 GP1A) died 2.63 (0.98–6.00) years after banking. 27 (24 GP1A) survivors returned 8.02 (3.70–14.00) years later, for fertility (n=17), biochemical (n=16) and/or clinical (n=9) re-evaluation and five are now infertile (all GP1A: three medium, two high gonadotoxicity risk). Fertility is preserved in all returning low risk (<20%) patients (n=12) but a significant minority at highest risk (>80%) died (14/45, 31%). Of 18 patients (GP2) who failed to bank at diagnosis (GP2A, n=13) or 2nd remission (GP2B n=5), five died after 1.75 (0.05–3.94) years (one medium, four high risk) and six (4 GP2A) all still azoospermic, returned 8.72 (6.60–11.20) years later. There were no intergroup differences in risk, survival or fertility rates.

Conclusion: Low gonadotoxicity risk patients, at low priority for fertility preservation, were correctly identified before treatment. High risk patients need prioritising but were least likely to survive. GP2 survivors were unlikely to recover fertility up to 11 years later. The low survivor re-evaluation rates suggest improved post treatment endocrine/fertility assessments are required to properly assess the cost-benefit of fertility preservation to underage patients.

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