Semen cryopreservation for men banking for severe oligozoospermia cancers and other pathologies prediction of post thaw outcome using basal semen quality

Capsule:
We demonstrate the ability of prefreeze semen quality to predict cryosurvival in terms of sensitivity and precision. This information allows appropriate counseling about the future possibilities of fertility for the patient.

Authors:
Selene Degl’Innocenti, M.L.T., Erminio Filimberti, Ph.D., Angela Magini, M.D., Csilla Gabriella Krausz, M.D., Giuseppe Lombardi, M.D., Maria Grazia Fino, M.L.T., Giulia Rastrelli, M.D., Mario Maggi, M.D., Elisabetta Baldi, Ph.D.

Volume 100, Issue 6, Pages 1555-1563.e3, December 2013

Abstract:

Objective:
To evaluate post-thawing sperm parameters in a large series of men cryopreserving for different cancers and oligospermia.

Design:
Retrospective observational study.

Setting:
Semen cryopreservation laboratory.

Patient(s):
Six hundred twenty-three patients undergoing semen cryopreservation for cancer or oligospermia who discontinued banking.

Intervention(s):
None.

Main Outcome Measure(s):
Postcryopreservation sperm motility and viability.

Result(s):
In oligospermic men, recovery of motile sperm after cryopreservation was possible in only a few out of the 219 samples cryopreserved for this problem. Similarly, independent of the reason for which cryopreservation was required, if one basal semen parameter fell below the 5th percentile of the World Health Organization reference values, recovery of motile and viable spermatozoa after thawing was low. Among samples cryopreserved for cancer, those with testicular cancer showed the lowest basal semen quality and recovery after thawing. In cases of hematological cancers or other types of cancers, motility recovery was similar to that of non-cancer-related samples. Receiver operating characteristic analyses demonstrate that basal progressive and total motility predict the recovery rate of motile sperm after thawing with high accuracy, sensibility and specificity.

Conclusion(s):
Our study demonstrates the ability of prefreeze semen parameters to predict cryosurvival in terms of sensitivity and precision. Using this information, the clinician could perform appropriate counseling about the future possibilities of fertility for the patient.

  • Nicolas Garrido

    First of all, congratulations for your nice work and efforts in order to address one important topic, this is the predictability of post thawing quality in semen
    samples.

    Our group also published a similar work in the past, which was not mentioned in your paper, Sperm cryopreservation in oncological patients: a 14-year follow-up study. Meseguer M, Molina N, García-Velasco JA, Remohí J, Pellicer A, Garrido N. Fertil Steril. 2006 Mar;85(3):640-5., with different conclusions, with shorter simple size. This may obey, as the author’s state, to the difficulty about generalizing these results.

    Also, a difference may be the limits to define the ROC curve’s events: “ROC was used as a binary classifier system to identify the accuracy of precryopreservation semen parameters in predicting post-thawing recovery of at least 1% motility.”
    Although our results of the ROC curves were not published, our data, involving thousands of patients freezing samples, provided no predictive value of any prefreezing test, to forecast survival rates of above 40% of total motile cells.

    I do not particularly agree with some of the statements in the discussion, for instance, where the authors conclude that, given the previously reported alteration on sperm DNA fragmentation and condensation, “All the above data should be taken into account during patient management, and clinicians should inform the patients about the negative impact of cryopreservation on an already altered semen quality and that ICSI may be required in case of an ART procedure with cryopreserved semen.”

    This is surprising, since they provide their counseling based on indirect evidences about the
    reproductive impairment of thawed samples (DNA fragm, and condensation), instead
    of having their opinion based on direct evidences (namely, the results with
    ICSI from frozen/thawed or fresh samples), that they have referred previously
    (references 18 and 19).

    Can the authors comment regarding this last point?

    Thank you very much in advance for your attention

    All the best

    Nico

    • elisabetta baldi

      Dear Nico, thank you for your comment.

Translate »