目的:精子冷冻保存是保留成年男性癌症患者生育能力的可行有效方法吗?
结论:精子冷冻保存是一种有效的生育能力保存方法,可能使癌症患者受益。
背景:精子冷冻保存是有效保持男性生育力的唯一方法。这是ART中的重要程序。最近,由于癌症治疗的显著进步,越来越多的研究报道了癌症患者精子冷冻保存的结果.
■我们在以下数据库中对2021年12月31日之前发表的相关研究进行了广泛的文献检索:CENTRAL,CNKI,Cochrane系统评论,EMBASE,MEDLINE,pubmed,和WebofScience。使用的搜索词为“(冷冻保存或冷冻或冷冻或储存或冷冻或冷冻或冷冻或储存)和(精子或精液或精子)和(癌症或肿瘤或恶性肿瘤或肿瘤)”。
方法:我们纳入了所有报道在癌症治疗前或治疗期间提供或尝试冷冻保存精子的研究,这些研究被认为有治疗相关生育能力受损风险的男性患者。我们评估了每项研究中所有数据的合格性。主要排除标准如下:非癌症患者;儿科和青少年癌症患者;不报告使用冷冻保存的精子;使用新鲜精液进行ART;不报告在治疗前或治疗期间提供精子冷冻保存或试图这样做的癌症患者人数;使用实验性生育力保存技术,如保存睾丸组织或精原干细胞;重复数据;摘要,病例报告,注释,reviews,或社论;报告的数据不足。使用纽卡斯尔-渥太华量表和非随机研究方法学指数评估纳入研究的质量。
结果:这项荟萃分析包括69项非随机研究,32.234例患者进行精子分析,23.178例患者冷冻保存至少一份精子样本。合并的冷冻保存失败率为10%(95%CI,8-12%),精子处置率和精子使用率分别为23%(95%CI,16-30%)和9%(95%CI,8-10%),分别。怀孕,流产,分娩率为28%(95%CI,22-33%),13%(95%CI,10-17%),和20%(95%CI,15-25%),分别。亚组分析显示更高的妊娠率和分娩率,以及较低的冷冻保存失败率,在最近的研究中,与十年前发布的研究相比。亚洲的研究报告说,精子处理和怀孕率高于其他大洲。我们的分析显示每个周期的临床妊娠率为34%(27-41%),24%(14-35%),和9%(5-15%),每个周期的交付率为23%(17-30%),18%(11-26%),ICSI为5%(1-9%),IVF,IUI,分别。
结论:与所有荟萃分析一样,应该考虑一些限制。我们研究的第一个局限性是数据跨度为36年。在此期间,世界卫生组织修订了精子分析标准,和其他重要的变化。还有一个限制,因为结果没有分析癌症类型与精子质量之间的相关性。许多早期的研究受到样本量小和缺乏对照组的限制。此外,几乎所有的研究都没有考虑到疾病的严重程度,这可能会对结果产生重大影响。因此,进一步的研究应该评估癌症类型的影响,特别是,病情的严重程度对精子质量的影响才能得出更准确的结论。同样,大多数研究未能区分不同类型肿瘤的患者,而是得出了被认为适用于所有癌症患者的概括性结论,这是不恰当的.在目前的分析中,我们没有关于患者疾病的深入信息,尽管已经做出了广泛的努力,对各种类型肿瘤患者的结局进行了全面的系统回顾和荟萃分析,必须承认结果是有偏见的。然而,使用每个研究中获得的平均结果,没有患者级别的数据,也可能是偏见的来源。
结论:精子冷冻保存是一种有效的生育力保存方法,可能使癌症患者受益。观察到的9%的冷冻精子利用率可能低估了实际使用量,因为短的随访时间不足以获得年轻癌症幸存者使用冷冻精子的全面数据。ART在保存生育力和实现妊娠中起着重要作用,这项荟萃分析显示,在接受保留生育能力的癌症患者中,ICSI的临床结局优于IVF或IUI.
背景:这项工作得到了国家自然科学基金(批准号:82001634,81960550),和中国博士后科学基金(2019M661521)。没有竞争的利益可以宣布。
背景:CRID42022314460。
OBJECTIVE: Does sperm cryopreservation serve as a feasible and effective method for preserving fertility in adult male patients with cancer?
CONCLUSIONS: Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer.
BACKGROUND: Sperm cryopreservation is the only way to efficiently preserve male fertility. It is an important procedure in ART. Recently, due to remarkable advances in cancer treatment, an increasing number of studies have reported the outcomes of sperm cryopreservation in patients with cancer.
UNASSIGNED: We conducted an extensive literature search for relevant studies published through to 31 December 2021, in the following databases: CENTRAL, CNKI, Cochrane Systematic Reviews, EMBASE, MEDLINE, PUBMED, and Web of Science. The search terms used were \'(cryopreservation OR freeze OR freezing OR banking OR cryostorage OR storage) AND (sperm OR semen OR spermatozoon) AND (cancer OR tumor OR malignancy OR neoplasm)\'.
METHODS: We included all studies that reported offering or attempting to cryopreserve sperm before or during cancer treatment in male patients considered at risk of treatment-related fertility impairment. We evaluated the eligibility of all data in each study. The major exclusion criteria were as follows: non-cancer patients; pediatric and adolescent cancer patients; not reporting the use of cryopreserved sperm; use of fresh semen for ART; not reporting the number of patients with cancer offered sperm cryopreservation or attempting to do so before or during treatment; using an experimental fertility preservation technique such as preservation of testicular tissue or spermatogonial stem cells; duplicate data; abstracts, case report, comments, reviews, or editorials; insufficient data reported. The quality of the included studies was assessed using the Newcastle-Ottawa scale and the Methodological Index for Non-Randomized Studies.
RESULTS: This meta-analysis included 69 non-randomized studies, with 32 234 patients referred for sperm analysis and 23 178 patients cryopreserving at least one sperm sample. The pooled failed-to-cryopreserve rate was 10% (95% CI, 8-12%), and the sperm disposal and sperm use rates were 23% (95% CI, 16-30%) and 9% (95% CI, 8-10%), respectively. The pregnancy, miscarriage, and delivery rates were 28% (95% CI, 22-33%), 13% (95% CI, 10-17%), and 20% (95% CI, 15-25%), respectively. Subgroup analysis showed higher pregnancy and delivery rates, as well as a lower failed-to-cryopreserve rate, in recent studies compared to those released a decade ago. The studies from Asia reported higher sperm disposal and pregnancy rates than in other continents. Our analysis showed clinical pregnancy rates per cycle of 34% (27-41%), 24% (14-35%), and 9% (5-15%) and delivery rates per cycle of 23% (17-30%), 18% (11-26%), and 5% (1-9%) for ICSI, IVF, and IUI, respectively.
CONCLUSIONS: As with all meta-analyses, some limitations should be considered. The first limitation of our study is that the data span 36 years. During this time, the World Health Organization has revised its sperm analysis standards, and other important changes have been made. There is also a limitation in that the outcome does not analyze the correlation between the type of cancer and sperm quality. Many of the earlier studies were limited by small sample sizes and a lack of control groups. Furthermore, almost all studies did not consider the severity of the disease, which could potentially have a substantial impact on the results. Consequently, further research should evaluate the effect of the type of cancer and, in particular, the severity of the condition on sperm quality in order to draw more precise conclusions. Similarly, it is inappropriate that most studies failed to differentiate between patients with different types of tumors and instead drew generalized conclusions that are presumed to apply to all patients with cancer. In the present analysis, we did not have in-depth information on patients\' disease, and although extensive efforts were made to conduct a thorough systematic review and meta-analysis of the outcomes for patients with various types of tumors, the results must be acknowledged as being subject to bias. However, the use of average results obtained in each study, without the patient-level data, might also represent a source of bias.
CONCLUSIONS: Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer. The observed utilization rate of frozen sperm at 9% may underestimate the actual usage, as the short follow-up period is inadequate for obtaining comprehensive data on the use of frozen sperm in young cancer survivors. ART plays an important role in fertility preservation and the achievement of pregnancy, with this meta-analysis showing that ICSI delivers better clinical outcomes than IVF or IUI in patients with cancer undergoing fertility preservation.
BACKGROUND: This work was supported by the National Natural Science Foundation of China (grant no. 82001634, 81960550), and the China Postdoctoral Science Foundation (2019M661521). There are no competing interests to declare.
BACKGROUND: CRID 42022314460.