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Men with cancer rendered infertile by surgery, chemotherapy, radiation and hormone therapy that are needed to control or cure their disease are increasingly being offered the chance to preserve their reproductive potential through artificial reproductive technologies. Cryopreservation of sperm and testicular tissue have increasingly helped boys and men preserve their fertility. There is a growing subspecialty within reproductive medicine aimed at fertility preservation in this population. Furthermore, strategies are being developed that may in the future revolutionize the approach to such patients. Written by international authorities in the field of fertility preservation, this comprehensive book is aimed at clinicians dealing with male cancer patients, in particular, urologists, andrologists, oncologists, pediatricians and nursing staff as well as clinicians in reproductive endocrinology. The text reviews the impact of cancers and their treatment on male fertility, the available fertility preservation strategies and post-treatment management.
The male hypothalamic-pituitary-gonadal (HPG) axis is a finely controlled system whose role is to promote spermatogenesis and androgen biosynthesis. Testosterone is thought to feed back to restrain activity of the gonadotropin-releasing hormone (GnRH)-gonadotrope secretory unit. GnRH is released from the hypothalamus in a pulsatile pattern, and the stimulation of gonadotropin biosynthesis and secretion by GnRH is dependent on the pulsatile nature of GnRH delivery to the anterior pituitary. Gonadotropins follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are glycoproteins consisting of a common a subunit and a hormone-specific β subunit that are associated through noncovalent interactions. GnRH stimulates in vitro the synthesis of gonadotropin subunits and increases a, LH-β, and FSH-β subunit mRNA levels as well as the transcriptional activity of corresponding gene promoters. Testosterone seems to exert a direct feedback control of LH secretion, while its action on FSH secretion is mostly indirect.