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Recent advances in the treatment of cancer have led to greater longevity among men in reproductive ages with a 75% five-year cancer survival rate in boys aged 15 years or younger  and 66% among men aged 15–44 . There is increased recognition that quality of life including paternity is significant issues for cancer survivors. We will focus primarily on patients with testicular cancer and lymphoma that generally affects younger patients in the reproductive window with an excellent overall survival. However, one must realize in our modern society the age of desiring paternity has increased due to postponement of marriage as well as for other social reasons. Therefore, this chapter will focus not only on those who completed chemotherapy as children but adult cancer patients as well.
All sperm accrue varying amounts of DNA damage during maturation and storage, a process that appears to be mediated through oxidative stress. The clinical significance of genetic damage in the male germ line depends upon severity and how that damage is distributed among the sperm population. In human reproduction, the embryo is capable of significant DNA repair, which occurs prior to the first cleavage event. However, when the magnitude of genomic damage reaches pathologic levels, reproductive outcomes begin to be affected. Evidence now exists linking excessive sperm DNA fragmentation with time to pregnancy for natural conception, pregnancy outcomes of intrauterine insemination and in vitro fertilization, and miscarriage rates when intracytoplasmic sperm injection is employed. This review will discuss the pathophysiology of sperm DNA damage, the studies linking it to impaired reproductive outcomes, and how clinicians may render treatment to optimize the chance of paternity for their patients.
Obstructive azoospermia (OA) is a common presenting condition of male infertility, resulting from either congenital or acquired blockage of the reproductive tract. Men facing a diagnosis of OA now have an array of treatment options, including definitive reconstruction and various forms of sperm retrieval. The optimum treatment decision for OA will depend on the goals, values, and expectations of the patient and his partner. In this review we will discuss the therapeutic approach to OA, stressing the requirement of a clear and thoughtful plan for staged intervention. Any proposed treatment strategy should optimize the chances of paternity while minimizing damage to the male genitourinary system. Special attention will be paid to the role of microdissection testicular sperm extraction (microTESE), as it is a useful and often underutilized rescue procedure for OA. Specifically, the advantages and disadvantages of microTESE will be evaluated, with particular focus on success rates and safety.
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.
Childhood tumors are classified into 12 major diagnostic groups: leukemias, lymphomas, central nervous system (CNS) tumors, sympathetic nervous system tumors, retinoblastomas, renal tumors, liver tumors, bone tumors, soft tissue sarcomas, germ cell tumors, epithelial tumors and other and unspecified malignant cancers. Epidemiological studies have shown an association between exposure to medical radiation during pregnancy and risk of childhood cancer in offspring. The effects of maternal lifestyle during pregnancy on embryonic and fetal development are well known effects on the subsequent risk of cancer. Several features of maternal lifestyle during pregnancy have been studied regarding their association with childhood cancer, including diet, breastfeeding, smoking and alcohol consumption and the use of cosmetics. Parental illicit drugs use has been associated with several types of childhood cancer. Lymphoma, melanoma and testicular, cervical and thyroid cancers account for the vast majority of cancers in adolescents and young adults.