AbstractHuman spermatozoa cryopreservation is currently the only method that offers men with cancer some insurance against iatrogenic clinical interventions. Unfortunately, semen quality before cryopreservation and following thawing proves highly variable. This has negative implications for both fertility preservation and future assisted conception treatment choice, which itself proves highly variable. There is a general lack of data on the men who require the local service, and those men who use their stored gametes. There is uncertainty concerning the outcome measures used to evaluate sample quality; the threshold limits for selecting assisted conception treatment; the cryopreservation method itself; and how an individual patient or ejaculate will respond to sperm cryopreservation.
The aim of this research was to characterise a population of men with cancer referred for sperm cryopreservation, and to define and quantify the sources of uncertainty that limit fertility insurance and future assisted conception choice. It was found that an innovative quality tool and computer assisted semen analysis had potential to improve the analysis of sperm quality, and that a unique freezing receptacle could improve that quality. Men with testicular or prostate cancer, poor semen quality or poor living conditions were more likely to need additional samples frozen. For men with cancer, motile count recovery following sperm cryopreservation may indicate the severity of their disease. In addition, there was evidence that intra cytoplasmic sperm injection is being used unnecessarily for cancer patients. Although the numbers of men with cancer seeking the service is dramatically increasing, currently we are not storing enough sperm to meet the needs of most cancer patients who use their stored samples. The findings in this thesis highlight the need for change to current practice and policy for sperm banking for cancer patients in the National Health Service.
|Date of Award||Sep 2014|
|Sponsors||Imperial College Healthcare NHS Trust|
|Supervisor||Sally Anne Kilburn (Supervisor), Matt Guille (Supervisor) & Rhiannon McGeehan (Supervisor)|