Male Fertility Preservation Research Articles

Epigenetic characterization of adult rhesus monkey spermatogonial stem cells identifies key regulators of stem cell homeostasis.

Spermatogonial stem cells (SSCs) play crucial roles in the preservation of male fertility. However, successful ex vivo expansion of authentic human SSCs remains elusive due to the inadequate understanding of SSC homeostasis regulation. Using rhesus monkeys (Macaca mulatta) as a representative model, we characterized SSCs and progenitor subsets through single-cell RNA sequencing using a cell-specific network approach. We also profiled chromatin status and major histone modifications (H3K4me1, H3K4me3, H3K27ac, H3K27me3 and H3K9me3), and subsequently mapped promoters and active enhancers in TSPAN33+ putative SSCs. Comparing the epigenetic changes between fresh TSPAN33+ cells and cultured TSPAN33+ cells (resembling progenitors), we identified the regulatory elements with higher activity in SSCs, and the potential transcription factors and signaling pathways implicated in SSC regulation. Specifically, TGF-β signaling is activated in monkey putative SSCs. We provided evidence supporting its role in promoting self-renewal of monkey SSCs in culture. Overall, this study outlines the epigenetic landscapes of monkey SSCs and provides clues for optimization of the culture condition for primate SSCs expansion.

The effect of myo-inositol antioxidant activity on human sperm parameters and DNA damage in ultra-rapid and conventional freezing methods

Male fertility preservation is still challenged by cell damage induced during sperm cryopreservation and impaired sperm structure and function. Sperm ultra-rapid freezing, despite a higher protective effect compared to conventional freezing method, is still associated with suboptimal sperm cryosurvival and needs to be modified to increase its efficiency in sperm protection. Sperm freezing media supplemented with antioxidants can improve sperm parameters following freezing-warming process. In this study, we aimed to investigate the effect of employing ultra-rapid freezing and myo-inositol on sperm cryosurvival. Thirty semen samples with normal sperm parameters were collected and each one was divided into four portions to cryopreserve by conventional freezing, ultra-rapid freezing, conventional freezing + myo-inositol 2 mg/ml, and ultra-rapid freezing + myo-inositol 2 mg/ml. Sperm samples warmed after at least 24 h of freezing and sperm cryosurvival were analyzed by evaluation of sperm motility, viability, morphology and DNA fragmentation index (DFI). Freezing method had a significant influence on post-thaw sperm DFI and morphology (p < 0.05) and the interaction between freezing method and antioxidant supplementation significantly affected sperm morphology (p < 0.05). The highest percentage of sperm normal morphology and minimal DFI was achieved using ultra-rapid freezing supplemented by myo-inositol antioxidant compared to other groups (P < 0.05). The highest sperm DNA damage after freezing-warming was observed following the conventional freezing method. In conclusion, sperm freezing method was identified as factor strongly influencing sperm DFI and morphology after thawing/warming. Sperm samples can be rapidly frozen using the modified freezing media supplemented by myo-inositol without impacting sperm DNA and morphology.

Hydrogel encapsulation facilitates a low-concentration cryoprotectant for cryopreservation of mouse testicular tissue

Cryopreserved testicular tissue offers a promising method to restore fertility in male infertility patients. Current protocols rely on high concentrations of penetrating cryoprotectants (pCPAs), such as dimethyl sulfoxide (DMSO), which necessitating complex washing procedures and posing risks of toxicity. Hydrogel encapsulation presents a non-toxic alternative for cellular cryopreservation. This study investigates the effects of various types, concentrations, and thicknesses of hydrogel encapsulation on the cryopreservation of mouse testicular tissue. Testicular tissues loaded with varying concentrations of DMSO were encapsulated in alginate or gelatin-methacryloyl (GelMA) hydrogels. We evaluated hydrogels as potential CPAs to reduce pCPA concentrations and determine optimal combinations for cryopreservation. Post-cryopreservation, tissues were cultured using organ culture methods to assess spermatogenesis progression. Cryomicroscopy and differential scanning calorimetry (DSC) were used to examine ice crystal formation, melting enthalpy, and non-freezing water content in different hydrogels during cooling. Results indicate that 3 % alginate or 5 % GelMA hydrogel with thin encapsulation optimally preserves mouse testicular tissue. Using 20 % DMSO in 5 % GelMA thin encapsulation showed comparable apoptosis rates, improved morphology, higher mitochondrial activity, and enhanced antioxidant capacity compared to conventional 30 % DMSO without encapsulation. This suggests that hydrogel encapsulation reduces pCPA concentration by 10 %, thereby mitigating toxic damage. Hydrogel encapsulation can reduce basement membrane shrinkage of testicular tissue during cryopreservation. Moreover, frozen tissues remained viable with preserved germ cells after being cultured for one week on alginate methacryloyl (AlgMA) hydrogel using the gas-liquid interphase method. Cryomicroscopy and DSC studies confirmed the hydrogel's ability to inhibit ice crystal growth. In conclusion, this study introduces novel strategies for male fertility preservation and advances cryopreservation technology for clinical applications in assisted reproduction.

Global status of research on fertility preservation in male patients with cancer: A bibliometric and visual analysis

BackgroundRecently, male fertility preservation before cancer treatment has become more prevalent. The research in this field has progressed over time, with some studies having a major impact and providing guidance for further research. However, the trends and hotspots of research on fertility preservation in male cancer patients may have changed; exploring them is essential for relevant research progress. DesignWe extracted relevant studies from the Web of Science Core Collection database, capturing information on the countries of study, affiliations, authors, keywords, as well as co-citations of references and journals. To identify publication trends, research strengths, key subjects, prominent topics, and emerging areas, we conducted a bibliometric analysis using CiteSpace. ResultsWe included 3201 articles on fertility preservation in male cancer patients published over January 1999 to December 2023 were included. Although the relevant research growth rate was slow initially, the number of publications increased annually. Of all study countries, the United States, Germany, and Japan reported the earliest studies; the United States published the highest number of relevant studies. The US institutions remained at the forefront for all 25 years, and the US researcher Ashok Agarwal published the most articles. Literature co-citation analyses indicated a transformation in the study participants; they comprised a younger demographic (i.e., a large number of adolescent male patients underwent fertility preservation); moreover, fertility preservation techniques evolved from sperm cryopreservation to testicular tissue cryopreservation. Research on reproductive outcomes of sperm cryopreservation was the recent hotspot in male fertility preservation research, and the impact of immunotherapy and checkpoint inhibitors on male fertility requires further research. ConclusionsMale fertility preservation will be a major future research focus, with closer connections and collaborations between countries and organizations. Our results present the historical data on the development of research on male fertility preservation in cancer patients, providing relevant insights for future research and development in this study area.

Fertility preservation in males with cancer of trends, region development, and efficacy in mainland China from 16 regions Chinese sperm banks.

Male cancer survivors experience confusion about fertility following cancer treatment. The aims of this study were to evaluate survivors' semen quality in different tumor type groups in China and to analyze the current situation and challenges of male cancer patients with sperm cryopreservation. This was a multicenter retrospective study of male patients with cancer who underwent sperm cryopreservation in 16 regions of the national sperm banks over an 11-year period from 2010 to 2020. The number of male cancer patients with sperm cryopreservation showed an overall upward trend. The development of male cancer fertility preservation (FP) in the eastern, central, and western regions of Chinese displayed imbalance. There are seven tumor types for sperm preservation in the top incidence ten tumor types, including lymphoma, leukemia, nasopharyngeal carcinoma, sarcoma, thyroid cancer, and brain tumor. Moreover, nasopharyngeal carcinoma is a high incidence rate in China, which is related to high sperm preservation rate, different from other countries. The most percentage of males receiving sperm cryopreservation in the testicular cancers (15-39years old) of China in 2020 was 5.55%, 1.29% in the lymphoma, and 0.39% in the leukemia. According to the type of cancer, a statistically significant lower pre-sperm density, total sperm output, and post-sperm density was observed in testicular cancers. It is worth noting that the prevalence of azoospermia 22.2% in leukemia patients attribute to urgent treatment before sperm cryopreservation. Disposition of cryopreserved sperm categories included continued storage (47.2%), discarded (9%), death (0.9%), and use (3.7%). This study provides the firstcomprehensive national statistical census and review of fertility preservation in male cancer patients with respect totrends, prevalence, and cancer types. The development of male cancer fertility preservation in China is imbalanced and percentage of males receiving sperm cryopreservation in the adolescent and young adult cancers was low. Sixteen human sperm banks from China analyze current problems and challenges, and then prioritize steps toward the achievement of the FP strategy framework for Healthy China 2030.

Mechanisms underlying human sperm cryodamage: the role of reactive oxygen species (ROS) and antioxidants

Sperm cryopreservation is an efficient procedure for male fertility preservation, although the freeze-thaw procedure causes irreversible structural and functional changes in human spermatozoa. Indeed, the procedure is responsible for harmful changes that may affect sperm biology. In mammalian cells, cryopreservation induces a shift of redox homeostasis towards increasing generation of reactive oxygen species (ROS). The characteristics of ROS and the cellular outcomes depend on the cell type. Supra-physiological ROS levels during cryopreservation severely impact sperm survival, reproductive potential and DNA integrity, the latter a fundamental factor for fertilisation and transmission of paternal genetic information to offspring. The aim of this review is to summarise current knowledge of the main molecular mechanisms underlying ROS generation during sperm cryopreservation and its subsequent effects. In addition, we report current experimental approaches based on the supplementation of cryopreservation media with enzymatic and non-enzymatic antioxidants with the aim of minimising the harmful effects of ROS, and thus improving post-thaw sperm quality. Current data indicate that the potential use of antioxidants as constituents of the sperm freezing solution in clinical settings would require considerable attention. KEY WORDS: Spermatozoa, cryopreservation, ROS, oxidative stress, antioxidants.

Association of Endogenous Seminal L-Carnitine Levels with Post-Thaw Semen Parameters in Humans

Cryopreservation of semen is a useful tool for male fertility preservation. Some evidence for a beneficial effect of L-carnitine supplementation of freezing media on cryopreserved semen samples has been reported. Here, we examined the association of endogenous levels of seminal L-carnitine with post-thaw semen parameters. We also investigated the effect of freezing medium supplemented with L-carnitine on sperm characteristics, related to endogenous seminal L-carnitine levels. Semen analyses were performed on 125 fresh samples, and after standard cryopreservation and with L-carnitine as a supplement. Participants were categorized into two groups based on the median levels of endogenous seminal L-carnitine: low L-carnitine (≤38.8 µg/ml) and high L-carnitine (&gt;38.8 µg/ml). After standard cryopreservation, semen samples with high L-carnitine levels showed higher rapid progressive, progressive and total sperm motility and a reduced seminal static oxidation–reduction potential (ORP) level than samples with low L-carnitine levels. Only in post-thaw samples with low L-carnitine levels, there was an increase in the amount of sperm neck midpiece defects, compared to the fresh samples. Cryopreservation with L-carnitine had the most beneficial effect on rapid progressive sperm motility in samples with high endogenous L-carnitine levels. In conclusion, L-carnitine has a beneficial impact on sperm characteristics in post-thaw samples both as an endogenous component in seminal plasma and as a supplement in the freezing medium, by improving sperm motility and reducing seminal oxidative stress.

(094) Safety and Efficacy of Enclomiphene Compared to Clomiphene for Hypogonadal Men

Abstract Introduction Clomiphene, and its trans isomer enclomiphene, have been used off-label in recent years for hypogonadal men seeking to maintain fertility. Both drugs have become increasingly widespread within andrology clinics; thus, understanding the comparative benefits and risks of these medications are crucial for optimizing treatment decisions and providing improved therapeutic options. Objective To investigate the longitudinal benefits and risks associated with enclomiphene compared to clomiphene to provide valuable insights for clinicians when making treatment decisions in the management of hypogonadism and male fertility preservation. Methods We retrospectively studied patients who had been prescribed clomiphene, and later enclomiphene, at a university hospital within the observation range of 1/1/2021-12/31/2022, encompassing 66 patients. All included patients were prescribed clomiphene prior to switching to enclomiphene. Baseline laboratory values for each patient prior to being prescribed clomiphene were documented, followed by subsequent values for each of these variables in the most recent visit prior to stopping clomiphene as well as any noted adverse effects experienced during this time. Laboratory values and adverse effects were noted for the same patients in their most recent visit while taking enclomiphene. Adverse events were defined by 1) depressive thoughts; 2) weak muscle strength; 3) gynecomastia; 4) mood changes; or 5) agitation as well as changes in estradiol and hematocrit laboratory values. Two-tailed T-Tests were employed using SPSS to analyze the longitudinal impacts of clomiphene and enclomiphene on serum hormone values. Results In our cohort, men on clomiphene experienced any adverse events 18.18% of the time, whereas men on enclomiphene experienced any adverse events 3.45% of the time. From our data, men on enclomiphene had statistically lower rates of documented adverse events than the same men on clomiphene, indicating no increased risk on the newer drug; neither treatment yielded any serious adverse events. In looking specifically at hormone-related adverse events, estradiol increased significantly on clomiphene but not on enclomiphene (17.25 versus -0.29 pg/mL; t=4.271, p=.00005). However, there was no difference in change in hematocrit between the two medications (0.10% versus 0.79% increase; t=-1.103, p=.314). On average, testosterone increased 149.33 ng/dL from their baseline scores while on clomiphene and increased 108.55 ng/dL from their clomiphene values while on enclomiphene. When comparing the improvement of testosterone values attributed to clomiphene versus enclomiphene, the change of testosterone levels over time attributed to either medication are not statistically different (t-value = .883; p-value = .379). Lastly, men stayed on clomiphene for an average of 32.92 months before switching to enclomiphene. Conclusions Our findings show that enclomiphene provides the same magnitude of improvement in testosterone but through safer means, as noted by its lower rate of documented adverse events. These findings support the use of enclomiphene as a comparable treatment option for hypogonadal men while minimizing the risk of adverse effects. Further research and larger studies are warranted to validate these conclusions and explore additional long-term effects of enclomiphene. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant) American Medical Systems/Boston Scientific (Speaker) Augmenta LLC (Stockholder) Aytu BioScience (Consultant) Contraline, Inc. (Consultant) Endo Pharmaceuticals (Consultant/Speaker) Inherent Biosciences (Advisor) Lipocine (Consultant); Mohit Khera: Consultant- AbbVie, Halozyme, Clarus, Metuchen, Acerus, Boston Scientific, Coloplast, Endo.

Preservation of male fertility in patients undergoing pelvic irradiation.

As the number of cancer survivors increases, so does the demand for preserving male fertility after radiation. It is important for healthcare providers to understand the pathophysiology of radiation-induced testicular injury, the techniques of fertility preservation both before and during radiation, and their role in counseling patients on the risks to their fertility and the means of mitigating these risks. Impaired spermatogenesis is a known testicular toxicity of radiation in both the acute and the late settings, as rapidly dividing spermatogonial germ cells are exquisitely sensitive to irradiation. The threshold for spermatogonial injury and subsequent impairment in spermatogenesis is ~ 0.1 Gy and the severity of gonadal injury is highly dose-dependent. Total doses < 4 Gy may allow for recovery of spermatogenesis and fertility potential, but with larger doses, recovery may be protracted or impossible. All patients undergoing gonadotoxic radiation therapy should be counseled on the possibility of future infertility, offered the opportunity for semen cryopreservation, and offered referral to a fertility specialist. In addition to this, every effort should be made to shield the testes (if not expected to contain tumor) during therapy.

Insights Into Antioxidant Strategies to Counteract Radiation-Induced Male Infertility.

Significance: Radiotherapy, which employs ionizing radiation to destroy or prevent the multiplication of tumor cells, has been increasingly used in the treatment of neoplastic diseases, especially cancers. However, radiation collaterally leads to prolonged periods of sperm count suppression, presumably due to impaired spermatogenesis by depleting the germ cell pool, which has long-term side effects for male reproduction. Recent Advances: Studies of antioxidant compounds as a potential strategy for male fertility preservation have been performed mainly from animal models, aiming to prevent and restore the male germinal tissue and its function, particularly against the oxidative stress effects of radiation. Evidence in preclinical and clinical trials has shown that inhibitors of the renin-angiotensin system and other drugs, such as statins and metformin, are candidates for ameliorating radiation-induced damage to several tissues, including the testis and prostate. Critical Issues: Research for developing an ideal radioprotective agent is challenging due to toxicity in the normal tissue, tumor radioresistance, cellular response to radiation, costs, regulation, and timeline development. Moreover, male radioprotection experiments in humans, mainly clinical trials, are scarce and use few individuals. This scenario is reflected in the slow progress of innovation in the radioprotection field. Future Directions: Expanding human studies to provide clues on the efficacy and safety of radioprotective compounds in the human reproductive system is necessary. Drug repurposing, frequently used in clinical practice, can be a way to shorten the development pipeline for innovative approaches for radioprotection or radiomitigation of the repercussions of radiotherapy in the male reproductive system.

Bridging the Gap: Animal Models in Next-Generation Reproductive Technologies for Male Fertility Preservation.

This review aims to explore advanced reproductive technologies for male fertility preservation, underscoring the essential role that animal models have played in shaping these techniques through historical contexts and into modern applications. Rising infertility concerns have become more prevalent in human populations recently. The surge in male fertility issues has prompted advanced reproductive technologies, with animal models playing a pivotal role in their evolution. Historically, animal models have aided our understanding in the field, from early reproductive basic research to developing techniques like artificial insemination, multiple ovulation, and in vitro fertilization. The contemporary landscape of male fertility preservation encompasses techniques such as sperm cryopreservation, testicular sperm extraction, and intracytoplasmic sperm injection, among others. The relevance of animal models will undoubtedly bridge the gap between traditional methods and revolutionary next-generation reproductive techniques, fortifying our collective efforts in enhancing male fertility preservation strategies. While we possess extensive knowledge about spermatogenesis and its regulation, largely thanks to insights from animal models that paved the way for human infertility treatments, a pressing need remains to further understand specific infertility issues unique to humans. The primary aim of this review is to provide a comprehensive analysis of how animal models have influenced the development and refinement of advanced reproductive technologies for male fertility preservation, and to assess their future potential in bridging the gap between current practices and cutting-edge fertility techniques, particularly in addressing unique human male factor infertility.

Efficient pathway for men fertility preservation in testicular cancer or lymphoma: a cross-sectional study of national 2018 data

BackgroundIn 15–49 years-old men, the main cancers are testicular cancer (TC) and lymphomas (L): freezing of ejaculated sperm is primarily used for male fertility preservation (FP) before cancer treatment.Our objective was to analyze the French FP rate in 15–49 years-old men diagnosed with TC or L in 2018.We designed a national descriptive cross-sectional study of sperm banking rate in men with a diagnosis of TC, Hodgkin L (HL) or non-Hodgkin L (NHL).From the French National Cancer Institute (INCa) 2018 data, we extracted the estimated incidence of TC and L in metropolitan France. From the 2018 activity report of CECOS network (Centers for Study and Banking of Eggs and Sperm), we extracted the number of men with TC or L who banked ejaculated sperm. We estimated the proportion of 15–49 years-old men diagnosed with TC or L who banked sperm.ResultsAmong 15–49 years-old men, INCa estimated 38,048 new cancer diagnoses in metropolitan France in 2018: 2,630 TC and 3,913 L (943 HL and 2,970 NHL). The CECOS network provided data from 26/27 metropolitan centers (96% response rate): 1,079 sperm banking for men with TC, 375 for HL and 211 for NHL.We estimated that the 2018 sperm banking rate in France was 41% for TC, 40% for HL, and 7% for NHL.ConclusionsTo our knowledge, our paper is the first cross-sectional study with multicenter and national data analyzing FP rate in cancer men: it suggests an efficient pathway for men to FP before cancer treatment, compared to previously published studies. Although sperm banking rate in 15–49 years-old men could definitely be improved, further studies should evaluate the information given to patients before gonadotoxic treatments, the factors associated with the absence of sperm banking and whether this lack of referral induces a loss of chance for these men.

#312 : Outcomes for Women Who Utilise Electively Frozen Oocytes

Background and Aims: Frozen oocyte thaw (FOT) cycles are becoming increasingly common within IVF clinics in Australia, as women choose to freeze eggs and delay using those eggs until a more suitable time. Typically, Australian women freezing eggs are older than those women who have been studied in overseas FOT cycles. The aim of this study was to report outcomes of FOT cycles. Method: We performed a retrospective cohort study of 141 FOT cycles (from 129 patients) over a 10-year period from January 2010 to December 2020, at a single IVF clinic in Adelaide, Australia. We assessed the outcomes of those cycles in terms of oocyte warm survival, ICSI fertilisation rates, utilisation rates, pregnancy rates and live birth rates. Results: The average age of women undergoing FOT cycles was 36.5 ± 4.9 years. The reasons for egg freezing cycles included male factor (45.5%), elective (44.1%), religious (6.3%), fertility preservation (2.8%) and anonymous oocyte donation (1.4%). From the 143 FOT cycles, 1094 oocytes were collected; 82% of oocytes survived the warm process and 62% fertilized normally. There were 59 fresh embryo transfers (5.1% cleavage and 94.9% blastocyst, 22.0% DET and 78% SET) and 32 frozen blastocyst embryo transfers (12.5% DET and 87.5% SET). The pregnancy rate per fresh transfer was 30.0% (18/59) and per frozen transfer was 37.5% (12/32). The live birth rate per fresh transfer was 27% (16/59) and per frozen transfer was 37.5% (12/32). The live birth rate per initiated FOT cycle was 11% (16/143). Conclusion: Rates of live birth per initiated FOT cycle at our clinic was 11%, similar to the ANZARD live birth rate for all fresh cycles initiated in 2020 (10.9%). We therefore conclude that results for frozen oocytes are equivalent to fresh oocytes and can use this information when counselling patients on the outcomes of FOT cycles.

Childhood cancer and hematological disorders negatively affect spermatogonial quantity at diagnosis: a retrospective study of a male fertility preservation cohort

Childhood cancer and hematological disorders negatively affect spermatogonial quantity at diagnosis: a retrospective study of a male fertility preservation cohort

Does distance deter male fertility preservation?

Does distance deter male fertility preservation?

O-114 Fertility preservation in males with hereditary cancer syndromes: balancing the risks and benefits

O-114 Fertility preservation in males with hereditary cancer syndromes: balancing the risks and benefits

P-059 Sperm DNA fragmentation (SDF) after cryopreservation and sperm selection: implications for clinical pregnancies and live births after intrauterine insemination with donor sperm

Abstract Study question Can SDF assessment pre-cryopreservation, post-thaw and after post-thaw sperm selection predict clinical outcome in a heterologous intra-uterine donor insemination program (IUI)? Summary answer SDF increased post-cryopreservation in donor sperm and after post-thaw density gradient without affecting clinical pregnancy, live birth and miscarriage rates. What is known already Sperm cryopreservation is effective for preservation of male fertility and facilitates the storage of donor semen, while infectious disease screening can be completed and confirmed negative. Sperm viability and motility are the most vulnerable parameters during the freeze-thaw process. Inherent reactive oxygen species may induce SDF via oxidative stress. Controversial results are reported regarding induction of SDF after cryopreservation due to differences in cryo tolerance, methods of cryopreservation and methods used to evaluate SDF. Sperm selection post-thaw is indispensable to select a normal motile fraction for insemination. Again, results are controversial regarding influence on SDF levels after sperm selection post-thaw. Study design, size, duration This was a prospective, observational study. Between March 2015 and March 2019, eighteen potential sperm donors were screened via a three step plan – semen assessment, medical assessment and serological blood tests. In accordance with the Belgian legislation (2007), a sperm donor was matched to obtain a maximum of 6 pregnancies in acceptor women/couples, allowing for more than one offspring/woman or couple. A total of 106 acceptors were matched for heterologous intra-uterine insemination. Participants/materials, setting, methods Semen samples were collected after 2-7 days abstinence and standard semen parameters analyzed within 60 mins after ejaculation. Within the same time frame SDF test was performed using TUNEL assay both before and after cryopreservation and after a two-step discontinuous density gradient centrifugation post-thaw. Samples were cryopreserved by the conventional slow freezing method using sperm freeze solution. A yield of ≥ 2 M progressive spermatozoa post-thaw after selection was sufficient to contemplate IUI. Main results and the role of chance Mean female age at first cycle was 33.9 ± 4.1 years and donor age 28.5 ± 5.6 years. Out of 429 cycles, 100 (23.3%) resulted in clinical pregnancy. Excluding three ongoing pregnancies, we counted 75 live births (17.6% of cycles or 77.3% of pregnancies), while 21 pregnancies ended in miscarriage (4.9% of cycles or 21.6% of pregnancies) and 1 resulted in stillbirth. Progressive motility (59.3 ± 12.5%) decreased significantly after cryopreservation (30.0 ± 13.2%; p &amp;lt; 0.001), but increased post-thaw after density gradient centrifugation (61.6 ± 16.0%; p &amp;lt; 0.001). On the contrary, SDF (12.0 ± 5.9%) increased post-cryopreservation (26.3 ± 14.5%; p &amp;lt; 0.001) and further increased after sperm selection (34.9 ± 22.1%; p = 0.04). Using multilevel mixed-effects logistic regression (Odds ratio [95%CI]), we found that female age significantly influenced clinical pregnancy (0.911 [0.847-0.981]; p = 0.01), live birth (0.894 [0.834-0.959]; p = 0.002) and miscarriage rates (1.180 [1.033-1.347]; p = 0.015). There was no significant age-adjusted effect of SDF post-thaw after density gradient selection on clinical pregnancy (1.007 [0.994-1.021]; p = 0.30), live birth (1.001 [0.988-1.014]; p = 0.84) or miscarriage (1.021 [0.997-1.046]; p = 0.08). Median time-to-live birth was 4 cycles. Analyses of time-to-live birth with mixed-effects Cox models revealed no significant association with progressive motility; SDF before or after cryopreservation and after sperm selection post-thaw. Limitations, reasons for caution Results concern a small donor population, with high normal semen parameters and should therefore be extrapolated cautiously to subfertile men with normal and subnormal semen parameters. Wider implications of the findings In a donor IUI program with strict selection on conventional sperm parameters, differences in SDF before and after cryopreservation and gradient centrifugation do not change IUI outcomes, although cryopreservation and centrifugation increase SDF. Findings could be useful for the optimization of sperm freezing and selection in different assisted reproductive procedures. Trial registration number not applicable

Mediterranean Diet and Male Fertility

Diet has an impact on male reproductive potential, but few studies have focused on the specific impact of food groups or dietary patterns on fertility. Male reproductive health, as indicated by improved semen parameters and increased chances of conceiving, is associated with the Mediterranean diet, while the Western diet is considered a risk factor for male infertility. The potential mechanisms that may explain the impact of these diets on semen quality are still largely unknown. However, numerous studies suggest that nutritional interventions are crucial for the preservation and improvement of male fertility. This review aims to summarize the most recent evidence on the influence of components of the Mediterranean diet on sperm parameters. Unlike other risk factors, dietary modulation represents a great opportunity for improving overall health and can also be an important tool in recommendations for male reproductive health.

Hematology and oncology fellow education about sexual and reproductive health: A survey of program directors in the United States.

11029 Background: Sexual and reproductive health (SRH) concerns are important areas of health and quality of life for patients with cancer that should be included in routine cancer care, according to clinical guidelines. Yet, oncologists often hesitate to raise SRH with their patients due to lack of training. We conducted a national survey of hematology/oncology fellowship program directors (PDs) in the U.S. to understand the state of current fellowship education on three key SRH subjects: fertility, sexual health, and safe sex practices. We assessed rates of provision of formal/informal instruction and endorsement of barriers to formal instruction. Methods: A 13-item survey of education on fertility, sexual health, and safe sex practices in adult hematology/oncology programs was sent to all PDs in the U.S. via an online link or paper survey. PD’s received a $5 gift card for participating. Descriptive statistics and McNemar tests were used. Results: One hundred-twelve PDs responded to the survey (63% response rate). Of these, 75% of PDs reported their programs offered &gt;1 hour of formal instruction on fertility, 42% on sexual health, and 31% on safe sex practices; formal instruction was more common for fertility than either other subject (p’s &lt; .001). Male and female fertility preservation was addressed in 62% and 59% of programs, respectively. Cancer-related sexual side effects for women and men were covered in less than one-quarter of programs (23% and 20%, respectively). Regarding informal instruction, &gt; 73% of programs reported using clinical experience to train fellows in SRH; other informal instruction methods (i.e., case-based methods, webinars, journal clubs, grand rounds) were less common. Lack of experts/resources was the most widely endorsed barrier to providing education about fertility (55%), sexual health (75%), and safe sex practices (69%) and was more widely endorsed for sexual health and safe sex practices compared to fertility (p’s &lt; .01). Lack of space in the curriculum and the topic not being required were also commonly endorsed barriers. Conclusions: Data from this national survey of fellowship program directors show that training in SRH is rare, particularly for sexual health. Barriers to training, especially difficulties in finding content experts, may be leading to a heavy reliance on informal methods of instruction, which are both variable and incomplete. Concerted efforts to integrate SRH into fellowship training, including novel educational curricula, are needed if SRH is to be addressed in routine cancer care.

Male fertility preservation at risk of gonadotoxicity

Background: Along with other aspects of male reproduction, fertility preservation has made significant advances in the past ten years. The overall survival rate for childhood cancer has greatly improved in recent decades, with a current 5-year survival rate of over 80%, compared to roughly 58% in the late 1970s. Many of the most common reproductive issues, such as cryptorchidism and hypospadias in newborns as well as testicular cancer and lower sperm quality in young adult males, have recently become increasingly common. Although the precise cause of these unfavorable effects on reproduction is yet unknown, it has been suggested that they may be related to the presence of common chemicals in the environment or exposure to specific drug classes during fetal life. Large progress has been achieved in recent years toward understanding the biology of male and female reproduction in both animals and humans and applying this information to the creation of methods for fertility preservation in a variety of clinical and ecological contexts. Conclusions: A rapidly developing area, fertility preservation has a wide range of applications, from preserving the possibility of fertility in a child with cancer to preventing the extinction of an entire species. The emphasis on preserving fertility is now only placed on cancer patients who are of reproductive age, but its therapeutic importance may be extended to non-cancer patients as well.