Intracytoplasmic sperm injection (ICSI) with cryopreserved testicular spermatozoa retrieved via testicular sperm aspiration (TESA) or microdissection testicular sperm extraction (micro-TESE) is an effective treatment for azoospermia and cryptozoospermia. The current research on testicular sperm cryopreservation has primarily focused on comparing ICSI outcomes between fresh and frozen-thawed testicular spermatozoa. Another focus of these researches is evaluating treatment efficacy differences between ICSI using spermatozoa from patients with obstructive azoospermia (OA) versus non-obstructive azoospermia (NOA). However, few studies have investigated ICSI outcomes among patients with OA, NOA, and cryptozoospermia. This retrospective cohort study analyzed the data from 688 patients at Sichuan Human Sperm Bank (Chengdu, China) between September 2021 and April 2024, comparing cryopreservation efficacy, sperm utilization rate, ICSI outcomes, and delivery outcomes of cryopreserved testicular sperm suspensions in OA group (n = 542), NOA group (n = 114), and cryptozoospermia group (n = 32). Post-thaw analysis revealed that the median sperm viability before and after freezing, as well as the viability ratio, did not differ among the three groups (all P > 0.05). Sperm utilization in NOA group (60.5%) was significantly higher (both P < 0.0001) compared with cryptozoospermia group (31.3%) and OA group (19.9%), while no significant difference was found between OA and cryptozoospermia groups (P > 0.05). Of 162 couples undergoing ICSI, there were no differences in fertilization, clinical pregnancy, delivery, and miscarriage rates among patients with OA, NOA, and cryptozoospermia (all P > 0.05). In the cryptozoospermia group with five newborns, all were full-term with normal birth weights, but this group had the highest maternal pregnancy complication rate.

Testicular cancer (TC) affects young men in their reproductive years. Although sperm cryopreservation is recommended before treatment, real-world utilization and patient experiences in Canada remain poorly described. We conducted a retrospective chart review with a prospective telephone survey of men with TC who underwent sperm cryopreservation (2007-2019) at Manitoba's sole fertility preservation centre. Demographic, treatment, and semen parameters were abstracted from medical records. A structured questionnaire assessed counseling, decision-making, costs, banked sperm utilization, and fertility outcomes. Of 42 eligible men, 24 (57%) completed the survey. The mean age at banking was 25.6 years. Most (71%) received chemotherapy in addition to orchiectomy; 29% underwent orchiectomy alone. Only two men (8%) banked sperm before orchiectomy; the remainder did so prior to systemic therapy. Abnormal semen parameters were common (79%), with a median sperm concentration (13.0 million/mL, interquartile range [IQR] 3.0-21.5) and total sperm count (14.8 million, IQR 8.6-84.9) below WHO 2021 limits. Counseling occurred for 88% of men, though half felt rushed in their decision-making. The mean cost was approximately $2000 over three years, and 58% found this burdensome. Only three men (13%) used their cryopreserved sperm, all after chemotherapy, each resulting in a live birth through assisted reproductive technology (ART). Eleven men (46%) conceived naturally after treatment, eight (33%) had not yet attempted conception. In this Canadian cohort, sperm banking utilization was low, and most survivors achieved natural conception. Financial burden and decisional stress were frequent. Enhanced counseling and public funding for fertility preservation may improve equitable access and survivorship care.

This study aims to develop and evaluate a new approach to cryopreservation of goat semen to improve the efficiency of preserving their valuable genetic material. The relevance of this work is driven by the growing demand for goat milk and the need for import substitution in breeding, which necessitates the creation of highquality domestic sperm banks. Since goat semen does not tolerate freezing well and the availability of foreign cryoprotectants is limited, the aim of the study was to evaluate the effectiveness of mesenchymal stem cells (MSCs) isolated from adipose tissue (AT) and bone marrow (BM) as a biologically active component of a cryoprotective medium based on OptiXcell extender. Semen from Saanen and Alpine goats was used in the experiment. After isolation and cultivation of MSCs from adipose tissue and bone marrow, three groups were formed: control (sperm + OptiXcell) and two experimental groups (sperm + OptiXcell + BM MSCs or AT MSCs). Sperm quality was assessed at five stages: after collection, cooling, immediately after thawing, and after 2 and 4 hours of incubation, analyzing sperm motility, viability, and morphology. Analysis of variance (ANOVA) results revealed a statistically significant positive effect of MSC addition on key parameters. The experimental groups retained a significantly higher percentage of progressively motile sperm and recorded fewer immobile cells and cells with cervical defects compared to the control group. Furthermore, adiposederived MSCs tended to perform somewhat better in maintaining motility and reducing structural damage than bone marrow-derived cells, especially at late stages after thawing. Thus, the study demonstrates that the use of autologous MSCs in a cryoprotective medium significantly improves the post-thawing quality of goat sperm. The obtained data opens up the prospect of creating effective domestic cryopreservation environments, which is of great importance for the development of livestock farming and the implementation of genetic improvement programs in the current economic environment.

Linking joint exposures to indoor and outdoor air pollution and residential greenness with male sperm quality: Based on human sperm banks from two provinces in China.

Spinal ependymomas are intradural intramedullary tumors that present frequently in adults with a bimodal peak at 25–29 years and again at 45–59 years. The risk of progressive neurological deficit in these patients creates the need for surgical resection and radiation therapy. Myxopapillary ependymomas specifically occur at the conus medullaris within the lumbar spine, and these treatments can have a significant impact on patient fertility. However, recent reports illustrate that a vast majority of adults with cancer receive inadequate fertility preservation education, counseling, or resources, and providers tend to cite barriers such as lack of knowledge about fertility preservation options or referrals as well as discomfort with broaching the topic. This review aims to explore the extent to which fertility preservation counseling was offered by a neurosurgery department at a single institution to patients with ependymomas and the subsequent utilization of fertility preservation services. A retrospective review of our local spine tumor database from 2015 to 2025 identified 15 patients who underwent surgery for spinal ependymomas at Rhode Island Hospital. Patients who were outside of child-bearing years (<18 years to >44 years) were excluded (N = 4). Medical records were searched for references to fertility counseling within the notes as well as subsequent receipt of patient services. This cohort consisted of 3 female and 8 male patients with a median age of 42 years. Two patients underwent postoperative radiation treatment. Only one patient in the cohort received any type of fertility preservation counseling or discussion of fertility-related risks of treatment and was referred for sperm banking services. These results shed light on a gap in care regarding fertility in neurosurgical oncology. Previous research suggests that there are significant benefits of fertility preservation counseling and REI referral in every specialty that provides oncology care. This implies that, as a part of the oncological care team, neurosurgeons may be missing a critical opportunity to help their patients achieve goals that extend past their cancer journeys, and further development of protocols for fertility preservation counseling are needed in order for neurosurgeons to provide quality care beyond the doors of the operating room.

Approximately half of male cancer survivors experience infertility following cancer treatment, which can lead to psychosocial distress. The aim of this study was to identify support needs and reflections on the decision-making process related to sperm banking among adolescent male cancer survivors and their caregivers at 1 year post-diagnosis. As part of a randomized controlled trial testing a family-centered sperm banking decision-making intervention, males diagnosed with cancer (12-25 years old) and their caregivers completed semi-structured interviews 1 year post-diagnosis. Thematic analysis was conducted by three independent coders (κ=0.80) and focused on two interview questions: (1) Is there anything you wish you would have known or done before making the [sperm banking] decision? and (2) What information or support do you think is needed regarding your/your son's future fertility goals? Qualitative interviews with adolescents (n=20) and caregivers (n=18) revealed three primary themes: (1) satisfaction with information received at diagnosis, but retrospective desire for more decision-making time; (2) current desire for additional fertility-related support; (3) potential need for future fertility-related support. Despite satisfaction with the oncofertility consultation at diagnosis, clinical teams should prioritize fertility education moving forward and allow additional time for sperm banking decision-making (when possible) at diagnosis. Counseling gaps can lead to uncertainty, unplanned pregnancies, and adverse mental health outcomes. Thus, it is important to revisit issues surrounding fertility and family planning after treatment, particularly among adolescents transitioning to adulthood.

Global reports suggest declining sperm quality, but data from Asian populations under standardized conditions are limited. Investigating trends in China is critical for understanding modifiable factors affecting male fertility. To assess decade-long trends in semen quality among healthy Chinese men and evaluate associations with environmental factors. Design, Setting, and Participants: Retrospective cohort analysis of 5,886 semen samples from healthy sperm donors (aged 20-45 years) recruited between 2011 and 2018 at the Beijing Human Sperm Bank. All procedures adhered strictly to WHO 5th Edition laboratory standards. Main Outcomes and Measures: Annual trends in semen volume, sperm concentration (SC), total sperm count (TSC), progressive motility (PR), total motility (PR + NP), and percentage of progressive motility (PPR). Associations between semen parameters and environmental pollutants (SO₂, NO₂, PM10, PM2.5, waterborne PI/AN) were evaluated using Spearman correlation. From 2011 to 2018, significant improvements occurred across key parameters: SC increased by 12.3% (78-96.5 × 106/mL; p < 0.05 in 2013, 2018); TSC increased by 18.7% (200-283.5 × 106/ejaculate; p < 0.05 from 2014 to 2017); PR and PPR also significantly improved (p < 0.05 in multiple years). Negative correlations were observed between pollutants and semen quality: SO₂, NO₂, and PM10 inversely correlated with TSC (ρ = -0.719 to -0.929; p ≤ 0.045) and PPR (ρ = -0.826 to -0.922; p ≤ 0.011). Water pollutants (PI, AN) similarly correlated with reduced semen volume, TSC, and motility (ρ = -0.735 to -0.878; p ≤ 0.038). Contrary to global declines, semen quality significantly improved among healthy Beijing donors from 2011 to 2018. This improvement coincided with aggressive environmental policies (e.g., China's 2013-2017 Air Pollution Action Plan), suggesting pollution-related sperm damage may be reversible with targeted interventions.

Do men attending a recurrent miscarriage clinic have high double-stranded sperm DNA damage compared with a sperm donor population? This prospective cohort study included 100 men attending a recurrent miscarriage clinic, and 81 sperm donors from a European sperm bank who had proven fertility. All semen samples were evaluated using the Examen Lab alkaline (Exact) comet assay, which identifies the global (single and double strand) DNA damage, and the neutral (Extend) comet assay, measuring only double-stranded sperm DNA fragmentation (dsSDF). Semen analysis showed that 66 male partners of women with a history of recurrent miscarriage were classified as being within normal parameters. Of these, however, 66 men (61%) had raised global SDF, and 52% had raised dsSDF. When evaluating each test separately, the Exact comet (global SDF) assay presented an area under the curve (AUC) of 0.690 (95% CI 0.623-0.756), with the neutral Extend comet (dsSDF only) assay having an AUC of 0.876 (95% CI 0.834-0.914), and the incidence of damage showed an improved AUC of 0.909 (95% CI 0.874-0.940). This study of male factor SDF in a large cohort of men attending a recurrent miscarriage clinic, where they are rarely the focus of clinical investigation, shows a strong association with dsSDF and male factor-driven miscarriage contribution, highlighting the importance of male investigation in couples experiencing recurrent pregnancy loss.

Biobanking is the process whereby biological samples, e.g., blood, DNA, cells, tissues, and/or organs, from multiple individuals are stored for later use, such as future research or clinical use. In contrast to a simple freezer collection, a biobank usually maintains information for each sample, such as gender, ethnicity, lifestyle choices, clinical choices, and sometimes genomic data. Common categories of biobanks include sperm banks, umbilical cord banks, stem cell banks, tumor banks, clinical biobanks, etc. Biospecimens are collected with informed consent under approved standard operating procedures (SOPs) to minimize variability between samples, e.g., time of harvest, processing delay, temperature during transport, special tubes, special reagents, etc., and clinical notes are included so later analyses can if these variable affected outcomes. After collection, samples are transported promptly to processing facility where subsequent handling follows strict SOPs for downstream use. Processing is documented with chain of custody, time stamps, methods, for quality control (QC) records. Storage conditions are chosen based on specimen type, required analyses, anticipated duration of storage, and stability, balancing cost and logistics. Cell samples are processed into appropriate aliquots to reduce ice crystal formation during freeze-thaw procedures and frozen. Typical conditions include low temperature (-80oC), vitrification (-150oC), and liquid nitrogen (-196oC). The hypothesis being tested is that the same biobanking procedures are used for all adult cells involved in regeneration and repair of damaged tissues. This study will compare and contrast biobanking procedures of proposed endogenous adult cells involved in regeneration and repair of damaged tissues.

With the rapid advancement of Assisted Reproductive Technologies ART, human sperm banks urgently require a transition from traditional management models to intelligent

Sperm DNA damage is linked to male infertility and poor reproductive outcome. Single-stranded DNA (ssDNA) damage in sperm is the most common type of damage yet is not specifically targeted by the commonly used DNA damage assays. This study aimed to quantitatively detect sperm ssDNA damage using a novel, direct method. The sperm repair-assisted damage detection (SRADD) assay is a single-molecule technique that uses specific repair enzymes to excise damaged segments and incorporates fluorescently labeled nucleotides, enabling visualization and quantification of the damage. We assessed ssDNA damage in sperm donors following induced damage using varying concentrations of H2O2. The assay was evaluated for sensitivity, repeatability, and reproducibility. SRADD results were compared with the direct TUNEL assay and the indirect sperm chromatin dispersion (SCD) assay. SRADD demonstrated high inter-slide reproducibility (ICC = 0.95). Sensitivity was confirmed by quantifying induced damage in a dose-dependent manner (0.5, 1, 1.5 mM of H2O2), demonstrating mean damage ratios of 1.06, 2.16, and 4.83 relative to control, respectively. Baseline damage levels exhibited strong positive correlation with increased induced damage (r = 0.91, p < 0.001). Analysis of healthy sperm donors (n = 59) revealed that 8.5% of men with normal sperm parameters presented with high ssDNA damage levels. SRADD had a moderate correlation with SCD assay and no correlation with conventional semen parameters and TUNEL assay. The SRADD assay quantifies sperm ssDNA with high sensitivity and can process dozens of samples simultaneously, making it valuable for andrology and toxicology research and potentially useful in clinical settings such as sperm banks and male-infertility assessment. (6573-19-SMV).

The demand for sperm donation is increasing, yet only a small percentage of applicants are accepted, and little attention has been given to those who are rejected. The application process may reveal new medical or genetic information with potential personal and emotional consequences. The aim of this study was to explore how men experience rejection as sperm donors, including how they cope with the rejection and integrate potential new information into their lives. We conducted qualitative, in-depth interviews with 19 men rejected as sperm donors. Data was analyzed using thematic analysis. Some men received new medical information that raised significant concerns, particularly regarding their health, fertility, and family. However, for most it was not the reason for rejection that affected them most, but the rejection itself. They had begun to identify as donors, and being turned down felt like a blow to their sense of self. Over time, participants used different coping strategies: information seeking, actionable reasoning, positive reframing, normalizing, and postponing. Although the experience was personally and emotionally challenging for many, it ultimately did not have a lasting negative impact on their lives. Sperm donation is not only a medical act but also tied to social identity, with rejection having personal and emotional consequences. For men whose rejection is based on new medical information that causes significant concerns, sperm banks should support rejected donors and help them exit the process positively. Further research is warranted to find out how this can be done.

PurposeThe demand for sperm donation is increasing, yet only a small percentage of applicants are accepted, and little attention has been given to those who are rejected. The application process may reveal new medical or genetic information with potential personal and emotional consequences. The aim of this study was to explore how men experience rejection as sperm donors, including how they cope with the rejection and integrate potential new information into their lives.MethodsWe conducted qualitative, in-depth interviews with 19 men rejected as sperm donors. Data was analyzed using thematic analysis.ResultsSome men received new medical information that raised significant concerns, particularly regarding their health, fertility, and family. However, for most it was not the reason for rejection that affected them most, but the rejection itself. They had begun to identify as donors, and being turned down felt like a blow to their sense of self. Over time, participants used different coping strategies: information seeking, actionable reasoning, positive reframing, normalizing, and postponing. Although the experience was personally and emotionally challenging for many, it ultimately did not have a lasting negative impact on their lives.ConclusionsSperm donation is not only a medical act but also tied to social identity, with rejection having personal and emotional consequences. For men whose rejection is based on new medical information that causes significant concerns, sperm banks should support rejected donors and help them exit the process positively. Further research is warranted to find out how this can be done.

Abstract Introduction Ex-vivo testicular sperm extraction (TESE) is a viable alternative for fertility preservation in patients with testicular cancer. Sperm extraction is conventionally performed at the time of radical orchiectomy by a urologist via standard microsurgical technique. Here we provide an assessment of clinical implications of pathologist guided ex-vivo TESE, which may provide an opportunity to prioritize fertility outcomes in individuals with azoospermia or other difficulties with sperm banking while optimizing oncologic staging particularly relevant for non-palpable and satellite lesions. Objective To assess the fertility outcomes of pathologist guided ex-vivo assessment of radical orchiectomy specimens. Methods We performed a single-institution retrospective chart review of all patients who underwent radical orchiectomy for presumed testis cancer with concomitant ex-vivo TESE. The ex-vivo non-microsurgical sperm dissection was performed by one dedicated genitourinary (GU) pathologist. Sperm processing and storage was performed by embryologists on-site. Demographic, clinical, fertility and oncologic information was extracted from the electronic medical record. Results There were 11 patients who underwent concomitant orchiectomy and ex-vivo TESE between 2016 and 2025 (Table 1). 6 of 11 patients (55%) had documented azoospermia prior to surgery; the remaining (45%) were unable to bank sufficient ejaculated sperm preoperatively. Successful sperm retrieval and cryopreservation occurred in 8 individuals (73%) for an average of 3.8 vials (range 2-10). There was no correlation between likelihood of retrieval and preoperative semen analysis. Three patients had pathologic stage 2 tumors, all of which had successful cryopreservation, including one larger (7.9 cm) tumor which yielded 6 vials (case 3). Preoperative serum tumor markers and tumor histology did not correlate with the likelihood of successful ex-vivo TESE. Conclusions To our knowledge, this is the first cohort to specifically examine the outcomes of pathologist-guided ex-vivo TESE after radical orchiectomy. Our results indicate that ex-vivo TESE after radical orchiectomy can be effectively performed by a GU pathologist. Sperm retrieval rates remain comparable, and potentially improved, to those of surgeon-driven extraction. The care of patients with testicular cancer, specifically those undergoing TESE and cryopreservation, is typically performed at tertiary care centers where there is generally greater access to the expertise and resources of GU pathologists. This approach may prove beneficial in improving fertility outcomes while preserving important oncologic staging data and potentially eliminating the need for microsurgical dissection by a urologist. Given the low prevalence of concomitant azoospermia or oligospermia and testicular cancer, sample sizes to reliably examine the outcomes of onco-TESE are small and subject to inherent selection biases. Larger, prospective studies will need to further elucidate the true advantages. Disclosure No

Abstract Introduction There is wide variation in male fertility preservation practices. While physician preference accounts for some of this diversity, practice patterns often reflect multiple extrinsic factors including patient demographics, equipment availability, laboratory protocols, and state law. Objective We sought to characterize national trends in sperm retrieval and storage across reproductive urology practices in the United States. Methods An anonymous 34-item survey characterizing provider demographics, practice settings, fertility preservation procedures, andrology laboratory practices, and cryopreservation expenses was designed. Practicing reproductive urologists were identified using information available through professional societies. Our survey was constructed using the Qualtrics platform and distributed electronically between October 2024 and May 2025. Results 39 responses were received by urologists practicing across 21 states (response rate: 21%, n=189). A majority (74%, n=29) of survey responders practiced at academic medical centers, with others practicing at non-academic hospitals (8%, n=3) and private practices (13%, n=5). The most common indications for fertility preservation reported included oncologic care (42%), gamete storage for planned ART (31%), transgender care (18%), pre-vasectomy sperm banking (10%), and pre-deployment banking for military personnel (5%). Nearly all providers performed microsurgical sperm retrievals (97%, n=38, Figure) and oncologic testicular sperm extractions (85%, n=33) when indicated. More than half of providers offered conventional testicular sperm extractions (72%, n=28), microsurgical epididymal sperm aspirations (59%, n=23), testicular sperm aspirations (56%, n=22), penile vibratory stimulation (54%, n=21), or percutaneous epididymal sperm aspirations (52%, n=20). Fewer providers offered post-mortem sperm retrieval (49%, n=19), pre-pubertal testicular tissue cryopreservation (36%, n=14), or electroejaculation (31%, n=12). Most respondents (62%, n=24) had access to an on-site andrology laboratory. Semen analyses were evaluated using manual (53%, n=20), computer-assisted (11%, n=4), or combinatorial methods (26%, n=10). Though many (37%, n=14) providers were uncertain about institutional costs for semen specimen processing, a plurality of respondents (40%, n=15) reported fees ranging from $100-500 with the remainder (23%, n=9) reporting fees exceeding $500. Respondents most frequently reported semen storage fees ranging between $100-300 per year (39%, n=15), while approximately a third (31%, n=12) estimated these costs to range between $300-600 per year. However, 18% (n=7) of respondents reported higher costs for specimen storage and 13% (n=5) were uncertain about the expense of this service. Conclusions This multi-institutional, geographically diverse survey reveals significant variation in reproductive urology practice patterns and cost associated with semen analyses and storage. Future studies will explore differences in practice patterns to better understand the factors influencing this variation and their effect on male reproductive healthcare. In the absence of society guidelines, reproductive urologists must collaborate, share best practices, and maintain price transparency to ensure sperm retrieval remains accessible and affordable. Disclosure No

Purpose: Approximately half of male childhood cancer survivors experience treatment-related fertility impairment. Regrets about missed sperm banking opportunities have been reported, yet few decision tools for male adolescents with cancer exist. This study aims to report the development, testing, and adaptation of the Family-centered Adolescent Sperm banking values clarification Tool (FAST) using an iterative, user-centered design with male adolescents with cancer and their caregivers and to obtain feedback from clinicians and community partners. Methods: Males (12-25 years, diagnosed with cancer in the past year, received a routine fertility consult where sperm banking was offered) and caregivers completed the FAST on a screen-recorded device, a semi-structured interview, the System Usability Scale (SUS), and a sociodemographic questionnaire. Feedback informed FAST adaptations and was documented using the Framework for Reporting Adaptations and Modifications-Expanded. Descriptive statistics and thematic analysis characterized FAST completion information. Results: Ten families (16 caregivers, 9 adolescents) enrolled. Themes included: ease of navigation, perceived usefulness of the FAST, and perspectives on tool adaptations. Forty-three FAST adaptations were made in response to participant feedback. Median FAST completion time was 5 minutes and 37 seconds. The mean FAST SUS score was high at 84.60 (minimum = 57.50, maximum = 100, standard deviation = 11.08). Conclusions: Applying an iterative, user-centered approach, the FAST was developed, usability-tested, and adapted to a web-based format that families found easy to navigate and useful. Web-based tools, such as the FAST, could improve the sperm banking decision-making process for adolescent males and their caregivers by addressing unmet needs and ultimately improving satisfaction with fertility counseling outcomes.

Preservation of gonadal function following chemotherapy protocols with acvd and acvd-BV in adults diagnosed with advanced-stage Hodgkin lymphoma: A single center experience.

Knowledge and Attitudes Towards Fertility Preservation in Patients Undergoing Radical Prostatectomy.

Exposure to individual organophosphate esters and their mixture in relation to semen quality in Chinese men.

PurposeWidespread use of genome-wide testing during pregnancy and throughout life raises clinical, legal, and ethical questions. Results from such tests in the context of gamete donation have implications also for the donor and other recipients. Current guidelines do not fully address this matter. We aim to provide empirical data on clinician’s perspectives towards pre-donation genetic counseling and recontacting sperm donors for additional genome-wide genetic testing.MethodsIn-depth interviews were conducted with 19 healthcare professionals across Israel from different disciplines (sperm bank directors, fertility and genetic specialists) and were analyzed using the grounded theory approach.ResultsOverall participants emphasized the importance of pre-donation comprehensive genetic counseling, which should cover future potential genetic tests findings, and their implications for both donor and offspring health, along with offering donors the choice to allow recontact later on. Approximately half of the participants believed recontacting donors should happen before performing broader genetic tests on the offspring, mainly due to possible implications for the donor’s health. In contrast, about a third of participants advocated recontacting donors only if clinically significant findings are identified, driven by practical reasons concerning the benefit to the offspring and time-sensitive situations, like pregnancy.ConclusionThis study highlights the need for clear guidelines regarding donor recontact in the context of expanding genetic testing. A strong consensus exists on the necessity of comprehensive pre-donation genetic counseling, divergent views on recontact emphasize the need to balance the implications for donor health with practical considerations for offspring and timely medical interventions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-025-03694-0.