Infertility

Literature Review

Infertility have undergone appropriate therapy for localized disease in the form of RT or radical prostatectomy, they might still have a significant risk of an adverse outcome. The investigators suggest that patients with elevated PSA velocity, even with other low-risk characteristics, might benefit from concurrent androgen deprivation therapy when undergoing RT. As increasing numbers of researchers highlight the limited diagnostic utility of a single PSA value, many are left with the notion that PSA is “not a good test.” Studies such as these demonstrate that there is great value in the information provided by PSA, especially if PSA is viewed not simply as a static number but as a dynamic biologic descriptor. Infertility Freeze that Sperm Reviewed by Jacob Rajfer, MD Department of Urology, UCLA School of Medicine, and Harbor–UCLA Medical Center, Torrance, CA [Rev Urol. 2006;8(1):43-44] © 2006 MedReviews, LLC ne of the side effects of cancer therapy—be it radiotherapy, chemotherapy, and/or surgery—is a potential detrimental hit to the reproductive system. This could be devastating psychologically to couples in which the male partner has been treated for an oncological disease. The gonads themselves are very susceptible to radiotherapy and chemotherapy, and some surgical procedures destroy or disable the function of the male ductal system, which might result in a lack of seminal emission and/or a ductal obstruction. It is well recognized that the cancer itself might have an impact on the reproductive system, and infertility sometimes might be the presenting complaint of someone with an oncological disease, depending on the tissue affected and the severity of the disease. Thus, when the aforementioned oncological treatments are given to these patients, their fertility status is further compromised. These gonadotoxic effects can be either temporary or permanent. If the former, it can sometimes take 1 to 2 years after the completion of treatment for spermatogenesis to recover. In a number of patients, again depending on the type and duration of therapy, azoospermia might be permanent. As such, it seems prudent that any man who is O a potential future father be evaluated with a semen analysis if (1) he is diagnosed with a cancer, and (2) he is to undergo some form of therapy for this tumor. In Vitro Fertilization–Intracytoplasmic Sperm Injection Success Rates with Cryopreserved Sperm from Patients with Malignant Disease Revel A, Haimov-Kochman R, Porat A, et al. Fert Steril. 2005;84:118-122. In this study, the semen of 21 men was cryopreserved before their cancer treatment, in the hope that the frozen sperm could be used in some fashion in the future. The mean age of these male patients was 33 ± 7 years, the same as their female partners. Of the 21 men, 9 had lymphomas, 4 had sarcomas, 5 had testicular cancers (all underwent orchiectomy), and the remaining 3 had leukemia, prostate cancer, and histiocytoma in the inguinal canal, respectively. Although pretherapy sperm counts were not stated, the postthaw sperm count ranged from 1
105 to 106
106 motile sperm per milliliter. The longest freezing period was 18 years. The female partners of all 21 men underwent in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Out of 62 IVF procedures there were 26 pregnancies (42%), and from these 26 pregnancies there were 8 spontaneous abortions (31%) and 23 children (13 singletons and 5 pairs of twins). In 12 of the 21 couples (57%), at least 1 pregnancy was achieved. The lowest total motile sperm count that was successful was 1
105/mL. The Physicians who deal with men with cancer during their reproductive years need to realize that fertility is a major concern to these men, if not at the time of diagnosis, certainly at some time in the future. sperm frozen for 18 years was successful in achieving a pregnancy and live birth. This study highlights the fact that physicians who deal with men with cancer during their reproductive years need to realize that fertility is a major concern to these men, if not at the time of diagnosis, certainly at some time in the future. Therefore, the cryopreservation of sperm at the time of diagnosis, and before any therapy directed against the cancer, should be recommended. Even severely oligospermic men should be offered this opportunity because IVF with ICSI requires 1 sperm per egg. For men with abnormal preoperative sperm counts who are VOL. 8 NO. 1 2006 REVIEWS IN UROLOGY 43 Outcomes Research continued undergoing orchiectomy, consideration should be given to sperm extraction from the orchiectomy specimen, with cryopreservation of the extracted sperm. Although procedures such as intrauterine insemination can be performed if there are at least 5
106 motile sperm available for insemination, this procedure might not work, and the time might come when IVF with ICSI is the only alternative, despite the excellent sperm count after therapy. Kidney Stones stone prevalence in those with DM was significant for all 3 cohorts. The prospective development of an incident kidney stone event was significantly greater in both female cohorts with DM but not in the male group. In addition, the multivariate risk of incident DM was significant in subjects with a history of kidney stones for all 3 cohorts. These findings again demonstrate that stone formation might be linked to common systemic diseases. Similar associations have been previously demonstrated with hypertension.3,4 References 1. Diabetes Mellitus and Kidney Stone Formation 2. 3. Reviewed by Dean G. Assimos, MD Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC 4. Pak CY, Sakhaee K, Moe O, et al. Biochemical profile of stone-forming patients with diabetes mellitus. Urology. 2003;61:523-527. Abate N, Chandalia M, Cabo-Chan AV Jr, et al. The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance. Kidney Int. 2004;65:386-392. Strazzullo P, Barba G, Vuotto P, et al. Past history of nephrolithiasis and incidence of hypertension in men: a reappraisal based on the results of the Olivetti prospective heart study. Nephrol Dial Transplant. 2001;16:2232-2235. Borghi L, Meschi T, Guerra A, et al. Essential arterial hypertension and stone disease. Kidney Int. 1999;55:2397-2406. [Rev Urol. 2006;8(1):44] © 2006 MedReviews, LLC idney stone formation is a multifactorial process that is associated with other disease processes. Insulin resistance plays a key role in type 2 diabetes mellitus (DM), and it has been linked to uric acid stone formation.1,2 Insulin resistance might result in a deficit in ammonium production in the kidney, which lowers urinary pH, thus generating a favorable milieu for uric acid stone formation. K Diabetes Mellitus and the Risk of Nephrolithiasis Taylor EN, Stampfer MJ, Curhan GC. Outcomes Research Lower Urinary Tract Symptoms, Erectile Dysfunction, and Hypogonadism Reviewed by Michael P. O’Leary, MD, MPH Department of Surgery, Harvard Medical School; Division of Urology, Brigham and Women’s Hospital, Boston, MA [Rev Urol. 2006;8(1):44-45] © 2006 MedReviews, LLC Kidney Int. 2005;68:1230-1235. Taylor and colleagues searched for a prospective association between DM and kidney stone formation by conducting a cross-sectional study of 3 large cohorts: Nurses’ These findings again demonstrate that stone formation might be linked to common systemic diseases. Health Study I (older women), Nurses’ Health Study II (younger women), and the Health Professional Follow-up Study (men). At baseline, the multivariate relative risk of 44 VOL. 8 NO. 1 2006 REVIEWS IN UROLOGY Correlation Between LUTS (AUA-SS) and Erectile Dysfunction (SHIM) in an AgeMatched Racially Diverse Male Population: Data from the Prostate Cancer Awareness Week (PCAW) Barqawi A, O’Donnell C, Kumar R, et al. J Impot Res. 2005;17:370-374. rostate Cancer Awareness Week offers free or lowcost screening to men at hundreds of sites across the United States. In this report, an analysis of 6641 of these men included data on lower urinary tract symptoms P