Semen Cryopreservation and Assisted Reproduction

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Cryostorage of semen has become standard practice and should be offered to all men before undergoing potentially sterilizing therapy. Improvements in the techniques used to store semen (49) and advances in the field of assisted reproduction, such as intracyto-plasmic sperm injection (ICSI), have increased the chance of successful pregnancies using cryopreserved sperm. However, there are some limitations to this method of preserving fertility. First, it is not a feasible option for prepubertal patients. Furthermore, testicular function in adult men with malignant disease is often impaired before treatment (9) resulting in poor sperm quality or difficulty providing semen for storage. Oligospermia is found in a third to a half of patients with Hodgkin's disease, NHL, and testicular cancer before treatment and also occurs in men with leukemia and soft-tissue cancer (7a). Sperm motility is also impaired in these patients, and the process of freezing and thawing semen further reduces the sperm quality. Although successful fertilization may be achieved with only a few viable sperm using ICSI, pregnancy rates using this method are lower with abnormal semen than with normal semen (50). As a result, methods for protecting, or enhancing the recovery of normal spermatogenesis after gonado-toxic therapy have been pursued.

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