Fertility preservation in males with cancer: 16-year monocentric experience of sperm banking and post-thaw reproductive outcomes.

BACKGROUND: Anticancer treatments can impair male fertility. Cryopreservation of semen is an efficient procedure for fertility preservation. The aim of this study was to evaluate pre-freeze semen parameters among the various types of cancer, post-thaw sperm viability and reproductive outcome of samples used for assisted reproductive treatment (ART). METHODS: This study included 721 men with cancer that had their semen cryopreserved in our bank in 1999-2015. Semen analysis and cryopreservation were performed before the start of antineoplastic treatment, according to the World Health Organization recommendations, European Commission and Italian law. RESULTS: Among the 721 patient, 196 had seminoma of the testis, 173 Hodgkin's lymphoma, 108 mixed testicular tumors, 89 germ cell tumors, 67 other tumors, 46 hematological tumors, and 42 non-Hodgkin's lymphoma. The mean age of patients was significantly lower in Hodgkin's lymphoma compared to other tumors. Statistically significant lower volume, sperm count and number of straws stored were observed respectively in Hodgkin's lymphoma, mixed testicular tumor and hematological tumors. Nineteen patients used their frozen semen for 20 ART cycles. After thawing a significant reduction of motility and vitality was recorded. A lower fertilization rate was observed in patients affected by testicular tumor and lymphoma (35.42% and 50%) compared with other cancers (71.43%). No significant differences were observed in terms of cleavage and implantation rates. A total of five pregnancies and seven healthy newborns were achieved. CONCLUSIONS: Fertility preservation before gonadotoxic therapy is of great importance to patients with cancer and must be indicate before the start of treatment.

Semen quality and hormonal levels in infertile patients with varicocele.

OBJECTIVE: Aim of this study was to evaluate the semen quality and the serum concentration of follicle-stimulating hormone (FSH) and Testosterone (T) in infertile patients with and without varicocele. MATERIAL AND METHODS: 365 infertile patients undergoing Assisted Reproduction Tecnique (ART) were retrospectively included in the study. All subject were evaluated by history, physical examination, semen analysis, semen culture, mixed anti-immunoglobulin reaction test (MAR) for demonstration of sperm agglutination antibodies IgG and IgA, serum FSH and T determination. RESULTS: We observed 97 (26.6%) patients affected by varicocele compared to 268 (73.4%) without varicocele. A significant reduced percentage of motile spermatozoa (24.58 +/- 21.68 vs 21.01 +/- 12.62, p < 0.001) and lower sperm concentration (15.50 +/- 23.30 vs 16.50 +/- 15.22, p < 0.001) were observed in patients with varicocele compared to patients without varicocele. No significant differences were observed in sperm vitality between the two population of men with and without varicocele. Serum FSH (10.42 +/- 10.84 vs 9.11 +/- 18.81, p < 0.001) and Testosterone (5.73 +/- 5.97 vs 5.21 +/- 2.43, p < 0.001) levels were significantly higher in patients with varicocele compared to patients without varicocele. Detection of IgG and IgA sperm antibodies were negative in both man with and without varicocele. CONCLUSION: The direct connection between varicocele and infertility is not clear. The data of the present study suggest that the presence of a clinical varicocele rule out fertility in men affecting the hypothalamic pituitary-gonadal axis.

Effect of weight loss following bariatric surgery on myocardial dispersion of repolarization in morbidly obese patients.

BACKGROUND: Weight-stable obese subjects have an increased risk of arrhythmias and sudden death, even in the absence of cardiac dysfunction, and the risk of sudden cardiac death (SCD) with increasing weight is seen in both genders. The mechanism of unexplained deaths in obese patients is still unclear and may be related to ventricular repolarization abnormalities. The aim of this study is to determine the effect of severe obesity on spatial and transmural ventricular repolarization and to clarify the influence of bariatric surgery with a consequent substantial weight loss on arrhythmogenic substrate in the morbidly obese population. METHODS: For the study, we enrolled 100 severely obese patients; 50 age-matched non-obese healthy subjects were also recruited as controls. All subjects underwent conventional 12-lead electrocardiography for analysis of spatial and transmural ventricular repolarization assessed by corrected QT dispersion (QTc-d), corrected JT dispersion (JTc-d) and transmural dispersion of repolarization, (TDR). All subjects underwent bariatric surgery and were resubmitted to electrocardiographic, biochemical and anthropometric examination 12 months postoperatively. RESULTS: Severely obese patients had greater values in QTc-d, JTc-d and TDR than the normal-weight controls. Bariatric surgery reduced significantly the QTc-d value, JTc-d value and TDR value. There was a significant correlation between decrease of heterogeneity of repolarization indexes (QTd, JTd and TDR) and bariatric surgery-induced weight loss. CONCLUSIONS: In severely obese patients, surgically-induced weight loss is associated with significant decrease in the heterogeneity of ventricular repolarization. The reduction of spatial (QTc-d, JTc-d) and transmural dispersion of repolarization (TDR) may be of clinical significance, by reducing the risk of potentially fatal arrhythmias in morbidly obese subjects.

[Eco-color-Doppler venous catheterization of internal jugular vein in obese patient]. / La guida eco-color-Doppler negli accessi venosi centrali del paziente obeso.

AIM OF THE STUDY: The Authors analyzed the results of 120 central venous catheterisms of internal jugular vein performed by eco-color-Doppler from January 2000 to December 2004 in obese patients candidated to bariatric surgery. RESULTS: As the considerable adiposity and post-operation necessities, this procedure has been very useful. The average performing time was 10 minutes, 95.8% of success and 4.2% of impossibility (thrombosis internal jugular vein bilateral). CONCLUSIONS: The eco-color-Doppler guide CVC is a safe procedure with short performing time, low rate of failures and complications, and high rate success. It was very helpful in obese patients candidated to bariatric operation, allowing a comfortable and easy venous access, as well as the administration of liquids otherwise administered with difficulty by peripheral way, correlated to corporal weight in qualitative and quantitative terms, such at improve the process of post-operative recovery.