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Semen cryopreservation from oncological patients: the Italian experience
European Journal of Obstetrics & Gynecology and Reproductive Biology 113S (2004) S12–S13
Semen cryopreservation from oncological patients: the Italian experience G.M. Colpi*, E.M. Colpi, F. Castiglioni, C. Grugnetti Andrology Service, San Paolo Hospital—Polo Universitario, Via Di Rudinı` 8, 20142 Milano, Italy
Abstract The aim of the study is to summarize official data on semen cryopreservation for oncological patients in Italy. The first private semen bank for oncological patients in Italy was founded by Colpi in 1983 in Milan. In 1987, the first public semen bank was established in ‘‘Macedonio Melloni’’ Hospital (Milan) by Ragni. Normal semen samples are usually present in only 40% of oncological patients. The rate of semen sample use for assisted reproduction techniques is similar to international data (5%). At present, semen cryopreservation is possible only in about 20 Italian centers. # 2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Semen cryopreservation; Infertility; Assisted reproduction techniques; Oncological patients
1. Text Official data on semen cryopreservation for oncological patients in Italy are not easy to find. As a matter of fact, this activity has not been regulated by governmental organizations, but has been developed by single physicians or medical associations as a response demanded by medical ethics to solve a clinical problem created by the ever increasing survival rates of oncological patients. In 1983, G.M. Colpi founded the first semen bank in Lombardy, in a Milanese private center, where in the same year the semen samples of the first oncological patient were cryopreserved. His decision to start this new branch of activity was solely due to medical reasons. Thus this opportunity was confined mainly to patients treated in the urology department of Magenta Hospital (Milan), where Colpi was working at that time. Still for ethical reasons, in 1990 he offered his oncological semen bank, free of charge, to the hospital where he had meanwhile moved but the Catholic administration of the same hospital obliged him to withdraw this bank, reportedly upon the unfavorable opinions provided by the local bishop and by an academic bioethics expert. In fact, the use of semen which had been cryopreserved some years earlier, even for mere paracervical artificial insemination, was not considered legitimate by them, since Catholic morality does not accept that pregnancy may * Corresponding author. E-mail address: [email protected] (G.M. Colpi).
be pursued by separating fertilization from conjugal sexual intercourse. In the years, 1983–1990 Colpi collected semen samples from 31 oncological patients: 10 of these samples were lost at follow-up in 1992. In the following years, of the remaining 21 patients, eight (25.8%) used their cryopreserved semen samples for artificial insemination achieving two newborns in 32 cycles, six withdrew their samples for Assisted Reproduction Techniques (ART) procedures to be performed in other centers and six left their samples in the bank. In the meanwhile one subject had died [1]. In 1985, again in a private center in Padua, C. Foresta began to cryopreserve semen from oncological patients, 85% of them affected by testicular tumors (TT), 40–80 cases per year. In 1987, G. Ragni succeeded in establishing the first public semen bank for oncological patients, inside ‘‘Macedonio Melloni’’ Hospital in Milan, and then in the obstetrics and gynaecology department of the University of Milan, in ‘‘Luigi Mangiagalli’’ Hospital. In the period 1987–1999, Ragni cryopreserved 1417 semen samples (¼33.612 paillettes) from 651 oncological patients. He reported that normal semen samples, according to the WHO criteria [2], had been found only in 40% of the 197 lymphoma (Ly), 37% of the 238 TT and 37% of the 215 other tumors (OT) patients, the mean age of the latter being 27, 29 and 29 years, respectively. In the same period, out of the 651 reported patients, only 31 (4.7%) used their samples for ART procedures [3].
0301-2115/$ – see front matter # 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2003.11.003
G.M. Colpi et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 113S (2004) S12–S13
In April 1999, Colpi opened a second public semen bank in Milan, in ‘‘San Paolo Hospital’’. Until June 2002, 81 patients (56 affected by TT, 5 by Ly and 20 by OT) stored their semen samples, and their number is rapidly increasing month after month. Other public hospitals recently established semen banks for oncological patients such as La Sapienza University in Rome (Seminology Laboratory of the Medical Physiopathology Department) from June 1996, the University of Florence—Policlinico di Careggi (Clinical Physiopathology Department) from February 1998 (108 patients, of which 58 had TT, 44 Ly, 6 other), the University of Turin—San Giovanni Battista Hospital (Endocrinology Division) from October 2000 (77 patients), the University of Catania (second Endocrinology Chair) from April 2001 (eight patients). Other two public institutions have recently decided to open semen banks for oncological patients: the third Medical Unit of the Padua University and the Medical Andrology Department of the University of L’Aquila. From 1996, Cecos Italia, an organization including 22 private infertility centers which share a common self-regulation ethical code under the control of the Istituto Superiore di Sanita` started a program of semen cryopreservation for oncological and fertility losing patients. The rules on semen auto-preservation are stated in article 9 of the Bylaws, which reads: . . .The semen samples which were cryopreserved only for future personal use belong exclusively to their owner. In case of their owner’s death, the semen samples must be destroyed: in no case may they be transferred to any other person. The cryogenic containers used for cryopreservation must be different from those used for cryopreservation of samples by donors. The service of cryopreservation must be offered at a ‘‘social cost’’, meaning that it must be referred to a sort of reimbursement of expenses. . . . At the end of 2000, nine hundred patients were reported to have semen samples cryopreserved in the Cecos Italia centers involved in this activity (Table 1). In detail, 127 males in 1996, 128 in 1997, 154 in 1998, 214 in 1999 and 277 in 2000: 40% of them owing to TT, 5% Hodgkin’s lymphoma, 15% leukemia or non-Hodgkin’s lymphoma, 5% bone marrow transplant, 35% for progressively decreasing sperm count.
Table 1 Cecos Italia centers involved in cryopreservation of semen in oncological patients Arc-Ster, Mestre (Venice) Biogenesi, Monza (Milan) Cecos CRAU, Rome CIFS, Florence Ecomed, Milan Centro Genesis, Caserta
Gynecos, Palermo Lodovica Medical Center, Milan Raoul Palmer, Reggio Emilia Studio Gemma, Padua Tecnobios, Bologna
S13
As far as use of semen samples for ART procedures, data were obtained only from one of these Cecos centers, the CIFS in Florence. In the end of 2000, the thawing procedure had involved 23% of patients: 8% due to the patient’s death, 10% due to spontaneous fertility recovery after treatment, and 5% due to the use of the samples in ART procedures. Livi recently reported at fourth National Cecos Congress that out of 3681 requests for artificial inseminations by donor filed with Cecos Italia centers in the last 4 years, 15% had been justified by azoospermia following previous chemo/radiotherapy. National data about use of cryopreserved pre-treatment samples by oncological patients is comparable to data reported in the international literature [4–6], apart from Colpi’s limited experience, where the higher rate (25.8%) may be explained by strong preceding persuasion about samples’ use. The social requirement to offer a chance of future fertility to oncological patients is further supported by the equally ever increasing lay view of health problems by Italian population, as well as by the substantial non-compliance with the excessive strict religious provisions by a growing sector of the Catholic population. This has led, in the last few years, to the establishment of public semen banks designed for such activity. This branch of activity is also beginning in many already existing private semen banks. In other words, a sort of network of these banks all over Italian territory is spontaneously coming about, although still inadequate, and Northern Italy seems to be better covered as regards this social and health requirement. 2. Condensation A review of basic data regarding semen banks in Italy, where semen cryopreservation for oncological patients is still a scarce procedure. References [1] Colpi GM, Grugnetti C, Mancini M. Management of infertility following treatment of testicular tumours. Arch Ital Urol Androl 2000;72(1):1–5. [2] WHO manual for the standardized investigation, diagnosis and management of the infertile male, World Health Organization, 1992. [3] Dalla SA, Ragni G, Restelli L, Salvi R, Diaferia D, Crosignani PG, Is semen cryopreservation for patients with malignant diseases useful? Twelve years experience. In: Proceedings of the 16th Annual Meeting ESHRE, Bologna, 25–28 June 2000, Hum Reprod (Suppl). [4] Redman JR, Bajorunas DR, Goldstein MC, Evenson DP, Gralla RJ, Lacher MJ, et al. Semen cryopreservation and artificial insemination for Hodgkin’s disease. J Clin Oncol 1987;5(2):233–8. [5] Fossa SD, Aass N, Molne K. Is routine pre-treatment cryopreservation of semen worthwile in the management of patients with testicular cancer? Br J Urol 1989;65(5):524–9. [6] Lass A, Akagbosu F, Abusheikha N, Hassouneh M, Blayney M, Avery S, et al. A programme of semen cryopreservation for patients with malignant disease in a tertiary infertility centre: lessons from 8 years’ experience. Hum Reprod 1998;13(11):3256–61.
Semen cryopreservation from oncological patients: the Italian experience G.M. Colpi*, E.M. Colpi, F. Castiglioni, C. Grugnetti Andrology Service, San Paolo Hospital—Polo Universitario, Via Di Rudinı` 8, 20142 Milano, Italy
Abstract The aim of the study is to summarize official data on semen cryopreservation for oncological patients in Italy. The first private semen bank for oncological patients in Italy was founded by Colpi in 1983 in Milan. In 1987, the first public semen bank was established in ‘‘Macedonio Melloni’’ Hospital (Milan) by Ragni. Normal semen samples are usually present in only 40% of oncological patients. The rate of semen sample use for assisted reproduction techniques is similar to international data (5%). At present, semen cryopreservation is possible only in about 20 Italian centers. # 2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Semen cryopreservation; Infertility; Assisted reproduction techniques; Oncological patients
1. Text Official data on semen cryopreservation for oncological patients in Italy are not easy to find. As a matter of fact, this activity has not been regulated by governmental organizations, but has been developed by single physicians or medical associations as a response demanded by medical ethics to solve a clinical problem created by the ever increasing survival rates of oncological patients. In 1983, G.M. Colpi founded the first semen bank in Lombardy, in a Milanese private center, where in the same year the semen samples of the first oncological patient were cryopreserved. His decision to start this new branch of activity was solely due to medical reasons. Thus this opportunity was confined mainly to patients treated in the urology department of Magenta Hospital (Milan), where Colpi was working at that time. Still for ethical reasons, in 1990 he offered his oncological semen bank, free of charge, to the hospital where he had meanwhile moved but the Catholic administration of the same hospital obliged him to withdraw this bank, reportedly upon the unfavorable opinions provided by the local bishop and by an academic bioethics expert. In fact, the use of semen which had been cryopreserved some years earlier, even for mere paracervical artificial insemination, was not considered legitimate by them, since Catholic morality does not accept that pregnancy may * Corresponding author. E-mail address: [email protected] (G.M. Colpi).
be pursued by separating fertilization from conjugal sexual intercourse. In the years, 1983–1990 Colpi collected semen samples from 31 oncological patients: 10 of these samples were lost at follow-up in 1992. In the following years, of the remaining 21 patients, eight (25.8%) used their cryopreserved semen samples for artificial insemination achieving two newborns in 32 cycles, six withdrew their samples for Assisted Reproduction Techniques (ART) procedures to be performed in other centers and six left their samples in the bank. In the meanwhile one subject had died [1]. In 1985, again in a private center in Padua, C. Foresta began to cryopreserve semen from oncological patients, 85% of them affected by testicular tumors (TT), 40–80 cases per year. In 1987, G. Ragni succeeded in establishing the first public semen bank for oncological patients, inside ‘‘Macedonio Melloni’’ Hospital in Milan, and then in the obstetrics and gynaecology department of the University of Milan, in ‘‘Luigi Mangiagalli’’ Hospital. In the period 1987–1999, Ragni cryopreserved 1417 semen samples (¼33.612 paillettes) from 651 oncological patients. He reported that normal semen samples, according to the WHO criteria [2], had been found only in 40% of the 197 lymphoma (Ly), 37% of the 238 TT and 37% of the 215 other tumors (OT) patients, the mean age of the latter being 27, 29 and 29 years, respectively. In the same period, out of the 651 reported patients, only 31 (4.7%) used their samples for ART procedures [3].
0301-2115/$ – see front matter # 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2003.11.003
G.M. Colpi et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 113S (2004) S12–S13
In April 1999, Colpi opened a second public semen bank in Milan, in ‘‘San Paolo Hospital’’. Until June 2002, 81 patients (56 affected by TT, 5 by Ly and 20 by OT) stored their semen samples, and their number is rapidly increasing month after month. Other public hospitals recently established semen banks for oncological patients such as La Sapienza University in Rome (Seminology Laboratory of the Medical Physiopathology Department) from June 1996, the University of Florence—Policlinico di Careggi (Clinical Physiopathology Department) from February 1998 (108 patients, of which 58 had TT, 44 Ly, 6 other), the University of Turin—San Giovanni Battista Hospital (Endocrinology Division) from October 2000 (77 patients), the University of Catania (second Endocrinology Chair) from April 2001 (eight patients). Other two public institutions have recently decided to open semen banks for oncological patients: the third Medical Unit of the Padua University and the Medical Andrology Department of the University of L’Aquila. From 1996, Cecos Italia, an organization including 22 private infertility centers which share a common self-regulation ethical code under the control of the Istituto Superiore di Sanita` started a program of semen cryopreservation for oncological and fertility losing patients. The rules on semen auto-preservation are stated in article 9 of the Bylaws, which reads: . . .The semen samples which were cryopreserved only for future personal use belong exclusively to their owner. In case of their owner’s death, the semen samples must be destroyed: in no case may they be transferred to any other person. The cryogenic containers used for cryopreservation must be different from those used for cryopreservation of samples by donors. The service of cryopreservation must be offered at a ‘‘social cost’’, meaning that it must be referred to a sort of reimbursement of expenses. . . . At the end of 2000, nine hundred patients were reported to have semen samples cryopreserved in the Cecos Italia centers involved in this activity (Table 1). In detail, 127 males in 1996, 128 in 1997, 154 in 1998, 214 in 1999 and 277 in 2000: 40% of them owing to TT, 5% Hodgkin’s lymphoma, 15% leukemia or non-Hodgkin’s lymphoma, 5% bone marrow transplant, 35% for progressively decreasing sperm count.
Table 1 Cecos Italia centers involved in cryopreservation of semen in oncological patients Arc-Ster, Mestre (Venice) Biogenesi, Monza (Milan) Cecos CRAU, Rome CIFS, Florence Ecomed, Milan Centro Genesis, Caserta
Gynecos, Palermo Lodovica Medical Center, Milan Raoul Palmer, Reggio Emilia Studio Gemma, Padua Tecnobios, Bologna
S13
As far as use of semen samples for ART procedures, data were obtained only from one of these Cecos centers, the CIFS in Florence. In the end of 2000, the thawing procedure had involved 23% of patients: 8% due to the patient’s death, 10% due to spontaneous fertility recovery after treatment, and 5% due to the use of the samples in ART procedures. Livi recently reported at fourth National Cecos Congress that out of 3681 requests for artificial inseminations by donor filed with Cecos Italia centers in the last 4 years, 15% had been justified by azoospermia following previous chemo/radiotherapy. National data about use of cryopreserved pre-treatment samples by oncological patients is comparable to data reported in the international literature [4–6], apart from Colpi’s limited experience, where the higher rate (25.8%) may be explained by strong preceding persuasion about samples’ use. The social requirement to offer a chance of future fertility to oncological patients is further supported by the equally ever increasing lay view of health problems by Italian population, as well as by the substantial non-compliance with the excessive strict religious provisions by a growing sector of the Catholic population. This has led, in the last few years, to the establishment of public semen banks designed for such activity. This branch of activity is also beginning in many already existing private semen banks. In other words, a sort of network of these banks all over Italian territory is spontaneously coming about, although still inadequate, and Northern Italy seems to be better covered as regards this social and health requirement. 2. Condensation A review of basic data regarding semen banks in Italy, where semen cryopreservation for oncological patients is still a scarce procedure. References [1] Colpi GM, Grugnetti C, Mancini M. Management of infertility following treatment of testicular tumours. Arch Ital Urol Androl 2000;72(1):1–5. [2] WHO manual for the standardized investigation, diagnosis and management of the infertile male, World Health Organization, 1992. [3] Dalla SA, Ragni G, Restelli L, Salvi R, Diaferia D, Crosignani PG, Is semen cryopreservation for patients with malignant diseases useful? Twelve years experience. In: Proceedings of the 16th Annual Meeting ESHRE, Bologna, 25–28 June 2000, Hum Reprod (Suppl). [4] Redman JR, Bajorunas DR, Goldstein MC, Evenson DP, Gralla RJ, Lacher MJ, et al. Semen cryopreservation and artificial insemination for Hodgkin’s disease. J Clin Oncol 1987;5(2):233–8. [5] Fossa SD, Aass N, Molne K. Is routine pre-treatment cryopreservation of semen worthwile in the management of patients with testicular cancer? Br J Urol 1989;65(5):524–9. [6] Lass A, Akagbosu F, Abusheikha N, Hassouneh M, Blayney M, Avery S, et al. A programme of semen cryopreservation for patients with malignant disease in a tertiary infertility centre: lessons from 8 years’ experience. Hum Reprod 1998;13(11):3256–61.