november 2, 2013
DESCRIPTION
EXPERIMENTAL FERTILITY PRESERVATION INTERVENTIONS IN PRE-PUBERTAL BOYS WITH CANCER: A REPORT ON PREFERENCES OF TEENAGE CANCER SURVIVORS, PARENTS, AND PROVIDERS. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/1.jpg)
EXPERIMENTAL FERTILITY PRESERVATION INTERVENTIONS IN PRE-PUBERTAL
BOYS WITH CANCER: A REPORT ON PREFERENCES OF TEENAGE CANCER
SURVIVORS, PARENTS, AND PROVIDERS
Abha A. Gupta1; Rachel Donen2; Lillian Sung1; Katherine Boydell4; Leila Bahrambahri2; Anisha Prasad2; Sina Hadipour-Lamehsari1; Kirk Lo3;
Armando Lorenzo2
1Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; 2Urology, The Hospital for Sick Children, Toronto, ON, Canada;
3Urology, Mount Sinai Hospital, Toronto, ON, Canada;4Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
November 2, 2013
![Page 2: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/2.jpg)
Objectives
Parents, Providers & Survivors1) Identify the factors influencing pre-pubertal testicular
biopsy decisionsInterviews
2) Quantify preferences for testicular biopsy
Threshold Technique
![Page 3: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/3.jpg)
I = interstitial spaceSg = spermatogoniaSc = primary spermatocytesSd = spermatidsSt = Sertoli cell nuclei
Pre-Pubertal Pubertal
Male Fertility
• Pre-pubertal testes contain primordial germ cells that are also susceptible to toxicity but do not contain mature spermatocytes
![Page 4: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/4.jpg)
Infertility - CCSS Experience Abnormal semen parameters were noted at
cyclophosphamide dose > 7.5 g/m2
Permanent azoospermia consistently observed after the following total doses: • cyclophosphamide > 19 g/m2
• ifosfamide > 60 g/m2
• cisplatin 600 mg/m2
Lee SJ et al, JCO 2006
Alkylating Agents = Prolonged Azospermia
Most sarcoma therapy = Guarantees infertility in males
![Page 5: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/5.jpg)
![Page 6: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/6.jpg)
![Page 7: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/7.jpg)
Fertility Preservation
Post-pubertal boys (Standard of Care)Sperm banking
Testicular biopsy/Mature tissue banking
Mature sperm taken out IVF and/or ICSI
![Page 8: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/8.jpg)
Fertility Preservation
Pre-pubertal boysTesticular biopsy/Immature tissue banking?
Experimental
Extraction/Maturing sperm
IVF and/or ICSI
![Page 9: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/9.jpg)
We can do it in mice…
![Page 10: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/10.jpg)
First Step
Before develop fertility programIdentify needs, obstacles and resources
Preliminary researchAre parents even willing to consider testicular tissue
preservation at diagnosis?
(Ginsberg et al., 2010; van den Berg et al., 2007; Wyns et al., 2011)
![Page 11: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/11.jpg)
Methods
Mixed methods
QualitativeInterviews
QuantitativeThreshold Technique
(Greene, 2007)
![Page 12: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/12.jpg)
Methods
Participants
Parents of PP boys with cancerOncologists, NPs, Social Workers Survivors (male, AYA 14 -18 years)
![Page 13: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/13.jpg)
Main Interview Questions
Providers:• Which options would you present to families?Parents and Survivors:• Would you choose biopsy or no biopsy?All Groups• What kinds of things do you think about when trying to
make your decision?
![Page 14: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/14.jpg)
Methods: Threshold Technique
Testicular biopsy
vs.
No testicular biopsy
![Page 15: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/15.jpg)
Data Analysis
Since November 2012• 45 interviews and 258 surveys completed
![Page 16: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/16.jpg)
DemographicsParents =156 males = 9Median age 42 (range 23-62) years
Providers = 34 2NP, 2RN, 1 SW, males = 1129 were parents28 knew someone who had had fertility treatment
Survivors = 78Median age 17 (14-26)Leukemia 40, sarcoma 9 , lymphoma 11, other 18
![Page 17: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/17.jpg)
Baseline Scenario
• 50% Risk of infertility from treatment• 1% Risk of Complications from biopsy• 15% Chance technology develops• $350/year cost to store tissue family pays
![Page 18: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/18.jpg)
Preliminary Results
Preferred biopsy
• 110/152 Parents(72%)• 57/75 Survivors (76%)• 23/31 Providers (74%)
• …factors influencing their decision?• Risk of infertility, complications, cost
![Page 19: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/19.jpg)
52% 14%39% Parents
70% Survivors
30% Providers
17% 12%
65% 5%
![Page 20: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/20.jpg)
Why Biopsy Preferred
Chance for patients to have kids“It’s just important everyone has a chance to raise a family if
they want to. And that just because they were unlucky and got cancer there’d still be a way that they could end up having kids.”
Survivor
![Page 21: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/21.jpg)
Preliminary Results
Parents and Survivors desires:94% Parents want biopsy option presented
89% Survivors want biopsy option presented
![Page 22: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/22.jpg)
Preliminary ResultsNeed for Full Disclosure
“I think it’s part of disclosure. I feel if you found something on your own that your doctors didn’t tell you about, there is a risk that you are resenting the doctors for “Why didn’t they tell us about this? Why were we lucky enough to find out about it on our own and a lot of people wouldn’t be as lucky as us?
If I found out later… that you could have but nobody mentioned it, we would be angry.”
Parent
![Page 23: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/23.jpg)
Conclusions
Parents and survivors Prefer Biopsy
Survivors and parents want to know about testicular biopsy before treatment starts
![Page 24: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/24.jpg)
Next Step: Knowledge Translation
Develop FP Infographics1) Sperm banking2) Electro ejaculation and mature testicular tissue banking3) Immature testicular tissue banking4) Oocyte storage
![Page 25: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/25.jpg)
Infographic Example
![Page 26: November 2, 2013](https://reader036.vdocument.in/reader036/viewer/2022062411/568150bb550346895dbed84e/html5/thumbnails/26.jpg)
Questions?