Worried  About  Azoospermia  After Chemotherapy !!

Here is why you should  Preserve sperm with zero risk of disease transmission for future use perticularly after chemotherapy.  http://www.frozencell.org/blog/2018/03/16/preserve-your-sperm-with-zero-source-of-disease-transmission/

Since  incidence of carcinoma is increasing in fertile age. Therefore  use of chemotherapy is getting more common .  Azoospermia After Chemotherapy means drastic reduction in sperm count after chemotherapy. Most importantly  Azoospermia After Chemotherapy is irreversible in most of the case.  Most of the time patients are  aware about No-Sperm After Chemotherapy or Azoospermia After Chemotherapy. The person undergoing chemotherapy and his  all near & dear one  expect  to have baby  even after chemotherapy. Further they also hope that preserved sperms must be 100% safe for future use.  For male here choice is to  Preserve Sperm without HSA.  http://www.frozencell.org/blog/2018/06/01/why-to-preserve-cryo-preserve-human-sperm-with-hsa-hsa-additional-source-of-disease-transmission/

Fertility  After Chemotherapy

Since Azoospermia  after Chemotherapy  is a well known entity. Therefore every measure and precaution should be taken for safe sperm preservation. Presently  human sperms are  preserved with Human Serum Albumin (HSA).  Rarely  Avian protein (egg yolk)  and Animal protein (Fetal bovine serum or FBS) are  used in sperm freezing media.  Hence aim of this post  to make sperm preservation free from all possible future  risk.  Because  addition  of Human , animal or avian protein  directly increase the risk of infection.

Human protein ( Human serum albumin or HSA)                                                                                                Human serum albumin is a plasma derived product. There are four major factors which decide the probability of viral disease (symptomatic or asymptomatic)  after use of HSA.

1. Potential infectivity of starting material ( pooled blood or plasma)

2. Effectiveness of manufacturing process

3. Post manufacturing handling of the product

4. Immunological competence of recipient.

Even the FDA create a class warning for plasma products that states among other things that “the risk of transmission of infectious agents cannot be totally eliminated”.

At this point it is worth to point out that only number 1 and 2 factor can be controlled effectively.  Factor 3 depends on many local factor . And factor 4 is very difficult to  control any  way.  Even after taking all possible measure there is possibility of man made or mechanical mistake.

Avian Protein (Egg Yolk)                                                                                                                                                      During previous days use of this form of protein was very common. Even now a days some companies are trying to promote it in underdeveloped and  developing country.  It’s a matter of discussion that zoootics like avian flu,  nipah virus can be transmitted by this route or not.

Animal protein (Fetal bovine Serum or FBS)                                                                                                                  This form of protein  is not in use  for human sperm preservation particularly because of  Creutzfeldt  Jakob disease  (CJD).  CJD is a rare degenerative, fatal brain disorder.   CJD usually appears in later life and runs a rapid course.  Most noteworthy early diagnosis of this deadly disease is still very difficult.

Chemotherapy & sperm production

There are other factors also which  need consideration during  sperm preservation before Chemotherapy.

• Un-diagnosed & emerging viruses

• Animal parvo-viruses indicate considerable heat resistance at 60 degrees C.

• Role of Viral mutation may be an important factor, which  seems  to be theoretical. But it can increase the virulence & heat tolerance  at any point of time.

• Spores cannot be destroyed by pasteurization.

• In case of pure vegetarian partner, she may refuge to be inseminated by HSA  containing preserved sperm.

• Immuno- compromised patient (recipient) have additional risk to get infected  even by properly treated HSA.

Discussion  – Obviously  sperm should be preserved before chemotherapy. As  chemotherapy ,  radiotherapy   or surgical removal of testis  results in azoospermia  or no-sperm.  The burning question how  to preserve sperm?  Since it is a matter to carry on a generation, all possible  measure is required  to make safe preservation of sperm. One of the safest option is to preserve sperm with 100%  chemically defined  sperm freezing media. Even efficacy and complication of recombinant albumin has to be established , secondly its production rate and cost should  be considered.                                                                                                                                                                                                                        On other hand if sperm freezing media is  100% chemically defined  and its all  components are well known,  sperm will be preserved with zero risk of disease transmission  particularly in case of chemotherapy, radiotherapy or surgical removal of  testis.

References

1. Viral infectivity of albumin and plasma protein faction, Brian L. Erstad, Pharm.D, Supplied by The British Library – “The world’s knowledge”
2. Inactivation of parvovirus B19 during pasteurization of human serum albumin. ¹, Schmidt I, Willkommen H, Löwer J.