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Biomedical subjects

G Bahadur

Publications and source records attributed to G Bahadur.

At least 19 recordsLinked to original sources
PubMed2005

Semen quality before and after gonadotoxic treatment.

BACKGROUND: The aim of this study was to analyse the semen quality of patients before and after gonadotoxic therapy. PATIENTS AND METHODS: We evaluated semen quality in 314 patients over a 26 year period. The diagnostic categories were leukaemia (n = 13); lymphoma (n = 128); testicular cancer (n = 102); benign conditions (n = 13); and other malignant neoplasms (n = 58). The degree of azoospermia or oligozoospermia for each disease category was recorded. We then analysed the recovery in semen quality over time for each disease category. RESULTS: The mean patient age was 27.9 years (range 13-65 years). A total of 1115 post-treatment semen samples were analysed from 314 patients. There was a significant reduction in the post-treatment sperm concentration, sperm motility and semen volume compared with pre-treatment levels (P < 0.05) in the entire cohort. However, the sperm movement and motility grade remained unaffected. Patients with testicular carcinoma had the lowest pre-treatment sperm concentrations but also the lowest incidence of azoospermia after cancer treatment. Patients with lymphoma and leukaemia had the highest incidence of post-treatment azoospermia and oligospermia. Patients having the largest reductions in their sperm concentration after treatment required the longest recovery period for spermatogenesis. The diagnostic category was the only significant predictor of post-treatment azoospermia. CONCLUSION: Gonadotoxic treatment results in a significant reduction in sperm quality. The type of cancer or disease, and the pre-treatment sperm concentrations were found to be the most significant factors governing post-treatment semen quality and recovery of spermatogenesis. All categories of patients displayed varying degrees of azoospermia and oligozoospermia, and recovery of gonadal function from these states was not significant. This highlights the importance of ensuring sperm banking before treatment, including for patients with benign conditions. Several factors and associations are discussed further in order to give an insight into the pre- and post-gonadotoxic treatment effects.

Adolescent↗
PubMed2004

Ethics of testicular stem cell medicine.

The ethical issues raised by advances in reproductive technology allowing the transplantation of testicular stem cells to enable infertile men and cancer patients, including the pre-pubertal, to have children, and to provide new contraceptive prospects for fertile men are discussed. Consideration of respect for the patient's autonomy, the need for informed consent and the health of any offspring resulting from such a procedure are included. Topics covered include: the problems raised by cases needing consent for the transplantation of testicular stem cells from pre-pubertal and adolescent patients; the legal status of stem cells; the arguements for treating such tissue as property which might serve as a means of guaranteeing respect for patients' rights in disputed cases; aspects of patents and the ethics of allowing commercial traffic of such material; questions relating to health and safety, as well as xenotransplantation technology in humans; and posthumous procurement use of germ cells from minors. Proposals are made to enhance informed and effective consent, while supporting patient determination, choice, autonomy and technological advances. The paper appeals to the emerging EU directives in relation to tissue procurement, storing and use of tissue and cells to adopt a pragmatic and meaningful position which will help enhance patient determination and autonomy in relation to the emerging technologies in reproductive medicine, whilst providing a pragmatic way forward for fertility clinics and laboratories to function.

Ethics, Medical↗
PubMed2004

Mumps epididymo-orchitis with prolonged detection of virus in semen and the development of anti-sperm antibodies.

Epididymo-orchitis is the most common complication of mumps in post-pubertal men. A case of MMR vaccine failure, in whom mumps and mumps-associated unilateral epididymo-orchitis developed, is presented in this article. Mumps virus was isolated from the semen 14 days after onset and mumps RNA was detected in semen for up to 40 days using RT-PCR. Epididymo-orchitis was associated with transient but significant reduction in sperm count and severe abnormalities in sperm morphology. It also led to the appearance of anti-sperm antibodies, which may have potential long-term adverse effects on the patient's fertility. Sequencing of the SH gene of the virus showed this to be a new mumps genotype distinct from the virus circulating currently in the UK.

Adolescent↗
PubMed2002

Cryobiology ethics of human reproduction.

The article surveys the ethical and social issues that arise from recent developments in assisted reproductive technologies (ART) involving cryotechnology and argues that practitioners must understand ethical as well as technological issues. It discusses the risks associated with ART and the importance of the need to inform patients of them so that they can make considered decisions. It considers problematic areas in the use of ART, particularly the case of lesbian women who wish to conceive. It offers a philosophical definition of ethics and a framework for defining ethical, and unethical, clinical practice. It advocates a utilitarian approach to moral problems, one that attends to the moral consequences of actions. It examines the complex way that morality, law, and ethics interact and refers to controversial legal decisions in the United Kingdom concerning ART. This article considers the various rights (of donors, prospective parents, and offspring) that need to be taken into account by practitioners of ART.

Cryopreservation↗
PubMed2002

Semen production in adolescent cancer patients.

BACKGROUND: The influence of an accompanying person (parent, guardian or nurse) on the ability of an adolescent (post-pubescent, <20 years of age) to produce a semen sample for cryopreservation, is undetermined, as is the potential for use of urine samples to retrieve sperm in those adolescents that are unable to produce a semen sample. METHODS: The records from 1991-2000 inclusive were reviewed to derive those adolescent patients who were unable to produce semen for cryopreservation prior to undergoing treatment for a malignant condition. RESULTS: During the study period 238 adolescents attended our unit of whom 205 (86.1%) banked semen ('producers'). The remaining 33 adolescents (13.9%) were initially unable to produce a sample ('non-producers'), four of these provided a urine specimen for analysis (12.1%) and of these one had sufficient sperm for cryopreservation. Of the 'accompanied' patients 29.7% (19/64) were non-producers while in the 'unaccompanied' patients only 8.0% (14/174) were non-producers (chi(2) = 16.58, P < 0.001). The relative risk (RR) of not producing a semen sample for the accompanied group of patients was greater than that for the unaccompanied group (RR = 3.689, 95% confidence interval: 2.0-6.9). One patient returning alone successfully provided a semen sample for storage. CONCLUSION: Units should consider the effect of the presence of an accompanying person when an adolescent is unable to produce a semen sample and should consider requesting urine to retrieve sperm.

Adolescent↗
PubMed2002

Death and conception.

The complex moral, ethical and legal concerns that have arisen as a result of posthumous assisted reproduction (PAR) are examined in this report. Difficult questions such as what constitutes informed consent, and whether it is ethical to retrieve spermatozoa from patients who are in a coma, are considered. Legal issues, such as whether gametes can be considered as property and the need to clarify the legal definition of paternity in cases of children born in such circumstances, are also discussed, while other points regarding the advisability of PAR, respecting the wishes of the deceased donor and the need to protect the interests of the unborn child, are outlined. The motives of the gestating women, viewing their desire for PAR perhaps as part of the grieving process, and the effects on the children concerned are examined; it is concluded that there appears to be no adverse effect, but this finding might be premature. The report also asserts the need for responsible accounting on the part of fertility clinics, and calls for fairness, transparency and patience to help the bereaved reach an unbiased yet informed decision. This may be achieved by offering ample time for informed and support counselling. Finally, consideration should be expressed for the welfare of unborn child, in a balanced, pragmatic and sensible manner.

Child↗
PubMed2002

Semen quality and cryopreservation in adolescent cancer patients.

BACKGROUND: Adult cancer patients are routinely offered pre-treatment sperm cryopreservation. However, only recently has the welfare of adolescent cancer sufferers gained momentum, including their infertility, and unsurprisingly relatively little is known about their semen quality and feasibility of cryopreservation. METHODS AND RESULTS: A total of 238 adolescent cancer patients referred to our centre between 1991 and 2000, from post-pubertal age up to 19 years 11.9 months, were included. Their semen was processed after appropriate counselling. Semen cryopreservation was possible in 205 of the initial 238 patients referred (86.1%). The pathology of the cancer cases included Hodgkin's lymphoma, non-Hodgkin's lymphoma, osteosarcoma, Ewing's sarcoma, acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), testicular, leukaemia, and others. The mean sperm counts were broadly uniform across the disease and age groups, except for the AML group. There was no cancer group analysed in which sperm could not be stored. Semen volume was broadly uniform across the disease groups, except the ALL and Ewing's sarcoma groups, which showed relatively lower and higher mean semen volumes respectively. Older adolescent patients appeared to have a higher mean semen volume. CONCLUSIONS: Semen cryopreservation was possible in most adolescent cancer cases regardless of age or diagnosis. In all cases the quality of the semen was potentially useful for assisted conception procedures. An offer to freeze sperm in all patients aged >12 years should be made. Adequate support and counselling of both the boys and their parents is essential.

Adolescent↗
PubMed2001

Gaining consent to freeze spermatozoa from adolescents with cancer: legal, ethical and practical aspects.

Sperm banking for early adolescent cancer patients requires delicate, sensitive handling and, in the UK, consideration is required of statutory elements. No information at present exists about how adolescents with cancer are normally treated or counselled for sperm banking. Here we highlight the type of issues in relation to fertility preservation faced by clinicians and those faced by adolescents at a sperm storage laboratory. We explore the very real difficulties of bringing together these medical fields of assisted reproduction, oncology and the various pieces of legislation and focus specifically on gaining consent. Attention is paid to counselling and communication to help the patient reach an effective and informed decision to store spermatozoa. The role of parents in contributing towards communication and support, together with the legal constraints in decision making, is acknowledged. How absolute and fully 'informed' consent should be will always remain a contentious issue amongst the various specialists and disciplines. In relation to sperm storage, as a minimum the patients should understand the process that they are undertaking so that it is undertaken freely and without pressure. The practical approach to gaining consent that we are using seems a logical and practical method to help early adolescent patients to store spermatozoa.

Adolescent↗
PubMed2001

The Human Rights Act (1998) and its impact on reproductive issues.

The Human Rights Act (HR Act) 1998 (UK) (Human Rights Act, 1998) came into effect on October 2, 2000. Instead of taking a case to the European Court of Human Rights in Strasbourg, litigants can enforce their rights in the UK. The Act will have an unprecedented effect in virtually all areas of the UK legal systems. In line with those countries who have incorporated the 'Convention' in domestic law, litigation is expected to increase. The extensive body of Convention law, as well as decisions of the domestic courts of other states which have incorporated the Convention, now becomes an integral part of UK jurisprudence. Broadly, the Act applies to public and not private bodies. The relevant bodies which embody reproductive issues and concerns are for example the National Health Service (NHS) and the regulatory bodies such as the Human Fertilisation and Embryology Authority (HFEA) (Human Fertilisation and Embryology Authority Act, 1990) and the Human Genetics Advisory Commission (HGAC). A profound impact on the NHS practice, interpretations of the HFEA Act and its Code of Practice can be envisaged in relation to the Convention rights. Cases involving reproductive issues are already emerging in relation to the HR Act and which include sex selection, the present embryo transfer policy, interpretation of fatherless offspring and the provision of fertility services under the NHS. This review is intended to raise awareness of the HR Act 1998 for persons interested in human reproductive issues and how the HR Act could impact on the current laws and practice. Whilst it is only possible to speculate on what might happen in relation to the HR Act, what is certain is that UK law will radically change to accommodate the requirements of the HR Act 1998.

Embryo, Mammalian↗
PubMed2001

Altruism in assisted reproductive technologies.

What makes reproductive technology unique is that it is in the forefront of creating human life, with an emphasis on 'giving'. Not surprisingly therefore, a significant appeal to altruism has crept into the language of reproductive technologies. If altruistic donations and behaviour involving reproductive technologies are to be encouraged we need to have a uniform understanding of the terminology. For this we need to explore how the term altruism has been used historically and is being used in modern language. It is also important to acknowledge that gender differences may influence altruistic behaviour. The suggested working definition for altruism has three major components; a motivational state, an ultimate goal and a desire to increase another's welfare. Within this framework definition, self-benefit is permissible provided the ultimate goal is not self-benefit. Altruistic donation is possible provided receiving money is not the primary motive. It is important in our efforts to improve the quality of donor and donations, which are central to assisted reproductive technologies, that any reference to altruism be restricted to the situation where only the ultimate goal, with a single motive, can be discerned. The success of recruiting altruistic donors will inevitably be associated with the attitudes and structures in which reproductive technologists operate. Through such transparency it is hoped more effective control will be achieved for donors over their donations. Irrespective of the setting, a true measure of an altruistic donation or behaviour can only be assessed by giving consideration to the primary motivational state, ultimate goal and benefit to another's welfare.

Journal Article↗
PubMed2000

Fertility issues for cancer patients.

The ethos of cancer treatment now lies in 'quality survival'. Fertility potential and preservation for male and female cancer patients has become an important feature of their management. We explore some issues about cancer, its treatment and how it could manifest itself in the fertility and reproductive health of these patients.

Female↗