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Available from: Ashraf T Soliman, Feb 10, 2014
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    ABSTRACT: The Centres for Disease Control and Prevention have defined a chronic diseases as an "illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely". Approximately 20% of all children have a chronic illness and 65% of them the illness is severe enough to interfere with daily activities. Failure of pubertal growth, delay or absence of sexual development, infertility and sexual dysfunction due to hypogonadism and defective spermatogenesis are well recognized disturbances among adolescents and young male adult patients with chronic diseases. The causes are multifactorial and can be due to disease itself, associated complications or drugs. Haemoglobinopathies, endocrine disorders, gastrointestinal and renal diseases are some examples that frequently cause some degree of disability. Infertility affects the future quality of life of these patients and is a predictor of stress in current and future relationships. Health care providers often neglect the reproductive health of chronically ill adolescents and young adults, although many studies indicate that they are sexually active and interested in knowing about their future fertility. This review article provides an overview of the literature concerning the impact of some chronic diseases in adolescents and young adults on reproductive health but will not address patients with cancer because it has been tackled adequately in the literature.MEDLINE database search of English-language medical journal articles published between 1975 and 2012 for papers related to reproductive health in adolescents and young adults with chronic diseases since childhood was done. Several Authors, recommend that all young adult patients with severe/prolonged chronic disease in childhood should be offered reproductive health care in a specialized center with appropriate expertise, involving a multidisciplinary team, including endocrinologists, andrologists, geneticists, psychologists, urologists and specialist nurses. Adequate information must be provided to these patients about adolescent reproductive health, including types of contraception, pregnancy, sexually transmitted infections and fertility. The importance of transitional care between pediatric and adult medical care should not be ignored. In the development of this process the adolescent must be involved in decision-making regarding treatment or referral. Reproductive health medicine should take a wider view to create a physical, psychological and genetic wellbeing of these patients.
    Pediatric endocrinology reviews: PER 10(3):284-96.
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    ABSTRACT: Failure of pubertal growth, delay or absence of sexual development, infertility and sexual dysfunction due to hypogo-nadism and defective spermatogenesis are well recognized disturbances among male patients with thalassaemia major (-thal). These problems are attributed mainly to the damage caused by chronic anaemia and deposition of iron in the pituitary gland and testicles. In our experience, more and more adult thalassemic patients in their second and third decade of life with the prospect of marriage wish to know their ability to father a child. It is possible to induce or restore sper-matogenesis with exogenous gonadotrophins. Although knowing the importance of good compliance with treatment, clini-cians have to consider the possibility that overzealous desferrioxamine treatment may adversely affect spermatogenesis and/or sperm function. Much progress has been achieved in the field of male infertility in both diagnostics and treatment. Assisted reproductive techniques may further help these patients to overcome previously untreatable causes of male infer-tility. This is not a comprehensive review of male fertility problems in thalassaemia. However, it is a short contribution written by pediatric endocrinologists and haematologist with a great interest in the subject and actively involved in the management of male infertility in -thal subjects. Today many patients with thalassaemia major (-thal) successfully survive into adult life, due to remarkable improvement of medical care and to a better understanding of pathogenesis, clini-cal manifestations and prevention of endocrine complications (1-5). Despite the improvement of the treatment, the involvement of the endocrine system still burdens the life of these patients. In fact, several studies have reported that as many as 51% to 66% of patients may have pubertal failure, sexual dysfunction and infertility, due to hypogonadism (1-5). The causes of male infertility in general popula-tion are multiple while in -thal are classically considered to be the result of iron deposition in the endocrine glands (4). Iron overload may be the result of economic cir-cumstances (expense of the chelation therapy), late onset of chelation therapy or poor compli-ance with treatment (6). Toxicity starts when the iron load in a particular tissue exceeds the tissue or blood-binding capacity of iron, and free non-transferrin iron appears. The 'free iron' is a cata-lyst of the production of oxygen species that damage cells and peroxidize membrane lipids leading to cell destruction (7). Other possible causes of hypogonadism in -thal include liver disorders, chronic hypoxia and associated endocrine complications, such as diabetes (8). This is not a comprehensive review of male fer-tility problems in thalassaemia. It is not meant to be. However, it is a short contribution written by pediatric endocrinologists and haematologist with a great interest in the subject and actively involved in the management of male infertility in -thal subjects.
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    [Show abstract] [Hide abstract]
    ABSTRACT: Failure of pubertal growth, delay or absence of sexual development, infertility and sexual dysfunction due to hypogo-nadism and defective spermatogenesis are well recognized disturbances among male patients with thalassaemia major (-thal). These problems are attributed mainly to the damage caused by chronic anaemia and deposition of iron in the pituitary gland and testicles. In our experience, more and more adult thalassemic patients in their second and third decade of life with the prospect of marriage wish to know their ability to father a child. It is possible to induce or restore sper-matogenesis with exogenous gonadotrophins. Although knowing the importance of good compliance with treatment, clini-cians have to consider the possibility that overzealous desferrioxamine treatment may adversely affect spermatogenesis and/or sperm function. Much progress has been achieved in the field of male infertility in both diagnostics and treatment. Assisted reproductive techniques may further help these patients to overcome previously untreatable causes of male infer-tility. This is not a comprehensive review of male fertility problems in thalassaemia. However, it is a short contribution written by pediatric endocrinologists and haematologist with a great interest in the subject and actively involved in the management of male infertility in -thal subjects. Today many patients with thalassaemia major (-thal) successfully survive into adult life, due to remarkable improvement of medical care and to a better understanding of pathogenesis, clini-cal manifestations and prevention of endocrine complications (1-5). Despite the improvement of the treatment, the involvement of the endocrine system still burdens the life of these patients. In fact, several studies have reported that as many as 51% to 66% of patients may have pubertal failure, sexual dysfunction and infertility, due to hypogonadism (1-5). The causes of male infertility in general popula-tion are multiple while in -thal are classically considered to be the result of iron deposition in the endocrine glands (4). Iron overload may be the result of economic cir-cumstances (expense of the chelation therapy), late onset of chelation therapy or poor compli-ance with treatment (6). Toxicity starts when the iron load in a particular tissue exceeds the tissue or blood-binding capacity of iron, and free non-transferrin iron appears. The 'free iron' is a cata-lyst of the production of oxygen species that damage cells and peroxidize membrane lipids leading to cell destruction (7). Other possible causes of hypogonadism in -thal include liver disorders, chronic hypoxia and associated endocrine complications, such as diabetes (8). This is not a comprehensive review of male fer-tility problems in thalassaemia. It is not meant to be. However, it is a short contribution written by pediatric endocrinologists and haematologist with a great interest in the subject and actively involved in the management of male infertility in -thal subjects.