In the present period of drastic technological changes, the best way of increasing the innovative capacity of an economy is no longer to accumulate resources in strategic fields nor to increase incentives to private firms and other actors, but to develop networks of creative interrelations between them. This depends more on collective processes than on traditional public decisions. In that perspective, local synergies and properly organised capacities of territorial structures are of great potential. In this paper it is proposed that the conception of technology policy be revised along such lines. Careful analyses of far-reaching experiences like Sophia-Antipolis bring about creative insights and help to build effective technology policies. In the first part of the paper the history of Sophia-Antipolis is analysed in the perspective of technology policy. In the second part we draw lessons regarding two issues: The territorial basis of technology policy, and the new forms of ‘public’ action.

Study question What is the proportion of men treated for testicular cancer or lymphoma who banked sperm before gonadotoxic treatment in France? Summary answer In 2018, 41% of men with testicular cancer and 28% of men with lymphoma banked sperm before gonadotoxic treatment in France. What is known already Cancer treatments significantly improved survival rates in men. In Europe, the 5-year survival rate is above 90% for testicular cancer (TC) and Hodgkin lymphoma (HL), which, with Non Hodgkin Lymphoma (NHL), are the most frequent cancers in men of reproductive age. However, surgery, chemotherapy and/or radiotherapy may damage male fertility: between 15% and 30% of men remain permanently infertile after treatment. Since 2011, the French bioethics law recommends and guarantees free access to fertility preservation for all patients needing gonadotoxic treatments. Few international data are available about the rate of male cancer patients who receive sperm cryopreservation before cancer treatment. Study design, size, duration We analyzed the data of male cancer incidence in 2018 published by the French National Institute of Cancer (INCa), only available and latest French national data, estimated from cancer registers of selected metropolitan departments (Defossez et al. 2019). We organized a survey among the 27 metropolitan centers of the CECOS network (public centers for study and conservation of human eggs and sperm) to collect the annual number of sperm cryopreservations for TC, HL or NHL. Participants/materials, setting, methods We compared the number of 0-59 years-old men with TC, HL or NHL in metropolitan France (extracted from 2018 INCa data) and the number of sperm banking for TC, HL or NHL in metropolitan centers of the CECOS network. Main results and the role of chance INCa estimated that 38,048 new cancers were diagnosed in metropolitan France in 2018 in men aged 0-59 years. TC accounted for 2,630 new cases and lymphomas for 3,913 new cases (943 HL and 2,970 NHL). Twenty-six out of 27 metropolitan CECOS centers answered the survey (96% participation rate): in 2018, 1,079 men banked sperm for TC, 375 for HL and 211 for NHL. In 2018, the fertility preservation rate in metropolitan France was 41% for TC and 28% for lymphomas (51% for HL, and 15% for NHL). The results of our national study are in accordance with Uçar et al. 2020, a monocentric study on 110 TC patients showing a 43% fertility preservation rate, but differ from those of Abdel-Razek et al. 2020, a monocentric study on 59 NHL and 26 HL patients, showing respectively 32% and 14% fertility preservation rates. A limit of our study is to be based on estimated cancer incidence from INCa reports without stratification on age and parenthood; sperm banking activity was measured in the CECOS network, which performs 90% of French male fertility preservation (French Biomedicine Agency 2018 data). This design may induce an underestimation of cancer incidence and of sperm banking activity. Limitations, reasons for caution Our study did not consider patients who were informed of fertility preservation but did not want to/could not bank ejaculated sperm (azoospermia, sperm collection failure, no-show). In CECOS network, the estimated rate of such patients is 10%. French overseas regions were not studied (lack of INCa data). Wider implications of the findings Our results suggest that despite the recommendations and facilities offered by the French bioethics law, the male patients’ pathway for fertility preservation before cancer treatments could be improved. Further study should evaluate if this suboptimal rate of fertility preservation is homogeneous on French territory or related to postal code. Trial registration number Not applicable

Study question What are the motivations, experience, and acceptability of thermal male contraception (TMC) in men using TMC as the only couple contraceptive ? Summary answer Men wished to share the role of providing contraception in a couple and to avoid the use of hormones. Sexual satisfaction was significantly improved. What is known already Two male contraceptive methods inducing spermatogenesis suppression have achieved contraceptive efficacy, on a large population for hormonal contraception and a smaller one for thermal contraception (TC). The suppression of sperm counts to below 1 million/mL results in fertility rates commensurate with female pills. TC is obtained by wearing 15 hours/day a contraceptive underwear (CU) inducing a 2°C increase in testicular temperature (Mieusset & Bujan 1994). As no commercially available male thermal contraceptive exists, little information regarding the acceptability of this approach to men has been reported and only one publication analysed the hypothetical acceptability of TMC (Amouroux et al. 2018). Study design, size, duration We contacted 72 men who had started the CU testing phase between June 2011 and September 2019. The participants completed an anonymous online survey of 93 questions exploring population characteristics, contraceptive histories, motivations for choosing TC, patient experience at the successive phases of use, relations with partner and environment, and satisfaction with TC. Sexual life was evaluated by rating (1 to 4): frequency and pleasure of sexual intercourse, sexual desire, morning and intercourse erections. Participants/materials, setting, methods Among men who had reached the contraception use phase, the quality ratings of sexual life were compared over time, from the contraceptive method used before TC (“N-1” method) to the 2 previous methods (“N-2” and “N-3”)): “N-3” versus “contraception use phase”, “N-3” versus “CU testing phase,” and “CU testing phase” versus “contraception use phase.” These comparisons were made for all 5 sexual life parameters by a paired samples Wilcoxon signed rank test. Main results and the role of chance Sixty-seven men responded (93% response rate);63 participated in the survey (94% participation rate). The median age was 31 [21-52], 30 men (48%) had a Master’s degree or more, 49 (78%) had no child and 24 (38%) no parental project. Among the men whose couple's contraception method immediately before TC (N-1) was a female method (n = 36/63, 57%), the 2 main reasons for switching to a male method were the wish to share the role of providing contraception in a couple (n = 31/36, 86%) and the willingness to take responsibility for contraception (n = 21/36, 58%). The main motivations for choosing TC were “not using hormones” (n = 59/63, 94%) and using a method regarded as “natural” (n = 49/63, 78%). Most of men (68%) adopted the method in less than 2 weeks. During the contraception use phase (n = 59 men), they described: i) significantly improved sexual satisfaction (3,49±0,29/4) compared to that experienced with previous contraceptive methods (3,27±0,58/4;p<0,01); ii) high female partner confidence (100% rather/totally confident partner) and support (88% rather/totally supporting partner); iii) improved self-esteem (n = 35/59, 59%). The main negative point was discomfort, reported by 24% of the men. The overall satisfaction score of using TC was 3.78±0.46/4, and 100% would recommend TC to other men. Limitations, reasons for caution The study population may seem small (63 men). However, it is not different from that of the previously pubished studies on men using hormonal contraception, which included 20, 38, 79 and 57 men, respectively. Our study also lacked a similar questionnaire for the female partners. Wider implications of the findings Men using TC successfully assumed the responsibility for and performed a daily task to provide couple contraception. This positive evaluation of TC together with its previously published contraceptive efficacy and reversibility on a small population, should encourage the development of this method. Trial registration number IRB No. 2020-09-10-005

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