MP31-05 PREDICTION OF MICRODISSECTION TESTICULAR SPERM EXTRACTION OUTCOME IN POST-CHEMOTHERAPY AZOOSPERMIC MEN USING CYCLOPHOSPHAMIDE EQUIVALENT DOSE

Abstract

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-05 PREDICTION OF MICRODISSECTION TESTICULAR SPERM EXTRACTION OUTCOME IN POST-CHEMOTHERAPY AZOOSPERMIC MEN USING CYCLOPHOSPHAMIDE EQUIVALENT DOSE Shi-Jie Tsai, I-shen Huang, and William J. Huang Shi-Jie Tsai Shi-Jie Tsai More articles by this author , I-shen HuangI-shen Huang More articles by this author , and William J. HuangWilliam J. Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cancer per se or therapies, particularly treatment involved with chemotherapy, appears to potentiate gonadal toxicity. For men with persistent postchemotherapy azoospermia, fatherhood can be possibly achieved via microdissection testicular sperm extraction (mTESE) combine with intracytoplasmic sperm injection (ICSI). Yet, the recovery of viable testicular sperm with mTESE is unpredictable in this population. Using cyclophosphamide equivalent dose (CED) as a means of quantifying exposure to alkylating agent, a cytotoxic agent that has been demonstrated to disrupt spermatogenesis, we sought to discover the sperm retrieval rate in men with persistent azoospermia postchemotherapy in relation to CED. METHODS: We retrospectively reviewed records of 910 patients with the diagnosis of non-obstructive azoospermia who had undergone mTESE between 2010 to 2018 in our institution and enrolled 14 patients with a prior history of chemotherapy. The oncological data and chemotherapy regimen of each individual were reviewed. For each patient’s regimen received, a CED was calculated using the equation proposed by Daniel Green et al. in 2014. The pretreatment hormone profile, CED, and outcomes of mTESE were analyzed. RESULTS: Testicular spermatozoa were successfully retrieved in 6 (43%) of the patients. The mean patient age was 36 years (range, 27-42 years) and the mean time interval from chemotherapy to mTESE was 10.4 years (range, 1-26 years). Although CED and alkylating agent exposure were not predictive factors for successful sperm retrieval (p=0.14), however, no men with CED >4000 mg/m2 (n=4) had viable sperm detected in testis during mTESE. As for the other 10 patients without alkylating agent exposure (i.e. CED=0 mg/m2), sperm can be recovered in 6 (60%) of them. Regarding cancer subtypes, patients diagnosed with testicular non-seminomatous germ cell tumor had favorable sperm retrieval rate (3/5, 60%), compared to patients with non-Hodgkin’s lymphoma (0/3, 0%) or leukemia (1/2, 50%), respectively. CONCLUSIONS: The chance of successful sperm retrieval using mTESE for men with persistent postchemotherapy azoospermia and a calculated CED >4000 mg/m2 is zero. These patients should be properly counseled with the CED model before pursuing surgical sperm retrieval . Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e556-e557 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shi-Jie Tsai More articles by this author I-shen Huang More articles by this author William J. Huang More articles by this author Expand All Advertisement Loading ...