Testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) results in secondary azoospermic patients after chemotherapy

Abstract

Objective: Anti tumoral treatments have increased the chance of remission or cure of many cancer types, also increasing life expectancies. Unfortunately, these treatments are often aggressive and can cause detrimental effects on fertility. Persistent azoospermia is frequently found in these men. This status can be treated by testicular sperm extraction (TESE) with the aim to recover some spermatozoa to be used in assisted reproduction techniques (ART). Our objectives in this study were: 1) to determine the probability of finding spermatozoa after cytotoxic treatments in those patients with long-term azoospermia caused by therapies against cancer, and 2) assessment of fertilization, embryo development and pregnancy rates, to describe the expectative that ART can offer to these men. Design: During five years, 12 men, mean age of 34 (range: 30–44) were evaluated for azoospermia secondary to chemotherapy alone (n=7) or combined with radiotherapy (n=5) after testicular cancer (n=6), Hodgkin’s lymphoma (n=3) or other malignancies. Some of them were unilaterally orchidectomized (n=3) or suffered retroperitoneal lymph node resection (n=3). The period within the treatment and TESE ranged 4–24 years (mean 10.8 years). Follicle-stimulating hormone concentrations were within the normal range except for two patients. All of them had repeated spermiograms showing azoospermia either in ejaculates (if possible) or urine. Females were normal except for one severe endometriosis. Materials/Methods: From the TESE, two parts were embedded within Bouin’s solution and were sent for histopathological examination. The remaining parts were checked for the presence of sperm cells. If the search resulted positive, samples were immediately frozen until future use for ICSI. Results: Five out of twelve patients (41.6%) had spermatozoa available for ICSI. All of them had testicular cancer. The pathology found in the testicular biopsy comprised discrete spermatogenesis in one patient, and Sertoli-cell only syndrome alone or with mixed causes in the remaining individuals. Mixed causes included hyalinisation, tubular sclerosis and spermatogenesis arrest at various stages. Of these five samples, four were frozen to be employed in next infertility treatments, because one of them yielded only few spermatozoa that were just enough to be injected, and then used in the moment. Twelve cycles were performed, divided in 8 with fresh and 4 with frozen/thawed embryos. Total fertilization failure was one case, and the average fertilisation rate in those patients was 52.4%, ranging between 33.3% and 83.3%. Only one pregnancy was achieved which resulted in a normal newborn. Conclusions: To our knowledge, this is the second extensive study available that comprises TESE and ICSI in long term azoospermic patients after treatments against cancer. Our results indicate that is possible to achieve pregnancy in these cases, although fertilization rates, number of cycles with no transfer, clinical pregnancies and take home baby rates seem to be worse than those expected for the pre-vasectomized men previously reported by our group. Testicular cancer patients have better chances for sperm recovery. A correct management should include the offer the cryopreservation of sperm samples prior to any treatment prescribed by their oncologists. Supported by: None provided.