Testis Sperm Extraction (TESE) Is Effective in the Azoospermic Male with a History of Prior Chemotherapy

Abstract

Objectives: Approximately 50% of the total group of men with non-obstructive azoospermia (NOA) will have sperm found within the testis parenchyma which can be used with ICSI to achieve biological paternity. Questions: what are the rates of sperm retrieval and pregnancy for subgroups with NOA, e.g., post-chemotherapy? The purpose of this study is to define the success of TESE and the pregnancy rates for only those men who are azoospermic due to chemotherapy so as to be able to counsel this type of NOA patient as best possible. Materials and Methods: 7 NOA men subsequent to chemotherapy and who underwent TESE comprise the study group. Harvested tissue was analyzed and cryopreserved if sperm were present and thawed homogenate used for subsequent cycles of ICSI. Age range: 28 to 43 years. legendAge at chemolegendC: cyclophosphamide; V: vincristine; D: doxorubicin; Chl: chlorambucil; Pro: procarbazine; P: prednisone; B: bleomycin; Cis: cisplatin.Reason for chemoChemo agents usedSperm present12Systemic LupusChlNo21Testis CancerCis, V, BNo4Nephrotic SyndromeC, P. ChlNo23Histiocytic lymphomaMechlorethamine, V, Pro, PYesPending24Hodgkin'sV, C, DYes7Twins lost at 25 weeks15Ewing's SarcomaV, D, Actinomycin DYes1Ongoing pregnancy15Testis CancerCis, Vp-16, BYes1Ongoing pregnancylegend C: cyclophosphamide; V: vincristine; D: doxorubicin; Chl: chlorambucil; Pro: procarbazine; P: prednisone; B: bleomycin; Cis: cisplatin. Open table in a new tab Results: Of the 7 men, 4 (57%) had sperm found during TESE. These 4 men were all pubertal or post-pubertal at the time of chemotherapy. The fertilization rate ranged from 58–80%. The twin aborteses were normal in appearance, premature rupture of membranes the cause. Conclusion: For the subgroup of men with NOA due to prior chemotherapy, TESE may be successful and pregnancy can be achieved. These are early and encouraging results but since there are so many types of chemotherapy agents used, large numbers of patients will be needed to give an individual patient an accurate assessment of his chances. In addition, the children will need to be followed carefully as there is no data as to their future health. Data that discusses naturally conceived offspring of post-chemotherapy men cannot be applied to this group as spermatogenesis in these men returned to good levels, unlike this study group who were more severely and permanently affected.