For the up to two-thirds of men with azoospermia after chemotherapy, microdissection testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) can salvage fertility, according to the largest reported series of postchemotherapy microdissection TESE-ICI to date. Although prechemotherapy sperm banking remains a recommended part of any treatment plan, researchers from Weill Cornell Medical College in New York City demonstrated that assisted reproductive techniques should be offered to patients who did not preserve sperm.
Hsiao and colleagues analyzed 84 TESE procedures performed in 73 patients with persistent postchemotherapy azoospermia (mean time since treatment, 18.6 years). Of the 61 patients who underwent testicular biopsy, 90.2% showed a Seroli-cell–only pattern and 9.8% showed hypospermatogenesis.
Surgeons retrieved sperm from 37% of patients, which equated to 42.9% of procedures. From these sperm, a 57.1% fertilization rate per injected oocyte was achieved, resulting in a 50% clinical pregnancy rate (confirmed by fetal heartbeat 32 days postprocedure) and a 42% live birth rate.
Sperm retrieval rates differed by disease site, with the highest rate (85%) seen in men who were treated for testicular cancer and the lowest rate (14%) in men treated for sarcoma. The researchers speculated that these rates correlate not with the cancer site but with the therapy commonly used for these cancers, that is, low gonadotoxic platinum-based chemo therapy and high rates of exposure and higher doses of alkylating agents, respectively.
Retrieval success was found to associate with exposure to an alkylating agent, with exposure associated with less success than no exposure (21.4% vs 45.7%, respectively). On multivariate analysis, however, this association did not reach significance. Testicular histopathology pattern correlated with retrieval rates as well. Hypospermatogenesis was uniformly associated with successful sperm retrieval (100%), whereas a Seroli-cell– only pattern correlated with a lower rate of success (38.2%).
Some factors did not affect retrieval rates. Testicular volume, follicle-stimulating hormone, time since chemotherapy, age at TESE, and luteinizing hormone use were not found to correlate with TESE outcome.
The researchers noted that because this was not a retrospective trial, it is difficult to determine the impact of a single agent when analyzed as part of a chemotherapy regimen. In addition, the small study did not accrue enough patients who received gonadal radiation treatment for the researchers to analyze the data.
The complete study is published online in the Journal of Clinical Oncology (March 14, 2011).
To sign up for our newsletter or print publications, please enter your contact information below.
