Intracytoplasmic sperm injection by testicular sperm in patients with aspermia or azoospermia after cancer treatment

Abstract

The aim of this retrospective study was to evaluate the efficiency of testicular biopsy and intracytoplasmic sperm injection (ICSI) in patients with aspermia or non-obstructive azoospermia (NOA) after cancer treatment. From 1996 to 2003, 30 men with a history of cancer, affected by aspermia or NOA and without sperm cryopreserved before cytotoxic treatment underwent testicular sperm extraction (TESE). In these men, clinical, hormonal and histological characteristics were compared; 13 underwent 39 TESE-ICSI cycles using frozen-thawed testicular spermatozoa (TESE-ICSI group). In the same period, 31 ICSI cycles were performed in 20 men with aspermia or NOA using ejaculated sperm frozen before cancer treatment (ejaculated sperm-ICSI group). Fertilization, blastocyst development, pregnancy and miscarriage rates were compared between the groups. Testicular volume, serum follicle-stimulating hormone level and Johnsen score indicated complete although reduced spermatogenesis in men with aspermia and abnormal spermatogenesis in men with NOA. After TESE, sperm retrieval was positive in 92% of men with aspermia and 58% of men with NOA. In TESE-ICSI patients with NOA a significantly lower proportion of embryos developed to the blastocyst stage than in patients with aspermia and in those after ICSI with frozen-thawed ejaculated sperm (23% vs. 43% and 47%, p = 0.03 and p < 0.01 respectively). In all groups the miscarriage rates were high; in patients with aspermia and NOA, characterized by increased age, the miscarriage rate tended to be higher in spite of similar female age and female indications of infertility. In patients affected by aspermia or NOA after cancer treatment and without sperm cryopreserved before treatment, TESE-ICSI using testicular sperm provide a chance to father a child.

Testicular sperm extraction and intracytoplasmic sperm injection outcome in cancer survivors with no available cryopreserved sperm

“…In our study, we have shown that half of the men (50.7%) unable to cryopreserve sperm prior to cancer treatment and diagnosed with permanent azoospermia had successful sperm retrieved with TESE and usable for at least one ICSI cycle, a rate similar to the control group. Our data is in line with the results of previous reports (from a total of 258 patients and 283 surgical retrievals, the rate of sperm recovery was 45.9%) [36][37][38][39][40][41][42][43] and also confirm that not all forms of cancer benefit from successful sperm recovery [39].…”

“…Cumulative live birth rates per couple in NOA cancer survivors did not differ from non-cancer NOA patients (40 vs. 46.5%), despite the significantly older age of the female partners in cancer survivors. However, compared with data in literature (60 deliveries out of 122 couples = 49.2%) [36][37][38][39][40][41][42][43], we showed a lower live birth rate, and this might reflect the mean older age of the female partners in our dataset [44]. The rate of first trimester (< 12 weeks) miscarriage were higher in both NOA and RE/FOE cancer survivors, than in the non-oncologic controls.…”

Sperm banking and the cancer patient

“…These reports of successful pregnancies with cryopreserved sperm in male cancer survivors are supported by numerous other studies [Meseguer et al 2006;Zorn et al 2006;Agarwal et al 2004;Ginsburg et al 2001;Lass et al 1998;Rosenlund et al 1998;Khalifa et al 1992;Palermo et al 1992].…”

Sperm Recovery and IVF after Testicular Sperm Extraction (TESE): Effect of Male Diagnosis and Use of Off-Site Surgical Centers on Sperm Recovery and IVF

“…Alkylating agents are the most toxic to Leydig and Sertoli cells leading to decreased testicular volume and increased FSH. [9] In addition, accidents and critical illnesses, along with requests for posthumous reproduction are increasing the need for TESE procedures. [10], [11]The ability to cryopreserve sperm after testicular extraction allows better coordination with oocyte retrieval.While cryopreservation of testicular sperm is equal to fresh, even among some cohorts of men with NOA [12]–[16], concern regarding limited sperm viability during the freeze-thaw in men with NOA [8] remain prompting some to perform TESE on the day of egg retrieval to avoid sperm loss from the freeze-thaw [17].…”