Adult men who were thought to be rendered sterile due to chemotherapy for childhood cancer may be able to reproduce with the help of a surgical technique that has recently been shown to locate and extract viable sperm in more than one-third of such former cancer patients.
Microdissection testicular sperm extraction (TESE) helps identify small, sperm-producing areas of the testicles and can then be used to extract these healthy sperm cells, even from testicles severely damaged by chemotherapy. In the current study, Peter N. Schlegel, MD, urologist-in-chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center (New York, New York), and colleagues performed 84 microdissection TESE procedures in 73 patients who were azoospermic after undergoing chemotherapy an average of 18.6 years earlier.
The clinicians were able to retrieve spermatozoa in 37% of patients and in 42.9% of overall procedures. Men who had had testicular cancer yielded the highest sperm-retrieval rates; those previously treated for sarcoma had the lowest.
Using in vitro fertilization by means of intracytoplasmic sperm injection (ICSI), Schlegel’s team achieved a 50% clinical pregnancy rate and a 42% live birth (20 children born in 15 deliveries) rate using the retrieved sperm.
“Although prechemotherapy sperm cryopreservation is recommended, treatment with microdissection TESE and ICSI are effective treatment options for many azoospermic men after chemotherapy,” wrote the authors in Journal of Clinical Oncology. ONA