Successful Treatment of Postchemotherapy Azoospermia With Microsurgical Testicular Sperm Extraction: The Weill Cornell Experience

Abstract

Purpose Advances in chemotherapy have led to greater longevity and paternity may be an important consideration for postchemotherapy survivors of childhood cancers. While traditionally considered sterile, men who are azoospermic after chemotherapy can be treated with microdissection testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). Patients and Methods Oncologic data, pretreatment hormone profiles, testicular histology, and outcomes of microdissection TESE-ICSI were reviewed. ICSI was performed in a programmed in vitro fertilization cycle using fresh spermatozoa. Embryos were transferred into the uterine cavity on the third day after microinjection. Results Eighty-four microdissection TESE procedures were performed in 73 patients. The mean time elapsed since chemotherapy was 18.6 years (range, 1 to 34 years). Spermatozoa were retrieved in 37% of patients and in 42.9% of overall procedures. A 57.1% fertilization rate (per injected oocyte) was achieved with ICSI allowing a 50% clinical pregnancy rate with a live birth rate of 42% overall. There were 15 deliveries, with a total of 20 children born. Hypospermatogenesis seen on preoperative biopsy was associated with 100% sperm retrieval while exposure to alkylating agents resulted in a significantly lower sperm retrieval rate. Patients with testicular cancer had the highest sperm retrieval rates while patients previously treated for sarcoma had the lowest retrieval rates. Conclusion To our knowledge, this represents the largest series of postchemotherapy microdissection TESE-ICSI to date. Sperm were retrieved in 37% of patients despite a prevalence of Sertoli cell–only pattern on preoperative biopsy. Although prechemotherapy sperm cryopreservation is recommended, treatment with microdissection TESE and ICSI are effective treatment options for many azoospermic men after chemotherapy.