BERKELEY, CA (UroToday.com) - In the past, men who were azoospermic after chemotherapy were routinely considered sterile, and fertility options included only donor sperm (substitutive therapy).
Recent results from treatment of men with idiopathic infertility problems have indicated that some, if not many men with non-obstructive azoospermia (low sperm production as the cause of an absence of sperm in the ejaculate), will have at least rare foci of sperm production within the testis that can be isolated and used for injection into their partners’ eggs using intracytoplasmic sperm injection (ICSI). The most effective surgical approach appears to be microdissection TESE (testicular sperm extraction), a detailed microsurgical procedure. This surgical procedure involves use of an operating microscope and is a tedious operation that involves a millimeter-by-millimeter search through the testicular tissue, identifying sites of sperm production based on the physical size and appearance of seminiferous tubules. It may take several hours to accomplish, and is done in conjunction with female treatment (IVF with ICSI).
In this report, the authors describe 84 treatment attempts of microTESE with ICSI for the female partners. Sperm were retrieved in 85% of men who had a solitary testis and had previously received platinum-based chemotherapy, but only 33% for those previously treated for lymphoma. Once sperm were found, the clinical pregnancy rate with ICSI was 50%. Even azoospermic men after chemotherapy have possible fertility options. Many of the men had low serum testosterone levels prior to attempted sperm retrieval and received medical therapy, typically with an aromatase inhibitor, to enhance endogenous testosterone production. It is not clear if this treatment increased sperm retrieval rates.
These results from a large referral center help to stratify the chance of successful treatment, when microTESE is used for sperm retrieval.
Peter N. Schlegel, MD* as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
*James J. Colt Professor of Urology
Chairman, Dept. of Urology
Weill Cornell Medical College