Onco-testicular sperm extraction (oncoTESE): A Contemporary Concept Review and Report of Australian Sperm Retrieval Rates and Fertility Outcomes.

To assess sperm retrieval rates of oncoTESE in men with testicular tumours and coexisting severe spermatogenic impairment.

Multi-centre Australian wide retrospective review of oncoTESE procedures performed within the last 10 years.

Patients were post-pubertal adults having a testicular tumour requiring orchidectomy, with severe oligozoospermia or non-obstructive azoospermia. Ipsilateral testicular sperm extraction was performed following radical inguinal orchidectomy. A contralateral micro-testicular sperm extraction was performed if no sperm or insufficient amounts were initially achieved. Surgical sperm retrieval rates, live birth rates and post operative serum testosterone were recorded.

4 surgeons compiled a total 13 patients. The mean age was 34.9 years. 7/13 were germ cell tumour (GCT), 4/13 had non GCT and 2/13 contained benign lesions. 12/13 patients were azoospermic and 1 was severely oligozoospermic. Sperm was found in 6/7 GCT patients; 3/7 were found in the ipsilateral testis whilst the remaining 4 underwent contralateral mTESE; sperm was retrieved in 3 of 4. The respective mean pre and post orchidectomy testosterone was 12.0 versus 14.1nmol/L (GCT cohort). Cryopreserved sperm has been used in assisted reproduction in 2 of 13 patients, with median follow up of 38.7 months. Including use of both cryopreserved and fresh sperm, 6 pregnancies were achieved, including 5 healthy live births and 1 miscarriage.

OncoTESE appears feasible, with acceptable sperm retrieval and subsequent live birth rates, following assisted reproduction. Despite significant underutilisation in the Australian population, oncoTESE should be considered in the management for TC patients with severe oligozoospermia, or non-obstructive azoospermia.

Urology. 2021 Nov 20 [Epub ahead of print]

Gideon Adam Blecher, Eric Chung, Darren Katz, Kim Shannon, John Bailee

School of Clinical Sciences, Monash University. Melbourne, Australia, Department of Urology, Alfred Health, Melbourne, Australia, Department of Urology, Monash Health, Melbourne, Australia. Electronic address: ., Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia, AndroUrology Centre, St Andrew's War Memorial Hospital, Brisbane, Qld, Australia., Department of Urology, Western Health, Melbourne, Vic., Australia, Men's Health Melbourne., IVF Australia, Sydney. NSW, Macquaire University. Sydney, Australia., Department of Urology, Monash Health, Melbourne, Australia.

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