Sperm retrieval using testicular sperm extraction (TESE) coupled with intracytoplasmic sperm injection (ICSI) resulted in sperm retrieval in 37% of patients who had undergone previous chemotherapy, reports a study in the Journal of Clinical Oncology. The US study, representing the largest series of post chemotherapy microdissection TESE-ICSI yet, found that the success of fertility techniques was related to the type of cancer that the patients had been originally diagnosed with.

Advances in chemotherapy have led to greater longevity for young men, with the preservation of fertility and paternity coming to the fore as a quality of life issue. It has been estimated that up to two thirds of men who undergo chemotherapy remain persistently azoospermic after treatment. Unfortunately low rates of sperm banking prevail due to issues such as inadequate understanding of he fertility effects of chemotherapy, cost of sperm banking, poor sperm quality, azoospermia at diagnosis, or a sense of urgency to begin chemotherapy. Indeed, a recent survey of patients treated at two major cancer centres showed that only 51% of respondents had been offered sperm banking and that only 24% had actually banked sperm.

While men rendered persistently azoospermic following chemotherapy have traditionally been considered sterile and referred for adoption or use of donor sperm, there is growing recognition that fertility can be salvaged with TESE-ICSI.

In the current study Peter Schlegel and colleagues, from New York Presbyterian Hospital (US), retrospectively identified 73 patients with persistent post chemotherapy azoospermia from a series of testicular sperm extraction procedures performed between June 1995 and December 2009 by a single surgeon in 892 patients.  The results show that spermatozoa were retrieved in 37% of patients (27 of73), with an overall sperm retrieval rate of 42.9% (36 of 84).  This resulted in a 57.1% fertilization rate per injected oocyte and a live birth rate of 42% overall. Altogether there were 15 deliveries involving a total of 20 children.

When the sperm retrieval rate was stratified according to indications for chemotherapy, the highest retrieval rates were seen in patients with testicular cancer (85.7%), followed by neuroblastoma (50%), leukemia (50%), non-hodgkin's lymphoma (36.4%), hodgkin's lymphoma (25.9%), and sarcoma (14.3%). "Sarcoma patients tended to have the lowest sperm retrieval rate due to high rates of exposure and higher doses of alkylating agents," write the authors.

With the mean time elapse since chemotherapy of 18.6 years this raises the question, write the authors, of whether sperm retrieval closer to the time of chemotherapy might have resulted in higher sperm retrieval rates.

"Our data demonstrates that many men with long-term azoospermia after chemotherapy can still have their fertility salvaged with the use of assisted reproductive techniques," conclude the authors.

Article: W Hsiao, PJ Stahl. E C Osterberg et al. Successful treatment of post chemotherapy azoospermia with microsurgical testicular sperm extraction: the Weill Cornell experience. Journal of Clinical Oncology. doi: 10.1200/JCO.2010.33.7808