Human Reproduction, Vol. 18, No. 6, 1281-1285,
June 2003
© 2003 European Society of Human Reproduction and Embryology
Testicular sperm extraction (TESE) and ICSI in patients with permanent azoospermia after chemotherapy*
1 Andrology Laboratory and Semen Bank, Instituto Valenciano de Infertilidad, 2 Fundación IVI, 3 Department of Paediatrics Obstetrics and Gynaecology and Department of Surgery, Valencia University School of Medicine, 4 Hospital Universitario Dr. Peset, Valencia and 5 Hospital Clínico Universitario, Valencia, Spain
6 To whom correspondence should be addressed at: Instituto Valenciano de Infertilidad, Plaza de la Policía Local, 3, Valencia 46015, Spain. e-mail: marcos.meseguer{at}ivi.es
BACKGROUND: Patients persistently azoospermic after chemotherapy have been considered traditionally as sterile unless sperm was frozen before therapy. Recent advances during the last decade combining testicular sperm extraction (TESE) and ICSI in patients with non-obstructive azoospermia allow these males to father their own genetic offspring. METHODS: A retrospective study was conducted of 12 patients with non-obstructive azoospermia after chemotherapy undergoing TESE between 1995 and 2002. Cancer type and anti-neoplastic treatments were recorded, together with maximum testicular volume, serum FSH levels and testicular histopathology. When TESE was successful, spermatozoa were cryopreserved for performing ICSI later. RESULTS: In five patients (41.6%) motile spermatozoa for cryopreservation and ICSI were retrieved. Four of them had received chemotherapy for testicular cancer, and one had been treated by chemotherapy/radiotherapy for Hodgkin’s disease. Clinical and histological parameters were unable to predict with certainty TESE outcome in an individual patient. Eight ICSI cycles were performed on five couples and one pregnancy was obtained which resulted in the delivery of a healthy girl. CONCLUSION: Some patients with permanent azoospermia after chemotherapy can be successfully treated by TESE–ICSI. This procedure, however, may have potential genetic risks. Therefore, freezing semen before starting gonadotoxic therapy is the strategy of choice, and patients should be counselled accordingly.
Key words: azoospermia/cancer/chemotherapy/ICSI/TESE
* This work was partially presented at the 57th Annual Meeting of the American Society of Reproductive Medicine at Seattle (WA) in October 12–17, 2002.
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