Hum. Reprod. Advance Access originally published online on September 25, 2006
Human Reproduction 2007 22(2):495-499; doi:10.1093/humrep/del376
Cryptozoospermia with normal testicular function after allogeneic stem cell transplantation: A Case Report
1 Department of Molecular and Clinical Endocrinology and Oncology 2 Department of Obstetrics—Gynaecology and Reproductive Medicine, ‘Federico II’ University, Naples 3 Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gametes Cryopreservation, University of Padova, Padova and 4 Department of Biochemistry and Medical Biotechnology, Unit of Haematology, ‘Federico II’ University, Naples, Italy
5 To whom correspondence should be addressed at: Department of Molecular and Clinical Endocrinology and Oncology, ‘Federico II’ University of Naples, via S. Pansini 5, Naples 80131, Italy. E-mail: tauchman{at}unina.it
One of the most frequent consequences of allogeneic haemopoietic stem cell transplantation (allo-SCT) in both males and females is gonadal insufficiency. We report the case of a 27-year-old myelodysplastic male who developed azoospermia after allogeneic transplantation of haemopoietic stem cells from his HLA-identical sister. Post-transplant azoospermia was alternated with intermittent severe oligospermia. The patient had a normal endocrine pattern and evidence of mild chronic graft-versus-host disease (cGVHD). Normal intratesticular spermatogenesis was revealed by bilateral fine needle aspiration (FNA) cytology. Inflammation was evident at semen analysis, but no infection was detected by microbiological examination and sperm culture. These findings, together with the re-appearance of sperm cells at semen analysis after a low-dose immunosuppressive treatment, suggested the presence of cGVHD of the urogenital tract, causing a reversible obstruction of the spermatic tract and cryptozoospermia. This is the first case report documenting a severe impairment of sperm count because of a reversible obstruction of the seminal tract, likely caused by cGVHD, in a long-term survivor of allo-SCT with normal endocrine pattern. An important practical consequence of this case report is the fact that azoospermia was cured using low-dose immunosuppressive therapy, and this allowed us to avoid expensive stimulatory treatments with gonadotrophins, which remain, however, ineffective if the obstruction of spermatic tracts is not removed. A spontaneous uncomplicated pregnancy occurred in the partner of the patient 3 months after the corticosteroid treatment withdrawal.
Key words: male infertility/testicular function/cryptozoospermia/allogeneic stem cell transplantation/chronic graft-versus-host disease
L.Tauchmanovà, C.Alviggi, C.Foresta, A.Colao and C.Selleri designed the study and participated in the collection and analysis of data. I.Strina, A.Garolla, G.Lombardi, G.De Placido and B.Rotoli participated in the collection and critical analysis of data. All authors helped write the manuscript.