THE ACHIEVEMENT OF PREGNANCIES USING ASSISTED REPRODUCTIVE TECHNOLOGIES FOR MALE FACTOR INFERTILITY AFTER RETROPERITONEAL LYMPH-NODE DISSECTION FOR TESTICULAR-CARCINOMA

Objective: To evaluate the success of electroejaculation with assisted reproductive technologies (ART) in anejaculate men after retroperiton eal lymph node dissection (RPLND) for testicular cancer. Design: Retro spective clinical study. Setting: Tertiary care, university-affiliated IVF program. Patients: Anejaculate men after RPLND, spouses. Interven tions: Electroejaculation, microsurgical sperm aspiration, various ass isted reproductive technologies. Main Outcome Measures: Sperm density and motility, fertilization rate, pregnancy rate (PR). Results: Compar ed with patients not receiving chemotherapy, patients who received che motherapy had diminished average sperm densities and motilities (63 x 10(6) and 20% versus 101 x 10(6) and 32%, respectively); decreased fer tilization rates per cycle for IVF and intracytoplasmic sperm injectio n (ICSI) (11% versus 26%, respectively); lower PRs per cycle of hMG-IU I and IVF (14% versus 60% and 8% versus 50%, respectively). No pregnan cies were achieved with natural cycle-TUI, clomiphene citrate-IUI, or GIFT. Two couples progressed to intracytoplasmic sperm injection with one achieving the successful delivery of healthy twins. The overall PR per cycle was 22%. Conclusions: Patients receiving chemotherapy had d ecreased sperm densities, motilities, fertilization, and PRs for each modality used. Rectal probe electroejaculation with ART can help aneja culate men after RPLND achieve biologic paternity. An early move to th e more aggressive therapies (hMG-IUI, IVF, ICSI) is supported.