Testicular sperm extraction combined with intracytoplasmic sperm injectionin the treatment of men with persistent azoospermia postchemotherapy

BACKGROUND. Men who remain azoospermic long after undergoing chemotherapy h ave generally been considered sterile. The authors report their experience with testicular sperm extraction (TESE) combined with intracytoplasmic sper m injection (ICSI) applied to azoospermic men who previously received chemo therapy for a variety of indications. METHODS. Among 231 cycles in 198 patients who underwent TESE-ICSI for nonob structive azoospermia from 1995 to 2000, 20 TESE procedures in 17 patients who previously received chemotherapy were identified. Ali TESE procedures w ere performed with microsurgical control under local anesthesia with sedati on or general anesthesia. The pretreatment hormonal profile, histology of t esticular biopsies, and outcomes of TESE-ICSI in this subgroup of patients were analyzed. RESULTS. The mean patient age was 37.4 years (range, 28-54 years), and the mean follicle-stimulating hormone level was 21.8 mIU/mL (range, 7.1-43.1 mI U/mL). The mean age for female partners was 33.5 years (range, 22-43 years) . Six patients had received chemotherapy for Hodgkin lymphoma (34%), four p atients had received chemotherapy for testicular neoplasm (24%), two patien ts had received chemotherapy for non-Hodgkin lymphoma (12%), two patients h ad received chemotherapy for leukemia (12%), one patient had received chemo therapy for Wilms tumor (6%), one patient had received chemotherapy for med iastinal germ cell tumor (6%), and one patient had received chemotherapy fo r nephrotic syndrome (6%). Three patients (18%) received additional radiati on therapy. The mean interval from chemotherapy to TESE was 16.3 years (ran ge, 6-34 years). All patients had at least two semen analyses to confirm az oospermia. A total of 20 attempts of TESE-ICSI were performed (mean, 1.2 at tempts per patient). Testicular histology revealed Sertoli cell-only patter n in 76% of patients. The remaining 24% of patients had hypospermatogenesis as their most advanced spermatogenic pattern. Among the men with Sertoli c ell-only pattern, 23% had sperm retrieved by TESE. Sperm retrieval was acco mplished in 9 of 20 attempts (45%), with biochemical pregnancy after sperm retrieval in 4 of 9 couples (45%) and clinical pregnancy in 3 of 9 couples (33%). Live deliveries were achieved in 2 of 9 couples (22%). Two healthy b oys and one girl were delivered. No correlation was noted between the outco me of TESE-ICSI and the underlying conditions that were treated with chemot herapy nor with the chemotherapeutic agents used. CONCLUSIONS. Using TESE-ICSI, sperm retrieval leading to pregnancy and the delivery of healthy children is possible for men with long-standing azoospe rmia after chemotherapy. The prognosis for sperm retrieval was not influenc ed clearly by the chemotherapy regimen or the disease treated. Diagnostic b iopsy also was of limited value in predicting the outcome of sperm retrieva l, Despite prolonged nonobstructive azoospermia after undergoing chemothera py, men no longer should be considered sterile in the era of advanced assis ted reproductive techniques. (C) 2001 American Cancer Society.