March 16, 2011 — A surgical technique allows the retrieval of sperm cells in men thought to be sterile after chemotherapy, according to a story published online March 14 in the Journal of Clinical Oncology.
Preservation of fertility is an important concern for young survivors of testicular cancer or lymphoma. Up to two thirds of patients will persistently have no measurable sperm after chemotherapy. Some patients will recover sperm count, but this varies with chemotherapy regimen and is poorly understood. Men with persistently negligible sperm counts have traditionally been referred to adoption or use of donor sperm.
Cryopreservation of sperm is 1 option for such patients, but many do not take advantage of it for a variety of reasons, including diagnosis before puberty, a lack of understanding of the fertility effects of chemotherapy, prohibitive cost, poor sperm quality, infertility at time of diagnosis, and unwillingness to wait before starting chemotherapy. Many men are not referred for semen preservation. In fact, as described by the researchers, one survey of patients treated at 2 different cancer centers reported that only 51% of respondents were offered sperm banking, and "only 24% of respondents actually banked sperm despite current recommendations from the American Society of Clinical Oncology."
Wayland Hsiao, MD, Peter J. Stahl, MD, and colleagues from the Weill Cornell Medical College, New York City, investigated the use of microdissection testicular sperm extraction (TESE) and intracytoplasmic sperm injection in a programmed in vitro fertilization cycle. They performed 84 TESE procedures in 73 patients an average of 18.6 years after chemotherapy (range, 1 - 34 years). Spermatozoa were successfully extracted in 37% of procedures and in 42.9% of patients overall.
The procedure achieved a fertility rate of 57.1% per injected oocyte, with a clinical pregnancy rate of 50% and a live birth rate of 42%. Twenty children were born from 15 deliveries. No birth defects were detected. When preoperative biopsies showed hypospermatogenesis, sperm retrieval success was 100% (6/6), whereas those with Sertoli cell only pattern had a success rate of 38.2% (21/55; P = .004). The highest rates were achieved in patients with testicular cancer (85.7%; odds ratio, 14.0; 95% confidence interval, 1.3 - 150.1; P = .029).
The study's weaknesses include a heterogeneous population with no standardization of chemotherapy, the inability to analyze the effect of individual agents within chemotherapy regimens, and an inability to analyze the effect of gonadal radiation on TESE outcomes because of insufficient patient population.
"Our recommendation is that sperm banking be offered before any chemotherapeutic therapy, even if the chance of azoospermia is thought to be small. However, 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," the authors write.
The study was supported by a grant from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. The authors have disclosed no relevant financial relationships.
J Clin Oncol. Published online March 14, 2011.
Preservation of fertility is an important concern for young survivors of testicular cancer or lymphoma. Up to two thirds of patients will persistently have no measurable sperm after chemotherapy. Some patients will recover sperm count, but this varies with chemotherapy regimen and is poorly understood. Men with persistently negligible sperm counts have traditionally been referred to adoption or use of donor sperm.
Cryopreservation of sperm is 1 option for such patients, but many do not take advantage of it for a variety of reasons, including diagnosis before puberty, a lack of understanding of the fertility effects of chemotherapy, prohibitive cost, poor sperm quality, infertility at time of diagnosis, and unwillingness to wait before starting chemotherapy. Many men are not referred for semen preservation. In fact, as described by the researchers, one survey of patients treated at 2 different cancer centers reported that only 51% of respondents were offered sperm banking, and "only 24% of respondents actually banked sperm despite current recommendations from the American Society of Clinical Oncology."
Wayland Hsiao, MD, Peter J. Stahl, MD, and colleagues from the Weill Cornell Medical College, New York City, investigated the use of microdissection testicular sperm extraction (TESE) and intracytoplasmic sperm injection in a programmed in vitro fertilization cycle. They performed 84 TESE procedures in 73 patients an average of 18.6 years after chemotherapy (range, 1 - 34 years). Spermatozoa were successfully extracted in 37% of procedures and in 42.9% of patients overall.
The procedure achieved a fertility rate of 57.1% per injected oocyte, with a clinical pregnancy rate of 50% and a live birth rate of 42%. Twenty children were born from 15 deliveries. No birth defects were detected. When preoperative biopsies showed hypospermatogenesis, sperm retrieval success was 100% (6/6), whereas those with Sertoli cell only pattern had a success rate of 38.2% (21/55; P = .004). The highest rates were achieved in patients with testicular cancer (85.7%; odds ratio, 14.0; 95% confidence interval, 1.3 - 150.1; P = .029).
The study's weaknesses include a heterogeneous population with no standardization of chemotherapy, the inability to analyze the effect of individual agents within chemotherapy regimens, and an inability to analyze the effect of gonadal radiation on TESE outcomes because of insufficient patient population.
"Our recommendation is that sperm banking be offered before any chemotherapeutic therapy, even if the chance of azoospermia is thought to be small. However, 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," the authors write.
The study was supported by a grant from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. The authors have disclosed no relevant financial relationships.
J Clin Oncol. Published online March 14, 2011.
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