Microdissection testicular sperm extraction and salvage hormonal treatment in patients with postchemotherapy azoospermia

摘要

Objective To investigate the efficacy of microdissection testicular sperm extraction (micro-TESE) in patients with postchemotherapy azoospermia (PCA), we reviewed our results of micro-TESE combined with intracytoplasmic sperm injection, which are the most commonly used fertility treatments. Furthermore, we investigated the efficacy of hormonal therapy for men who failed to recover sperm after micro-TESE. Methods Twenty-six patients with PCA with the mean age of 34.6 years (range, 23-42) were included in this study. The cancer types included testicular cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, leukemia, neuroblastoma, osteosarcoma, and malignant pheochromocytoma. The mean interval from chemotherapy to micro-TESE was 14.8 years (range, 7-25), and the mean age of the female partners was 34.1 years. Results Sperm were retrieved in 11 (42%) of the patients. Six patients who did not obtain successful sperm retrieval underwent human chorionic gonadotropin-based hormonal therapy, and sperm were retrieved from 2 patients by a second micro-TESE. In total, 7 (27%) pregnancies and 5 (19%) live birth deliveries were achieved. Patients with PCA after testicular cancer treatment were able to achieve a high rate (75%) of sperm retrieval and that exposure to alkylating agents resulted in lower sperm retrieval rates. Conclusion Micro-TESE-intracytoplasmic sperm injection is an effective fertility treatment for patients with PCA. Furthermore, patients who could not achieve successful sperm retrieval by micro-TESE might obtain improved outcomes with hormonal therapy, indicating that these treatments might provide the patients with PCA with the opportunity to retrieve sperm and father a child.