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 retroperitoneal lymph node dissection (RPLND) for testicular cancer.


METHODS
Retrospective clinical study.


METHODS
Tertiary care, university-affiliated IVF program.


METHODS
Anejaculate men after RPLND, spouses.


METHODS
Electroejaculation, microsurgical sperm aspiration, various assisted reproductive technologies.


METHODS
Sperm density and motility, fertilization rate, pregnancy rate (PR).


RESULTS
Compared with patients not receiving chemotherapy, patients who received chemotherapy had diminished average sperm densities and motilities (63 x 10(6) and 20% versus 101 x 10(6) 32%, respectively); decreased fertilization rates per cycle for IVF and intracytoplasmic sperm injection (ICSI) (11% versus 26%, respectively); lower PRs per cycle of hMG-IUI and IVF (14% versus 60% and 8% versus 50%, respectively). No pregnancies were achieved with natural cycle-IUI, 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 decreased sperm densities, motilities, fertilization, and PRs for each modality used. Rectal probe electroejaculation with ART can help anejaculate men after RPLND achieve biologic paternity. An early move to the more aggressive therapies (hMG-IUI, IVF, ICSI) is supported.
Hakim
L S
LS
Department of Urology, Boston University School of Medicine, Massachusetts 02118, USA.
Lobel
S M
SM
Oates
R D
RD
D000328:Adult; D003593:Cytoplasm; D004542:Ejaculation; D004558:Electric Stimulation; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007248:Infertility, Male / Q000628:therapy*; D007315:Insemination, Artificial; D008198:Lymph Nodes / Q000601:surgery*; D008297:Male; D008596:Menotropins / Q000627:therapeutic use; D008845:Microinjections; D008866:Microsurgery; D009865:Oocytes / Q000648:ultrastructure; D011247:Pregnancy; D012099:Reproductive Techniques; D012187:Retroperitoneal Space; D013094:Spermatozoa; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
D008596:Menotropins