Microdissection testicular sperm extraction in Japanese patients with persistent azoospermia after chemotherapy.
BACKGROUND
Combinations of surgery, radiation therapy, and chemotherapy can achieve high remission rates in patients with cancer, but these treatments can have damaging effects on spermatogenesis. In particular, cytotoxic chemotherapy may lead to irreversible spermatogenic dysfunction. Microdissection testicular sperm extraction (micro-TESE) is the only method that can address infertility in cancer survivors with persistent postchemotherapy azoospermia.


METHODS
We included 66 Japanese patients with postchemotherapy azoospermia who underwent micro-TESE for sperm retrieval in this analysis. Age, oncology data, hormone profiles, and outcomes of micro-TESE and subsequent intracytoplasmic sperm injections (ICSIs) were reviewed.


RESULTS
The common disease in our patients was testicular cancer (21 patients), followed by acute lymphoblastic leukemia and Hodgkin's lymphoma (nine patients). In this cohort of 66 patients, sperm was successfully retrieved in 31 patients (47 %), and clinical pregnancy occurred in 23 cases (35 %). The live birth rate was 27 %. No significant differences in sperm retrieval, clinical pregnancy, and live birth rates were seen between testicular cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute lymphoblastic leukemia, acute myeloid leukemia, or sarcoma cases. Multiple logistic regression analysis showed that the chance of retrieving sperm during micro-TESE could not be predicted by any variable.


CONCLUSIONS
Cryopreservation of sperm should be offered before any gonadotoxic chemotherapy takes place. However, micro-TESE and subsequent ICSI could be effective treatment options for patients with persistent postchemotherapy azoospermia whose sperm were not frozen before therapy. Our results suggest that micro-TESE-ICSI could benefit 27 % of such Japanese patients.
Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan. shintakeshi@nifty.com.|Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan. shintakeshi@nifty.com.
Takeshi
T
Shin
Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Tomohiro
T
Kobayashi
Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Yukihito
Y
Shimomura
Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Toshiyuki
T
Iwahata
Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Keisuke
K
Suzuki
Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Takashi
T
Tanaka
Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Mai
M
Fukushima
Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Megumi
M
Kurihara
Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Akane
A
Miyata
Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Yoshitomo
Y
Kobori
Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.|Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
Hiroshi
H
Okada
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D053713:Azoospermia / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D015925:Cryopreservation / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D007564:Japan / Q000453:epidemiology; D008297:Male; D042282:Microdissection / Q000379:methods; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D053625:Sperm Retrieval; D016896:Treatment Outcome
D000970:Antineoplastic Agents
Azoospermia; Cancer survivor; Chemotherapy; Infertility; Male; Testicular sperm retrieval