Testicular sperm extraction in a patient with metachronous bilateral testicular cancer

Case report: remedial microdissection testicular sperm extraction after onco-microdissection testicular sperm extraction failure

BACKGROUND

Testicular cancer (TC) mostly occurs in men aged 14 to 44. Studies have shown that TC seriously damages male fertility, and 6% to 24% of patients with TC were even found to suffer from azoospermia when they are diagnosed. At present, some studies have pointed out that onco-microdissection testicular sperm extraction (mTESE) can extract sperm from tumor testicles. However, there are almost no reports on remedial measures after onco-mTESE failure. Given the valuable opportunity for fertility preservation in patients with TC and azoospermia, it is necessary to provide effective remedial methods for patients with failed onco-mTESE.

METHODS

Two young men, who were diagnosed with TC and also found to have azoospermia, tried onco-mTESE while undergoing radical orchiectomy for fertility preservation. However, sperm extraction failed in both patients. Subsequently, the isolated testicular tissue of the patient in case 1 suffered from TC again, and the patient in case 2 was scheduled to receive multiple cycles of gonadotoxic chemotherapy. Because both had a plan to have a birth in the future, we performed remedial mTESE.

RESULTS

Sperm was successfully extracted from both patients. The patient recovered well, without complications. The patient couple in case 1 underwent 1 intracytoplasmic sperm injection (ICSI) cycle but did not achieve clinical pregnancy.

CONCLUSIONS

There is still an opportunity to extract sperm successfully using onco-mTESE, despite the difficulty of fertility preservation in TC patients with azoospermia. If sperm extraction from the tumor testis fails, implementing remedial mTESE as early as possible would likely preserve the last chance of fertility for these patients.

A male phenotype (XY) hermaphrodite treated for seminoma, fathered a healthy child by IVF-ICSI technique

OBJECTIVE

To report a successful delivery of a healthy infant fathered by an infertile 46, XY true hermaphrodite who suffered from a seminoma.

DESIGN

Case report

SETTING

IVF unit in University hospital.

PATIENT(S)

Male 41 years (true hermaphrodite), his wife 35 years.

MAIN OUTCOME MEASURES

Laboratory, pathology tests and ultrasound tests.

RESULTS

The above patient treated and cured from seminoma, the couple had in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) using frozen testicular sperm and had a healthy baby.

CONCLUSION

This is the first case report of a successful delivery of a healthy infant fathered by an infertile 46, XY true hermaphrodite who suffered from a seminoma. Once treated and cured, the couple had IVF and ICSI using frozen testicular sperm and had a healthy baby.

Testicular sperm extraction in cancerous testicle in patients with azoospermia: A Case Report

The aim of this study is to evaluate the feasibility of testicular sperm extraction (TESE) in a cancerous testicle during orchiectomy for testicular neoplasm. This is a retrospective study and includes case histories of four azoospermic patients with incidental testicular cancer. None of the patients had fathered children prior to surgery and all patients were strongly motivated by the desire to have offspring. Patients underwent surgical exploration via inguinotomy and spermatic cord clamping. After nodule excision, micro-TESE was performed from the same albugineal incision, under microscopic guidance. Frozen section examination was not performed in the case of large nodules (>3 cm in diameter). Two patients showed classic seminoma and underwent orchiectomy. In two patients, a Leydig cell tumour was found (one patient underwent orchiectomy for large nodule size). Micro-TESE was performed in four patients. Spermatozoa were found in three patients and the retrieved sperm was cryopreserved. One ICSI cycle was performed, but pregnancy failed. In azoospermic patients with testicular nodules, TESE in the cancerous testis is feasible and may avoid further surgery, without any oncological risk.

Reproductive prognosis in male patients with azoospermia at the time of cancer diagnosis

OBJECTIVE

Fertility status evaluation in patients found azoospermic at the time of malignancy diagnosis.

DESIGN

Case series follow-up.

SETTING

University Hospital Sperm Banking service.

PATIENT(S)

Male cancer patients found azoospermic between 1986 and June 2000.

INTERVENTION(S)

Patients were interviewed about their reproductive history and were invited for a free semen analysis.

MAIN OUTCOME MEASURE(S)

Pregnancy rate (PR) and percentage of patients with viable spermatozoa in the ejaculate.

RESULT(S)

Sixty-five patients were enrolled; 16 were lost at follow-up, 7 died, and 42 were followed to the end of the study. The median (range) time of follow-up for the 42 remaining patients was 9 years (2-14 years). Seventeen patients had wanted to father a child; 12 had a child (71%, 95% confidence interval [CI] 48%-88%). Semen analysis results were available in 11 patients. Resumption of spermatogenesis was documented in 9 cases (82%, 95% CI 53%-97%).

CONCLUSION(S)

Spontaneous fertility recovery is frequent in patients who are azoospermic at the time of cancer diagnosis.

Preserving the reproductive potential of men and boys with cancer: current concepts and future prospects

The introduction of ICSI has totally changed the reproductive prospects for boys and men who are treated for cancer. With post-pubertal boys and adult men, semen cryopreservation should be offered to every patient undergoing a cancer treatment since preservation of fertility cannot be guaranteed for an individual patient and treatment may shift to a more sterilizing regimen. In the ICSI era, all semen samples, even those containing only a few motile sperm, should be accepted for cryopreservation. Patients who are azoospermic at the time cancer is diagnosed may be offered testicular sperm extraction and cryopreservation of testicular tissue. With pre-pubertal boys, no prevention of sterility by sperm banking is possible since no active spermatogenesis is present. However, in the next decade, prevention of sterility in childhood cancer survivors will become a major challenge for reproductive medicine. In theory, testicular stem cell banking is the only way of preserving the future fertility of boys undergoing a sterilizing chemotherapy. In animal models, testicular stem cell transplantation has proved to be effective; however, it remains to be shown that this technique is clinically efficient as well, especially when frozen-thawed cells are to be transplanted. Malignancy recurrence prevention is an important prerequisite for any clinical application of testicular stem cell transplantation. Although still at the experimental stage, cryobanking of testicular tissue from pre-pubertal boys may now be considered an acceptable strategy.

Successful pregnancy outcome using sperm from severely diseased men with testicular cancer and collagen disease: Three case reports

Objective:  To confirm the feasibility of using fresh or frozen/thawed spermatozoa from cancer and collagen diseased patients for intracytoplasmic sperm injection (ICSI). Patients:  Two participants were diagnosed with testicular carcinoma and one patient was diagnosed with collagen disease. Methods:  Of the two carcinoma patients, one patient provided a fresh testicular biopsy sample and one patient ejaculated fresh sperm after surgical operation. One collagen diseased patient's sperm was frozen, and three samples were used in subsequent ICSI treatment cycles. Their female partners underwent controlled ovarian hyperstimulation for the retrieval of oocytes. Results:  Two patients with testicular cancer and their respective partners achieved successful pregnancies from ICSI using fresh sperm after surgery. The patient suffering from collagen disease had a successful pregnancy from ICSI using sperm frozen prior to chemotherapy treatment. Conclusions:  Patients with testicular carcinoma or collagen disease who might desire to father children in the future should be offered sperm preservation prior to the initiation of chemotherapy treatment. Under currently available treatment, patients with cases of severe disease can still become biological fathers. (Reprod Med Biol 2004; 3: 69-75).