TESE efficacious in one-third of childhood cancer survivors

Microdissection testicular sperm extraction (TESE) can effectively locate and extract viable sperm in more than one-third of adult male childhood cancer survivors who were previously considered sterile due to prior chemotherapy treatment, according to a recent study.

Many of these men were subsequently able to father children with the help of in vitro fertilization. The findings, which were published online in the Journal of Clinical Oncology (March 14, 2011), offer a new option for many cancer survivors who want to have children but were thought to be infertile because of earlier cancer treatment, researchers say.

"It was previously assumed that most male survivors of childhood cancer whose semen contained little to no viable sperm were incapable of fathering children," said senior author Peter Schlegel, MD, of Weill Cornell Medical College and New York-Presbyterian Hospital/Weill Cornell Medical Center, New York. "This study demonstrates that some of these men do in fact still produce healthy sperm, and that this technique can help men experience parenthood."

In the study, 1,072 TESE procedures were performed between 1995 and 2009 on 892 patients with azoospermia. This group included a subgroup of 73 former cancer patients an average of 19 years after receiving chemotherapy.

Researchers were able to retrieve sperm in 37% (27 of 73) of male cancer survivors and in 42.9% of individual procedures. They subsequently applied intracytoplasmic sperm injection (ICSI) to fertilize an egg with a single sperm. This resulted in slightly more than a 57% fertilization rate, a pregnancy rate of 50% (18 of 36), and the births of 20 children. Dr. Schlegel and his co-authors believe this is the largest group of men who have had microdissection TESE-ICSI after chemotherapy to date.

The team found that sperm retrieval rates differed according to the type of chemotherapy the men received. Men who received platinum drugs, such as those who were treated for testicular cancer, had the highest rate of sperm retrieval at 85%. Men treated with alkylating agents such as cyclophosphamide had lower sperm retrieval rates, ranging from 26% to 36%; this group mainly consisted of men treated for lymphoma. Men treated for sarcoma had the lowest retrieval rate, at only 14%.

"When we started this study, we thought sperm retrieval rates would be close to zero among the group of cancer survivors, but we were surprised to discover that in many cases, small areas of testicular tissue survived and resumed sperm production over a period of several years," Dr. Schlegel said. "Even in this situation, where we thought sperm production had ceased, there still may be an opportunity for fertility with the use of assisted reproductive techniques like this one."