The case of an infertile couple in which a testicular seminoma and azoospermia were discovered in the husband during infertility treatment is described. A small piece of testicular tissue, obtained by biopsy from the healthy testis [testicular sperm extraction (TESE)], was deep-frozen before oncology therapy was initiated. The patient's lymphocyte karyotype was normal and no Y microdeletions were found. After conclusion of oncology treatment, the tissue was thawed and successfully used in the intracytoplasmic sperm injection (ICSI) procedure. A healthy girl was born. Testicular tumours are known to impair fertility in the majority of patients, and fertility deteriorates further after cytotoxic and surgical oncology treatment. Until recently in Slovenia, for young oncology patients cryopreservation was applied only to high quality ejaculate fulfilling the criteria for intrauterine insemination or in-vitro fertilization after thawing. Failing that, the only remaining options were fertilization by donor spermatozoa or child adoption. New assisted reproductive technologies, of which the ICSI procedure is the most successful, are suitable for the treatment of only the most severe cases of male infertility. It is reasonable to cryopreserve even poor quality ejaculate prior to the oncology therapy, as well as testicular tissue in cases of azoospermia.

The combination of 4-epi doxorubicin (4-epi-DX) and 5-fluorouracil (5-FU) versus 5-FU alone was studied in previously untreated patients with metastatic gastric and rectosigmoid cancer. 5-FU alone was administered at the dose of 12mg/kg/day i.v. on days 1, 2, 3, 4 and 5 every 3–4 weeks. The combination regimen included 4-epi-DX 40 mg/m²/day i.v., on days 1 and 2 (80 mg/m²/cycle) and 5-FU administered as in the single-agent schedule, but at a somewhat lower dose (10 mg/m²/day i.v. on days 1, 2, 3, 4 and 5). Sixty-two patients with gastric cancer were evaluable, 30 in the 5-FU group and 32 in 4-epi-DX + 5-FU group. The results showed 6 partial remissions out of 30 patients treated with 5-FU alone (response rate 20%) with a median remission duration of 4 months. With 4-epi-DX + 5FU the response rate was 41% (13/32) with 1 complete and 12 partial remissions. The median remission duration was 8 months. The difference in treatment results was statistically significant (p <0.05). In rectosigmoid cancer the group on 5-FU included 26 patients who showed a response rate of 19% (5/26). 4-epi-DX + 5-FU resulted in 6 responses (2 complete remissions, 4 partial remissions) out of 27 patients treated (22%). Median remission duration in the 5-FU group was 3 months whereas it was 6 months in the 4-epi-DX + 5-FU group. Toxicity was mild and well tolerated in both treatment modalities. The results of the study in gastric cancer showed a clear-cut superiority of 4-epi-DX + 5-FU over 5-FU alone, while no difference in response rate was observed between the two approaches in rectosigmoid cancer. Nevertheless, rectal localization of primary tumors showed a slightly better response to 4-epi-DX + 5-FU (33 vs. 16%).

The aim of this retrospective study was to evaluate the efficiency of testicular biopsy and intracytoplasmic sperm injection (ICSI) in patients with aspermia or non-obstructive azoospermia (NOA) after cancer treatment. From 1996 to 2003, 30 men with a history of cancer, affected by aspermia or NOA and without sperm cryopreserved before cytotoxic treatment underwent testicular sperm extraction (TESE). In these men, clinical, hormonal and histological characteristics were compared; 13 underwent 39 TESE-ICSI cycles using frozen-thawed testicular spermatozoa (TESE-ICSI group). In the same period, 31 ICSI cycles were performed in 20 men with aspermia or NOA using ejaculated sperm frozen before cancer treatment (ejaculated sperm-ICSI group). Fertilization, blastocyst development, pregnancy and miscarriage rates were compared between the groups. Testicular volume, serum follicle-stimulating hormone level and Johnsen score indicated complete although reduced spermatogenesis in men with aspermia and abnormal spermatogenesis in men with NOA. After TESE, sperm retrieval was positive in 92% of men with aspermia and 58% of men with NOA. In TESE-ICSI patients with NOA a significantly lower proportion of embryos developed to the blastocyst stage than in patients with aspermia and in those after ICSI with frozen-thawed ejaculated sperm (23% vs. 43% and 47%, p = 0.03 and p < 0.01 respectively). In all groups the miscarriage rates were high; in patients with aspermia and NOA, characterized by increased age, the miscarriage rate tended to be higher in spite of similar female age and female indications of infertility. In patients affected by aspermia or NOA after cancer treatment and without sperm cryopreserved before treatment, TESE-ICSI using testicular sperm provide a chance to father a child.

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