In-vitro fertilization and intracytoplasmic sperm injection in the treatment of infertility after testicular cancer

Abstract

Treatment of testicular cancer (TC) may cause infertility due to reduced sperm quality with or without an ejaculation problem. In cases of anejaculation or retrograde ejaculation, spermatozoa can be obtained by transrectal electroejaculation (TE) or testicular sperm extraction (TESE) and used for in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). In this study, 15 out of 17 couples evaluated for infertility after TC, underwent a total of 21 treatment cycles, resulting in 18 embryo transfers. Spermatozoa were obtained by TE in 16 cycles, by masturbation in three cycles and by TESE in one. In one cycle no spermatozoa were found using TESE. Fertilization and cleavage was achieved by IVF in seven cycles and ICSI in 11 cycles; average fertilization rates of 57 and 55% respectively were observed. Twelve clinical pregnancies occurred, of which 11 have been delivered or are ongoing. The ongoing pregnancy rate was 57% per cycle. These results show that infertility after testicular cancer can be treated effectively with IVF and that ICSI even permits treatment of patients who have severe oligozoospermia.

Intracytoplasmic sperm injection (ICSI) using cryopreserved sperm from men with malignant neoplasm yields high pregnancy rates

“…To date, there are only very limited data in the literature regarding the use of cryopreserved sperm from patients with malignant disease, most consisting of case reports (5)(6)(7)(8)(9)(10) or limited case series (11)(12)(13)(14)(15)(16)(17)(18). Moreover, it is yet unclear whether ICSI should be performed in all cases or in just those with poor sperm quality.…”

Gonadal dysfunction and fertility problems in cancer survivors

“…This should be done prior to initiation of cancer treatment, ideally also before orchiectomy in testicular cancer patients [26]. If retrieval of sperm by masturbation fails, which especially may be the case in young adolescents; other methods for sperm retrieval may be considered, like electroejaculation, electrovibration, microsurgical epididymal aspiration or testicular sperm cell extraction (TESE) [59,60]. The last two procedures may even reveal sperm in men with nonobstructive azoospermia, although the pregnancy rate following ICSI is lower in cases of non-obstructive than obstructive azoospermia [60].…”

“…If medical treatment fails, there are also other available methods for retrieval of sperms [59,60]. Testicular sperm cell extraction is also an opportunity in men with non-obstructive azoospermia following chemotherapy, and in one study, sperm were in such cases extracted in 70% (14/20), and parenthood was achieved by 8 of 12 couples where intracytoplasmatic sperm cell injection (ICSI) subsequently was performed (including one ongoing pregnancy at the end of the study period) [69].…”

Testicular Tissue Cryopreservation

“…In patients undergoing orchiectomy for testicular cancer, sperm can be aspirated from the vas deferens or from the epididymis [11], or from the testis [12,13]. However, not only in men with testicular cancer spermatozoa can be obtained by testicular biopsy but also in men with other malignancies: testicular sperm has been extracted from biopsies of azoospermic men with malignant lymphomas [14].…”