Helping Adult Male Survivors of Childhood Cancer Regain Fertility

A new study has shown that a microsurgical technique can effectively extract viable sperm in adult male childhood cancer survivors, who were previously considered sterile due to prior chemotherapy treatment.

Researchers at the New York-Presbyterian Hospital/Weill Cornell Medical Center (New York, NY, USA) reviewed oncologic data, pretreatment hormone profiles, testicular histology, and outcomes of TESE and intracytoplasmic sperm injection (ICSI) in 1,072 procedures performed between 1995 and 2009 on 892 patients with azoospermia. The group included a subgroup of 73 former cancer patients who were treated at an average of 19 years after receiving chemotherapy. Sperm was retrieved in 37% of the male cancer survivors using microdissection testicular sperm extraction (TESE), a technique that enables doctors to identify small areas in the testicles where sperm cells are produced and carefully extract them, even in men whose testicles have been severely damaged by chemotherapy.

The researchers subsequently applied the ICSI in vitro fertilization technique to fertilize an egg with a single sperm, and the embryos were transferred into the uterine cavity on the third day after microinjection. This resulted in a slightly more than 57% fertilization rate, a pregnancy rate of 50% (18 of 36), and the births of 20 children. According to the researchers, the findings offer a new option for many cancer survivors who want to have children, but were thought infertile because of earlier cancer treatment. The study was published early online on March 14, 2011, in the Journal of Clinical Oncology.

"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,” said senior author Peter Schlegel, MD, urologist-in-chief at NYP. "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.”

Another important finding was 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%.

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NewYork-Presbyterian Hospital/Weill Cornell Medical Center