The achievement of pregnancies using assisted reproductive technologies for male factor infertility after retroperitoneal lymph node dissection for testicular carcinoma

Sperm cryopreservation before testicular cancer treatment and its subsequent utilization for the treatment of infertility

Aims. In this study we report our results with storage of cryopreserved semen intended for preservation and subsequent infertility treatment in men with testicular cancer during the last 18 years. Methods. Cryopreserved semen of 523 men with testicular cancer was collected between October 1995 and the end of December 2012. Semen of 34 men (6.5%) was used for fertilization of their partners. They underwent 57 treatment cycles with cryopreserved, fresh, and/or donor sperm. Results. A total of 557 men have decided to freeze their semen before cancer treatment. Azoospermia was diagnosed in 34 men (6.1%), and semen was cryopreserved in 532 patients. Seminoma was diagnosed in 283 men (54.1%) and nonseminomatous germ cell tumors in 240 men (45.9%). 34 patients who returned for infertility treatment underwent 46 treatment cycles with cryopreserved sperm. Totally 16 pregnancies were achieved, that is, 34.8% pregnancy rate. Conclusion. The testicular cancer survivors have a good chance of fathering a child by using sperm cryopreserved prior to the oncology treatment, even when it contains only limited number of spermatozoa.

The genetic and phenotypic basis of infertility in men with pediatric urologic disorders

Male factor is a major component of infertility for many couples. The presence of congenital genitourinary anomalies in male partners can cause male infertility. We reviewed the state-of-the-art treatment and outcomes for male infertility caused by pediatric urologic disorders. Disorders were classified by whether they led to infertility through pre-testis, testicular, or post-testis effects. Despite the complexity of pediatric urologic disorders that can affect fertility, natural paternity and paternity through assisted reproductive technology are common. Given the significant recent advances in infertility treatments, paternity with many currently untreatable pediatric disorders is likely in the future.

Infertility and testis cancer

Testicular cancer is the most common solid organ tumor in young men and affects men during their reproductive years. Current therapeutic regimens have significantly improved survival but often adversely impact fertility. Understanding the effects of testicular cancer, the systemic effects of neoplasia, and the effects of treatment protocols, such as radiotherapy, chemotherapy, and retroperitoneal lymph node dissection, is essential to restoring and maintaining fertility in men who have germ cell neoplasms.

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.

Storing reproduction for oncological patients: some points for discussion

Since the introduction of sophisticated techniques of assisted reproduction such as IVF and ICSI, all male patients that undergo a cancer treatment jeopardizing their future fertility status should be offered the opportunity to bank their semen. Only azoospermic semen samples are to be rejected for pre-treatment banking. Patients who became severely oligospermic or azoospermic after chemotherapy but did not bank their semen, are often not allowed to have assisted reproduction because of the concerns about the mutagenic aspects of their treatment. In a small case series (n = 10), we recovered testicular sperm for ICSI in 40% of patients who became azoospermic after chemotherapy. Since, so far, the few clinical data available do no not suggest an increased risk for congenital anomalies in children born from patients obtaining a pregnancy during chemotherapy, the question remains whether the concerns raised about treating patients who became oligozoospermic or azoospermic or even about semen banking during chemotherapy are incontestable.

Semen cryopreservation after orchidectomy in men with testicular cancer

OBJECTIVE

To assess the feasibility of semen cryopreservation after orchidectomy in patients with testicular tumour.

PATIENTS AND METHODS

The quality of semen samples was investigated in 36 men with testicular tumour (mean age 31.7 years, range 20-49) who were referred to our infertility centre for semen cryopreservation. For each patient, the number of straws, semen volume, number of spermatozoa, and sperm motility before and after freezing were evaluated.

RESULTS

Fifteen patients (42%) banked sperm before and 21 (58%) after orchidectomy; the delay was >7 days in 19 patients (53%). The mean age, histological diagnosis and tumour stage did not differ significantly whatever the time of cryopreservation. Semen quality did not differ significantly in patients who cryopreserved sperm before or after orchidectomy and there were no significant differences in sperm values whatever the delay before preservation. Semen quality was the same in patients with seminoma or nonseminoma tumour.

CONCLUSION

These findings indicate that spermatogenesis of the contralateral testis is sufficient for successful semen cryopreservation after orchidectomy. Urologists should be encouraged to increase the awareness among oncology teams and patients about the new developments in preserving fertility for patients with cancer.

Birth after electroejaculation coupled to intracytoplasmic sperm injection in a gun-shot spinal cord-injured man

We describe the case of a man who, after a gun-shot wound, has become paraplegic. As a consequence of his spinal cord injury he developed infertility due to incomplete erection and anejaculation. After several unsuccessful penile vibratory stimulation attempts, it was possible to achieve ejaculation by means of transrectal electrostimulation. However, the total sperm motility count, the percentage of normal sperm morphology, and the vitality and hypo-osmotic swelling test scores were rather low, and in particular viability was strikingly decreased during sperm preparation. These parameters further decreased following electroejaculate, forcing us to use intracytoplasmic sperm injection instead of conventional in vitro fertilization for the treatment cycle. A normal pregnancy was achieved which resulted in birth of a healthy girl on 1st January 1997.

Experience with vasal sperm aspiration

PURPOSE

We describe our experience with vasal aspiration of sperm in patients with azoospermia secondary to neurogenic anejaculation or obstruction of the vas deferens.

MATERIALS AND METHODS

We performed 15 vasal sperm aspirations on 11 patients with neurogenic anejaculation or vasal obstruction.

RESULTS

Adequate sperm was obtained from all 15 aspirations with an average sperm count of 42 x 10[6] (range 0.5 to 252 x 10[6]) and an average motility of 73.4% (range 16 to 100%). Aspirations were performed for use with assisted reproductive techniques in 12 cases and for cryopreservation alone in 3. Following assisted reproductive techniques 6 of the 12 aspirations (50%) resulted in pregnancy.

CONCLUSIONS

Vasal aspiration of sperm should be considered when electroejaculation fails, is not available or is contraindicated. Although the overall sperm quality and pregnancy rate are higher with vasal aspiration and in vitro fertilization than electroejaculation and intrauterine insemination, vasal aspiration is a more technically demanding and costly approach to conception.

Why cancer patients request disposal of cryopreserved semen specimens posttherapy: a retrospective study

OBJECTIVE

To determine why patients with cancer stop storing semen in a sperm bank program.

DESIGN

Retrospective study.

SETTING

Hospital andrology laboratory.

PATIENT(S)

Cancer patients (n = 56) who discontinued sperm storage.

INTERVENTION(S)

A database of 342 patients with cryopreserved sperm was searched for disease diagnosis, marital status before and after diagnosis, type of therapy, number of specimens banked, interval between diagnosis and sperm banking, and postthaw semen characteristics. Patients discontinuing storage were surveyed.

MAIN OUTCOME MEASUREMENT(S)

Reasons for discontinuing storage and clinical correlation of the decision.

RESULT(S)

Reasons included patient death (n = 21); fertility but no plans for more children (n = 23); good sperm quality (n = 8); and no plans to have children (n = 4). Patients were similar in age, number of specimens, and interval between diagnosis and treatment, but they showed significant differences in type of treatment and time in the program. Cost of cryopreservation and specimen storage was not cited.

CONCLUSION(S)

Most patients decided to discontinue sperm banking because either they regained fertility or had improved semen quality. Sperm banking should be strongly recommended for all patients with malignant diseases who may wish to have children, even if they eventually decide that the specimens are not needed.