Effects of Chemo- and Radiation Therapy on Microsurgical Testicular Sperm Extraction for Men with Non-obstructive Azoospermia.
Academic Article
Overview
abstract
OBJECTIVE: Men who survive cancer as children or young adults may have severe spermatogenic impairment with azoospermia requiring surgical sperm retrieval and assisted reproductive technologies. We assessed treatment outcomes from a large series of cancer patients with prior radiation and/or chemotherapy. MATERIALS AND METHODS: Men with non-obstructive azoospermia who underwent initial microsurgical testicular sperm extraction from 1995-2020 from a high-volume surgeon at a single institution were identified. Those with a history of malignancy treated by radiation therapy and/or chemotherapy were included. The primary outcome was successful sperm retrieval. RESULTS: A total of 106 men were evaluated, of whom 57 received chemotherapy and radiation, 44 received only chemotherapy, and 5 received only radiation. Sperm retrieval was successful in 39 of 106 (37%) men, with higher likelihood of retrieval in men who received only chemotherapy compared to men who received chemotherapy and radiation (61% vs. 18%, p<0.001). None of the 18 patients who received chemotherapy with radiation to the pelvis had successful sperm retrieval, compared to 26% of patients who received chemotherapy with extra-pelvic radiation (p=0.02). CONCLUSIONS: Chemotherapy and radiation for cancer may result in non-obstructive azoospermia that can be treated to allow fertility. However, pelvic radiation therapy is associated with the worst prognosis for successful treatment with microsurgical sperm retrieval and IVF; we observed no cases of successful retrieval in men who received pelvic radiation therapy. These data are useful for pre-treatment counseling, suggesting that men with prior radiation therapy may not be candidates for surgical sperm retrieval.
