An additional patient, in whom no sperm were retrieved with an initial TESE attempt had sperm return to his ejaculate after varicocele repair, said Dr. Goldstein, professor of reproductive medicine and urology at the New York Hospital-Cornell Medical Center. Sperm from this patient's ejaculate were used for ICSI that resulted in successful initiation of pregnancy and culminated in a live birth.
The Cornell team previously reported on TESE results in sperm retrieval from men with non-obstructive azoospermia (Urology 1997; 49:435-40).
"However, it was not known what the success rate would be among post-chemotherapy patients because of their risk for treatment-induced destruction of all tes-ticular foci of sperm production:' said Dr. Goldstein.“ The results of the present study show that TESE is as effective in men with long-standing azoospermia after chemo-therapy as it is in patients with other non-ob-structive etiologies."
Dr Goldstein recommends that the repair of any existing varicocele should be first attempted in men who are azoospermic after chemotherapy.
"Two years earlier, we reported that about 50% of azoospermic men who under-go microsurgical varicocelectomy will experience return of sperm to the semen. That study did not specifically evaluate the success of this surgery in men with azoo-spermia secondary to chemotherapy," he said. "However, the experience with the individual in the current series indicates microsurgical varicocele repair can be ben-eficial in these men as well."
If varicocele repair surgery does not lead to the appearance of sperm in the semen, Dr. Goldstein said TESE can be performed.
TESE-ICSI for azoospermia
The 12 post-chemotherapy patients in this study represented a subset of 142 patients who underwent TESE-ICSI for azoosper-mia between 1995 and 1999. TESE was performed microscopically using the tech-nique pioneered by Dr. Schlegel, associate professor of urology and reproductive medicine, Weill Medical College of Cornell University.
Patients ranged in age from 29 to 54 years with a mean age of about 39 years. Ages of their female partners ranged from 28 to 43 years. The indications for chemo-therapy among the 12 men included Hodgkin's lymphoma (five patients), tes-ticular neoplasm (three), non-Hodgkin's lymphoma (two), leukemia (one), and nephrotic syndrome (one).
Time elapsed between chemotherapy and TESE ranged from 4 to 18 years. No relationships were identified between the prognosis for sperm retrieval and either chemotherapy regimen received or disease treated.
Histological examination of biopsy spec-imens yielded findings consistent with the expected effects of chemotherapy. A Sertoli cell-only pattern was present in 90% of men while a single patient had hyposper-matogenesis as the most advanced sper-matogenic pattern.
Dr. Goldstein noted that in a recent paper from the Cornell group correlating histo-logic findings with the chance of retriev-ing sperm through TESE, the extraction procedure was successful in 24% of men with a Sertoli cell-only pattern (J Urol 1999; 161:112-6).
"Based on that rate and the even greater success we observed in the present series of patients, it seems entirely reasonable to recommend performing TESE in these chemotherapy patients, even if the biopsy shows a Sertoli cell-only pattern:' noted Dr. Goldstein.
The study was presented at the AUA meeting by Dr. Chan, a fellow at the Cornell Institute for Reproductive Medicine and department of urology.
(Cheryl Guttman, Urology Times Correspondent, reported this article. Urology Times, Vol.28, No.5. May 2000)