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Cryptozoospermia with normal testicular function after allogeneic stem cell transplantation: a case report.

L Tauchmanovà¹, C Alviggi, C Foresta

¹Department of Molecular and Clinical Endocrinology and Oncology, Federico II, University of Naples, Naples, Italy. tauchman@unina.it

Human Reproduction (Oxford, England)

|September 27, 2006

Summary

Allogeneic stem cell transplant (allo-SCT) can cause male infertility. This case shows azoospermia due to chronic graft-versus-host disease (cGVHD) was reversible with immunosuppression, leading to natural pregnancy.

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Area of Science:

Reproductive Medicine
Hematology
Immunology

Background:

Allogeneic stem cell transplantation (allo-SCT) is a common treatment for hematologic malignancies.
Gonadal insufficiency, including azoospermia and oligospermia, is a frequent complication post-allo-SCT.
Chronic graft-versus-host disease (cGVHD) can affect various organs, but its impact on male fertility requires further investigation.

Observation:

A 27-year-old male with myelodysplastic syndrome developed azoospermia after allo-SCT from an HLA-identical sibling.
Endocrine function remained normal, and testicular sperm production was preserved.
Semen analysis revealed inflammation but no infection, with intermittent sperm reappearance after low-dose immunosuppressive therapy.

Findings:

The patient's azoospermia and cryptozoospermia were attributed to reversible obstruction of the spermatic tract, likely caused by cGVHD affecting the urogenital tract.
This is the first reported case of reversible seminal tract obstruction due to cGVHD in an allo-SCT survivor with a normal endocrine profile.
Successful treatment with low-dose immunosuppressants restored sperm count, avoiding the need for costly and potentially ineffective gonadotropin therapy.

Implications:

Low-dose immunosuppressive therapy can effectively manage cGVHD-induced male infertility post-allo-SCT.
This approach offers a viable alternative to assisted reproductive technologies when obstruction is the primary cause of infertility.
The findings highlight the importance of evaluating for cGVHD in infertile male allo-SCT survivors and considering immunosuppression for fertility restoration, as evidenced by the subsequent natural pregnancy.