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

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.