Effect of intravesical immunotherapy on sperm parameters in young patients with non--muscle-invasive bladder
Manish Garg1, Satya Narayan Sankhwar1, Apul Goel1
1Department of Urology, King George Medical University (formally Chhatrapati Shahuji Maharaj Medical University), Lucknow, India.
Introduction:
To investigate the effects of intravesical immunotherapy on semen parameters in young patients with non-muscle invasive bladder tumour.
Methods:
A total of 17 sexually active male patients < 45 years of age underwent transurethral resection of bladder tumour (TURBT) from Jan 2010 to Dec 2012. On HPE analysis, T1 high grade was found in 16 patients and Ta grade high grade in 1 patient. Associated CIS was found in 4 patients. Induction course of 6 weeks of adjuvant BCG therapy was given. Semen analysis was done 1 week prior to BCG therapy and 3 months after BCG therapy. Serum levels of hormones like total testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were also measured.
Results:
Mean age of patients at diagnosis was 34.6 (29-43) years. Total semen volume was found to be decreased in 2 patients. Main parameter which was deteriorated was total sperm concentration which was significantly decreased in 12 patients and 5 patients even had their counts below oligospermia levels. Seven patients had associated decrease in sperm motility. However, no patient showed significant difference in other semen parameters. Also no patient had any change in androgen hormonal status except 2 patients in which serum testosterone was found to be non-significantly decreased.
Conclusion:
Intravesical therapy with BCG was found to adversely affect spermatogenesis and cause oligospermia. It is important that relatively young patients must be informed of these effects and advised to have sperm preservation before instillation of BCG therapy to avoid fertility issues in future.
Insights
Intravesical bacillus Calmette-Guerin (BCG) therapy can negatively impact sperm production in young men, leading to reduced sperm concentration and motility. Patients should consider sperm banking before treatment to preserve fertility.
Area of Science:
- Urology
- Oncology
- Reproductive Medicine
Background:
- Non-muscle invasive bladder cancer (NMIBC) treatment often involves intravesical immunotherapy.
- Bacillus Calmette-Guerin (BCG) is a common immunotherapy agent used for NMIBC.
- Assessing the impact of BCG on male fertility is crucial for young patients.
Purpose of the Study:
- To evaluate the effects of intravesical BCG immunotherapy on semen parameters.
- To assess changes in sperm concentration, motility, and volume post-BCG therapy.
- To investigate hormonal changes associated with BCG treatment in young males.
Main Methods:
- 17 sexually active males under 45 with NMIBC received TURBT and subsequent BCG therapy.
- Semen analysis was performed before and 3 months after BCG treatment.
- Serum hormone levels (testosterone, FSH, LH) were measured.
Main Results:
- Significant decrease in total sperm concentration observed in 12 patients, with 5 below oligospermia levels.
- Reduced sperm motility noted in 7 patients.
- No significant changes in semen volume or hormone levels, except for a non-significant decrease in testosterone in 2 patients.
Conclusions:
- Intravesical BCG therapy adversely affects spermatogenesis, potentially causing oligospermia.
- Young patients undergoing BCG treatment should be informed about fertility risks.
- Sperm preservation prior to BCG therapy is recommended to mitigate future fertility concerns.
