Related Experiment Video
Updated: Sep 24, 2025
Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia
Published on: May 27, 2022
Effects of Chemo- and Radiation Therapy on Microsurgical Testicular Sperm Extraction for Men with Nonobstructive
Aaron Brant1, Nahid Punjani1, Nikica Zaninovic2
1Department of Urology, Weill Cornell Medical College, New York, New York.
Purpose:
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 nonobstructive 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 nonobstructive 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 in vitro fertilization; we observed no cases of successful retrieval in men who received pelvic radiation therapy. These data are useful for pretreatment counseling, suggesting that men with prior radiation therapy may not be candidates for surgical sperm retrieval.
Insights
Cancer survivors with azoospermia (no sperm) can have fertility restored through surgical sperm retrieval. However, pelvic radiation significantly reduces success rates, impacting treatment counseling for these patients.
Area of Science:
- Reproductive Medicine
- Oncology
- Urology
Background:
- Cancer treatments like chemotherapy and radiation can cause severe male infertility, specifically nonobstructive azoospermia.
- Sperm retrieval techniques and assisted reproductive technologies offer potential fertility solutions for cancer survivors.
- Understanding the impact of specific cancer treatments on sperm retrieval success is crucial for patient counseling.
Purpose of the Study:
- To assess the outcomes of microsurgical testicular sperm extraction in men with nonobstructive azoospermia following cancer treatment.
- To evaluate the influence of prior chemotherapy and radiation therapy (including pelvic vs. extra-pelvic) on sperm retrieval success.
Main Methods:
- Retrospective analysis of 106 men with nonobstructive azoospermia who underwent microsurgical testicular sperm extraction (1995-2020).
- Patients had a history of malignancy treated with chemotherapy and/or radiation therapy.
- Primary outcome measured was successful sperm retrieval.
Main Results:
- Overall sperm retrieval success rate was 37% (39/106 men).
- Higher success rates were observed in men treated with chemotherapy alone (61%) compared to chemotherapy and radiation (18%).
- No successful sperm retrieval occurred in patients receiving chemotherapy with pelvic radiation; 26% success with extra-pelvic radiation.
Conclusions:
- Microsurgical sperm retrieval can treat nonobstructive azoospermia in cancer survivors, but outcomes vary significantly based on treatment history.
- Pelvic radiation therapy is strongly associated with a poor prognosis for successful sperm retrieval.
- Findings support improved pretreatment counseling regarding the likelihood of fertility restoration after specific cancer therapies.
Related Concept Videos
01:23Infertility in Males
01:41Spermatogenesis