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Case report: remedial microdissection testicular sperm extraction after onco-microdissection testicular sperm
Yi Zheng1,2,3, Ding-Ming Li1,2,3, Fu-Ping Li1,2,3
1Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
Background:
Testicular cancer (TC) mostly occurs in men aged 14 to 44. Studies have shown that TC seriously damages male fertility, and 6% to 24% of patients with TC were even found to suffer from azoospermia when they are diagnosed. At present, some studies have pointed out that onco-microdissection testicular sperm extraction (mTESE) can extract sperm from tumor testicles. However, there are almost no reports on remedial measures after onco-mTESE failure. Given the valuable opportunity for fertility preservation in patients with TC and azoospermia, it is necessary to provide effective remedial methods for patients with failed onco-mTESE.
Methods:
Two young men, who were diagnosed with TC and also found to have azoospermia, tried onco-mTESE while undergoing radical orchiectomy for fertility preservation. However, sperm extraction failed in both patients. Subsequently, the isolated testicular tissue of the patient in case 1 suffered from TC again, and the patient in case 2 was scheduled to receive multiple cycles of gonadotoxic chemotherapy. Because both had a plan to have a birth in the future, we performed remedial mTESE.
Results:
Sperm was successfully extracted from both patients. The patient recovered well, without complications. The patient couple in case 1 underwent 1 intracytoplasmic sperm injection (ICSI) cycle but did not achieve clinical pregnancy.
Conclusions:
There is still an opportunity to extract sperm successfully using onco-mTESE, despite the difficulty of fertility preservation in TC patients with azoospermia. If sperm extraction from the tumor testis fails, implementing remedial mTESE as early as possible would likely preserve the last chance of fertility for these patients.
Insights
For men with testicular cancer and azoospermia, remedial microdissection testicular sperm extraction (mTESE) offers a second chance for sperm retrieval after initial onco-mTESE failure. This approach preserves fertility options for future parenthood.
Area of Science:
- Reproductive Medicine
- Oncology
- Genetics
Background:
- Testicular cancer (TC) predominantly affects young men (14-44 years), often leading to azoospermia and impacting male fertility.
- While onco-microdissection testicular sperm extraction (onco-mTESE) can retrieve sperm from tumor-bearing testes, success is not guaranteed.
- Limited data exists on fertility preservation strategies following failed onco-mTESE in TC patients with azoospermia.
Observation:
- Two young men diagnosed with TC and azoospermia underwent onco-mTESE during orchiectomy for fertility preservation, but sperm extraction failed in both cases.
- One patient experienced a recurrence of TC in the remaining testicular tissue, while the other was scheduled for chemotherapy.
- Both patients desired future biological children, necessitating further fertility interventions.
Findings:
- Remedial microdissection testicular sperm extraction (mTESE) was successfully performed on both patients, yielding viable sperm.
- Both patients recovered well post-procedure with no reported complications.
- One patient couple proceeded with intracytoplasmic sperm injection (ICSI), though clinical pregnancy was not achieved in the first cycle.
Implications:
- Onco-mTESE failure does not eliminate all possibilities for sperm retrieval in TC patients with azoospermia.
- Remedial mTESE presents a viable option to salvage fertility opportunities when primary onco-mTESE is unsuccessful.
- Prompt implementation of remedial mTESE is crucial for maximizing the chances of preserving fertility in this vulnerable patient group.
