Androlog Mail
Re: Azoospermia after chemotherapy for germ cell tumor
From: Peter Schlegel (pnschleg@med.cornell.edu)
Dr. Meacham has recently inquired about the feasibility of sperm retrieval
from men with azoospermia after chemotherapy for germ cell
tumors. Obviously, the first question is whether treatment (RPLND)
affected antegrade sperm transport. This issue is cleared if a normal
volume ejaculate (or azoospermic specimen from electroejaculation is
obtained.) For men who have no sperm in antegrade or postejaculate
urine/retrograde specimens and are at least 6 years after chemotherapy, we
have performed testicular sperm retrieval on 34 occasions in conjunction
with a simultaneous IVF/ICSI attempt. For men previously treated for germ
cell tumors, despite the presence of a solitary testis, sperm were found
with microdissection TESE in 67% of these men. All were rechecked on the
day of TESE with analysis of antegrade semen specimens and/or
electroejaculation to confirm azoospermia before proceeding with
TESE. Several of these men had multiple successful attempts at TESE
(separated by one year or more), with no permanent change or trend in serum
testosterone levels.
Peter N. Schlegel, M.D.
Weill Medical College of Cornell University
New York, NY
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