Chan P T, Palermo G D, Veeck L L, Rosenwaks Z, Schlegel P N
James Buchanan Brady Foundation, Department of Urology and Cornell Institute for Reproductive Medicine, New York, New York, USA.
Cancer. 2001 Sep 15;92(6):1632-7. doi: 10.1002/1097-0142(20010915)92:6<1632::aid-cncr1489>3.0.co;2-i.
Men who remain azoospermic long after undergoing chemotherapy have generally been considered sterile. The authors report their experience with testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection (ICSI) applied to azoospermic men who previously received chemotherapy for a variety of indications.
Among 231 cycles in 198 patients who underwent TESE-ICSI for nonobstructive azoospermia from 1995 to 2000, 20 TESE procedures in 17 patients who previously received chemotherapy were identified. All TESE procedures were performed with microsurgical control under local anesthesia with sedation or general anesthesia. The pretreatment hormonal profile, histology of testicular biopsies, and outcomes of TESE-ICSI in this subgroup of patients were analyzed.
The mean patient age was 37.4 years (range, 28-54 years), and the mean follicle-stimulating hormone level was 21.8 mIU/mL (range, 7.1-43.1 mIU/mL). The mean age for female partners was 33.5 years (range, 22-43 years). Six patients had received chemotherapy for Hodgkin lymphoma (34%), four patients had received chemotherapy for testicular neoplasm (24%), two patients had received chemotherapy for non-Hodgkin lymphoma (12%), two patients had received chemotherapy for leukemia (12%), one patient had received chemotherapy for Wilms tumor (6%), one patient had received chemotherapy for mediastinal germ cell tumor (6%), and one patient had received chemotherapy for nephrotic syndrome (6%). Three patients (18%) received additional radiation therapy. The mean interval from chemotherapy to TESE was 16.3 years (range, 6-34 years). All patients had at least two semen analyses to confirm azoospermia. A total of 20 attempts of TESE-ICSI were performed (mean, 1.2 attempts per patient). Testicular histology revealed Sertoli cell-only pattern in 76% of patients. The remaining 24% of patients had hypospermatogenesis as their most advanced spermatogenic pattern. Among the men with Sertoli cell-only pattern, 23% had sperm retrieved by TESE. Sperm retrieval was accomplished in 9 of 20 attempts (45%), with biochemical pregnancy after sperm retrieval in 4 of 9 couples (45%) and clinical pregnancy in 3 of 9 couples (33%). Live deliveries were achieved in 2 of 9 couples (22%). Two healthy boys and one girl were delivered. No correlation was noted between the outcome of TESE-ICSI and the underlying conditions that were treated with chemotherapy nor with the chemotherapeutic agents used.
Using TESE-ICSI, sperm retrieval leading to pregnancy and the delivery of healthy children is possible for men with long-standing azoospermia after chemotherapy. The prognosis for sperm retrieval was not influenced clearly by the chemotherapy regimen or the disease treated. Diagnostic biopsy also was of limited value in predicting the outcome of sperm retrieval. Despite prolonged nonobstructive azoospermia after undergoing chemotherapy, men no longer should be considered sterile in the era of advanced assisted reproductive techniques.
接受化疗后长时间无精子症的男性通常被认为不育。作者报告了他们对睾丸精子提取（TESE）联合卵胞浆内单精子注射（ICSI）应用于因各种适应证先前接受过化疗的无精子症男性的经验。
在1995年至2000年因非梗阻性无精子症接受TESE-ICSI的198例患者的231个周期中，确定了17例先前接受过化疗患者的20次TESE手术。所有TESE手术均在局部麻醉加镇静或全身麻醉下进行显微外科控制。分析了该亚组患者的术前激素水平、睾丸活检组织学以及TESE-ICSI的结果。
患者平均年龄为37.4岁（范围28 - 54岁），平均促卵泡激素水平为21.8 mIU/mL（范围7.1 - 43.1 mIU/mL）。女性伴侣平均年龄为33.5岁（范围22 - 43岁）。6例患者因霍奇金淋巴瘤接受化疗（34%），4例患者因睾丸肿瘤接受化疗（24%），2例患者因非霍奇金淋巴瘤接受化疗（12%），2例患者因白血病接受化疗（12%），1例患者因肾母细胞瘤接受化疗（6%），1例患者因纵隔生殖细胞瘤接受化疗（6%），1例患者因肾病综合征接受化疗（6%）。3例患者（18%）接受了额外的放射治疗。从化疗到TESE的平均间隔时间为16.
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