Yu Benjamin, Darves-Bornoz Anne L, Brannigan Robert E, Halpern Joshua A
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
F S Rep. 2020 Oct 8;1(3):317-325. doi: 10.1016/j.xfre.2020.09.014. eCollection 2020 Dec.
To examine fertility preservation techniques in the setting of neurosarcoidosis, and to review the impact of corticosteroid and methotrexate therapy on fertility.
Case report of a patient with infertility secondary to anejaculation associated with spinal neurosarcoidosis, treated with systemic corticosteroids and methotrexate.
Academic tertiary-care hospital.
A 39-year-old man presented with neurosarcoidosis complicated by acute anejaculation, erectile dysfunction, and hypogonadism. He underwent fertility consultation and sperm cryopreservation before initiating methotrexate therapy. His pretreatment total testosterone was low, at 157 ng/dL.
Unsuccessful pharmacologic therapy and penile vibratory stimulation (PVS) were followed by microdissection testicular sperm extraction (microTESE). Clomiphene was administered for optimization of spermatogenesis before microTESE.
Vials of cryopreserved sperm, testis histopathology, and serum testosterone levels.
Eight vials of viable sperm were harvested by means of micro-TESE and cryopreserved. Despite intraoperative appearance of hypospermatogenesis, 90% of seminiferous tubules had active germ cell sloughing. Total testosterone increased to 278 ng/dL 2 months after initiating clomiphene.
Conventional fertility preservation techniques may be effective in the setting of neurosarcoidosis-induced infertility owing to largely intact spermatogenesis. PVS, though not effective for this patient, should be considered along with electroejaculation, given high success rates in other patients with neurogenic anejaculation. Corticosteroid-mediated hypogonadism also must be considered in these patients, because it can negatively affect downstream spermatogenesis. In addition, evidence for the impact of paternal methotrexate exposure on fertility is limited and requires further investigation. As such, fertility consultation before initiating methotrexate is highly recommended.
研究神经结节病患者的生育力保存技术，并综述皮质类固醇和甲氨蝶呤治疗对生育力的影响。
一名因脊髓神经结节病导致不射精继发不孕的患者，接受全身皮质类固醇和甲氨蝶呤治疗的病例报告。
学术性三级医疗医院。
一名39岁男性，患有神经结节病，并发急性不射精、勃起功能障碍和性腺功能减退。在开始甲氨蝶呤治疗前，他接受了生育咨询和精子冷冻保存。他治疗前的总睾酮水平较低，为157 ng/dL。
药物治疗和阴茎振动刺激（PVS）无效后，进行了显微外科睾丸精子提取（microTESE）。在microTESE前给予克罗米芬以优化精子发生。
冷冻保存的精子小瓶、睾丸组织病理学和血清睾酮水平。
通过microTESE采集并冷冻保存了8瓶有活力的精子。尽管术中出现精子发生低下，但90%的生精小管有活跃的生殖细胞脱落。开始使用克罗米芬2个月后，总睾酮升至278 ng/dL。
由于生精功能基本完好，传统的生育力保存技术在神经结节病所致不孕的情况下可能有效。PVS虽然对该患者无效，但鉴于其在其他神经源性不射精患者中的高成功率，应与电射精一起考虑。这些患者还必须考虑皮质类固醇介导的性腺功能减退，因为它会对下游精子发生产生负面影响。此外，父亲接触甲氨蝶呤对生育力影响的证据有限，需要进一步研究。因此，强烈建议在开始甲氨蝶呤治疗前进行生育咨询。
