Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
Medicine (Baltimore). 2024 Feb 23;103(8):e37201. doi: 10.1097/MD.0000000000037201.
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.
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.
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.
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.
睾丸癌（TC）主要发生在 14 岁至 44 岁的男性中。研究表明，TC 严重损害男性生育能力，6%至 24%的 TC 患者在诊断时甚至被发现患有无精子症。目前，一些研究指出，肿瘤微切割睾丸精子提取（mTESE）可以从肿瘤睾丸中提取精子。然而，对于 mTESE 失败后的补救措施几乎没有报道。鉴于 TC 伴无精子症患者生育保存的宝贵机会，有必要为 mTESE 失败的患者提供有效的补救方法。
两名年轻男性因 TC 被诊断为无精子症，在接受根治性睾丸切除术以保存生育能力时尝试了 mTESE，但两名患者均未能提取精子。随后，患者 1 的孤立睾丸组织再次发生 TC，患者 2 计划接受多周期性腺毒性化疗。由于两人都计划在未来生育，我们进行了补救性 mTESE。
两名患者均成功提取精子。患者恢复良好，无并发症。患者 1 夫妇接受了 1 次胞浆内单精子注射（ICSI）周期，但未获得临床妊娠。
尽管 TC 伴无精子症患者的生育保存困难，但使用 mTESE 仍有机会成功提取精子。如果从肿瘤睾丸中提取精子失败，尽早进行补救性 mTESE 可能为这些患者保留最后的生育机会。
