Karibe Jurii, Takeshima Teppei, Kuroda Shinnosuke, Takamoto Daiji, Kawahara Takashi, Osaka Kimito, Teranishi Jun-Ichi, Murase Mariko, Makiyama Kazuhide, Uemura Hiroji, Yumura Yasushi
Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan.
Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.
Transl Androl Urol. 2024 Aug 31;13(8):1463-1471. doi: 10.21037/tau-24-21. Epub 2024 Aug 26.
Cancer survivors in the adolescent and young adult generation often experience marriage, pregnancy, and childbirth after treatment; thus, fertility preservation is very important. In male patients, testicular sperm extraction (TESE) is sometimes performed due to azoospermia. Such a procedure is called oncological TESE (onco-TESE). In the present study, we aimed to define onco-TESE as TESE for fertility preservation in cancer patients, including those receiving gonadotoxic treatment.
Seventeen male patients with cancer who had undergone onco-TESE for fertility preservation at Yokohama City University Medical Center between April 2014 and March 2023 were included in the study.
Motile testicular sperm were acquired by TESE in 9 out of 17 cases. Among patients who had initiated chemotherapy before surgery, Motile sperm could be acquired by onco-TESE in 3 out of 9 cases. In chemotherapy-naive patients, Motile sperm were acquired by onco-TESE in 6 out of 8 cases. In the end, sperm cryopreservation was performed in 10 patients. Cryopreserved sperm were used in 2 of the 10 cases, and live birth was achieved after intracytoplasmic sperm injection in both cases.
Before starting gonadotoxic treatment, it is important to confirm whether the patient desires to bear children. If having a baby is desired, a referral to a reproductive medicine doctor is recommended. Fertility preservation before starting gonadotoxic treatment is preferable, but fertility preservation could be considered even after such a treatment.
青少年和青年一代的癌症幸存者在治疗后常经历结婚、怀孕和分娩；因此，生育力保存非常重要。在男性患者中，有时因无精子症而进行睾丸精子提取（TESE）。这种手术称为肿瘤学TESE（onco-TESE）。在本研究中，我们旨在将onco-TESE定义为癌症患者（包括接受性腺毒性治疗的患者）为保存生育力而进行的TESE。
纳入2014年4月至2023年3月期间在横滨市立大学医学中心接受onco-TESE以保存生育力的17例男性癌症患者。
17例患者中，9例通过TESE获得了活动的睾丸精子。在手术前开始化疗的患者中，9例中有3例通过onco-TESE获得了活动精子。在未接受过化疗的患者中，8例中有6例通过onco-TESE获得了活动精子。最终，10例患者进行了精子冷冻保存。10例中有2例使用了冷冻保存的精子，两例均通过胞浆内单精子注射实现了活产。
在开始性腺毒性治疗之前，确认患者是否有生育意愿很重要。如果希望生育，建议转诊至生殖医学医生处。在开始性腺毒性治疗之前进行生育力保存更佳，但即使在接受此类治疗后也可考虑生育力保存。
