Introduction: Testis cancer (TCa) is the most common cancer in young men. Testis sperm extraction (TESE) in men with azoospermia is a valuable option for fertility preservation in cancer patients. This study evaluates sperm retrieval rates during ex-vivo TESE (evTESE) in men with TCa.
Methods: Men undergoing orchiectomy with a preoperative centrifuged semen analysis demonstrating azoospermia were counseled regarding TESE to be performed at the time of their orchiectomy. In patients undergoing synchronous bilateral orchiectomy, both testes were surveyed for sperm. After orchiectomy, the testis was placed on a separate sterile field and using loupe magnification the testis was bivalved and surveyed. The area of tumor was deliberately avoided, and seminiferous tissue was excised from multiple areas throughout the testis. Tissue specimens were placed in sperm transport medium and processed and reviewed in the andrology laboratory. Where sperm was found, it was cryopreserved. Demographics, laboratory, and pathological parameters were recorded. Logistic regression was performed to define predictors of successful evTESE, including patient age, FSH level, testicular volumes, type of TCa and comorbidity profile in the model.
Results: 34 men with mean age of 31 ± 8 years were analyzed. Mean baseline total testosterone and FSH levels were 326 ± 115 ng/dL and 28 ± 19 IU/mL respectively. Mean pre-TESE testicular volume was 15 ± 10 ml. 50% had unilateral and 50% bilateral tumors (25% synchronous and 75% asynchronous tumors). 62% had seminoma, the remainder NSGCT. 24% (8/34) of the patients had a positive sperm retrieval. The median number of vials was 5. The median number of sperm/HPF was 5 (2, 50). In positive specimens, visible viability (twitch) was seen in 75% of patients. No variables were predictive of a positive sperm retrieval.
Conclusions: In our cohort of men with TCa and azoospermia who underwent evTESE, 1 in 4 patients had a positive sperm retrieval. No predictors of positive sperm retrieval were identified.
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