ICSI AS A TREATMENT FOR MEN WITH PERSISTENT AZOOSPERMIA POST-CHEMOTHERAPY. Peter T K. Chan, Gianpiero D. Palermo, Lucinda L. Veeck, Deborah Liotta, Carol Ann Cook, Peggy King, Marc Goldstein, Zev Rosenwaks, Peter N. Schlegel.

Center for Male Reproductive Medicine and Microsurgery; Center for Reproductive Medicine and Infertility, Cornell Institute for Reproductive Medicine, and Department of Urology, The New York Presbyterian Hospital-Weill Medical College of Cornell University. New York, NY.

INTRODUCTION AND OBJECTIVES: Men who remain azoospermic long after chemotherapy are generally considered sterile. We hereby report our experience of testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection (ICSI) applied to azoospermic men who previously received chemotherapy for a variety of indications.

METHODS: Among 142 patients who underwent TESE-ICSI for azoospermia from 1995 to 1999, 15 TESE procedures in 12 patients who previously received chemotherapy were identified. All TESE was performed microscopically under local anesthesia with sedation or general anesthesia. The hormonal profile, histology of testicular biopsies, and the outcome of TESE-ICSI of this subgroup of patients were analyzed.

RESULTS: Patients mean age was 38.9 (29-54) yr and the mean FSH was 21.2 (7.1-43) mIU/ml. Female partners mean age was 36.2 (28-43) yr. Five patients had chemotherapy for Hodgkin lymphoma (42%), 3 for testicular neoplasm (25%),2 for non-Hodgkin lymphoma (17%), 1 for leukemia (8%) and I for nephrotic syndrome (8%). The interval from chemotherapy to TESE was 4-18 years. All patients had at least 2 semen analyses to confirm azoospermia. A total of 15 attempts of TESE-ICS1 were performed (mean 1.3 attempts per patient). Histology revealed Sertoli cell only pattern in 90% of cases. One patient (10%) had hypospermatogenesis as the most advanced spermatogenic pattern. Sperm retrieval was accomplished in 7/15 (47%) attempts, with biochemical pregnancy after sperm retrieval in 3n couples (43%). Live deliveries were achieved in 2/7 couples (29%). Two healthy boys and one girl were delivered. An additional patient who failed to have sperm retrieved with TESE had sperm return to his ejaculate after varicocele repair. He initiated a pregnancy and delivery with ICS1 alone. No correlation was noted between the outcome of TESE-ICSI and the underlying conditions treated with chemotherapy.

CONCLUSIONS: Using TESE-ICSI, sperm retrieval leading to pregnancy and delivery of healthy children is possible for men with long-standing azoospermia after chemotherapy. The prognosis for sperm retrieval was not clearly influenced by the chemotherapy regimen or disease treated. Despite their prolonged azoospermia after chemotherapy, these men should no longer be considered sterile in the era of TESE-ICSI.

Support: Brady Urology Foundation

This abstract ( #1520) was presented at American Urological Annual Meeting, Atlanta, GA. May 3, 2000

(J. of Urol. ,vol.163, No. 4, Supplement, Wednesday, May 3, 2000)