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• W4238609937 abstract "Testicular cancer is the most common malignancy in young men. The disease is known to impair sperm quality. As many of these men have not yet fathered children, maintenance of reproductive health is important. Therefore, during the past decade sperm banking has become a routine procedure prior to treatment. However, sometimes azoospermia is diagnosed and the only chance of finding sperm is to examine testicular biopsies. Successful pregnancy and delivery after intracytoplasmatic sperm injection (ICSI) using fresh spermatozoa extracted from testicular tissue samples in a man with seminoma has been reported previously (1). In another case report, pregnancy and birth was reported from frozen thawed embryos achieved by ICSI of cryopreserved spermatozoa extracted from an orchidectomized, seminoma- bearing testis, causing obstructive azoospermia (2). Successful retrieval of spermatozoa at the time of radical orchidectomy for testicular cancer and a clinical singleton pregnancy using cryopreserved thawed sperm have also been described (3). In the present report testicular spermatozoa were found at the time of radical orchidectomy due to testicular seminoma in a man with nonobstructive azoospermia. Frozen thawed spermatozoa were later used for ICSI, resulting in a singleton pregnancy and delivery of a healthy child. A 37-year-old male and his 31-year-old female partner were referred to our in vitro fertilization (IVF) unit for treatment with ICSI as repeated semen analyses had diagnosed severe oligozoospermia. Unexpectedly, azoospermia was diagnosed on the morning of ovum pick-up and arrangements were made for an immediate testicular sperm aspiration (TESA) under local anesthesia. However, ultrasound prior to TESA revealed a focal area of low echogenicity within the right testis. Malignancy was suspected and TESA was conducted only on the left testis, without success. The patient later underwent a unilateral orchidectomy, and knife biopsies from the removed testis were microscopically examined for spermatogenetic cells. After mincing the tissue, occasional immotile spermatozoa were found and cryopreserved. Histopathology of the right testis revealed a seminoma. Open biopsies were also taken from the left testis, but no spermatozoa were found in these samples. Almost a year after cancer treatment, the couple was again enrolled in our ICSI program and retrieved oocytes were injected by frozen thawed immotile testicular spermatozoa from the neoplastic testis. Two good quality embryos were transferred, resulting in a singleton pregnancy and birth of a healthy child. Since delivery more than 2 years ago, the child has developed normally and stayed healthy. When testicular cancer is diagnosed, it is strongly advised that it should be treated without further delay. Definitive treatment of the malignancy should precede any attempts at pregnancy. In men with viable spermatozoa found in the ejaculate, cryopreservation of sperm cells ensures that IVF/ICSI can be performed at a later stage. Pregnancies have been achieved with frozen thawed ejaculated spermatozoa from men with testicular tumors and reduced sperm quality (4). Successful ICSI after TESE from the healthy testis in a man with seminoma and azoospermia has been described previously (5). By contrast, the present case report demonstrates that TESE from the affected testis, at the time of orchidectomy, is a reasonable option when no sperm are found in biopsies from the healthy side. Men with testicular cancer and azoospermia represent a special subgroup of patients. Baniel and Sella demonstrated recently that spermatozoa may be aspirated from the vas deferens and epididymis at orchidectomy for preservation in azoospermic men with testicular cancer (6). It is important to recognize that even semen of the poorest quality and quantity can produce pregnancy when used according to modern assisted reproductive techniques. It is therefore of importance to retrieve any amount of sperm available. In the present case, an extremely low number of immotile spermatozoa were found. Despite this, cryopreservation was carried out and ICSI could be performed at a later date. No data are available for an estimation of the risk of cancer in the offspring of fathers who had cancer of the testis at the time of conception. A close follow-up of these children is therefore important. However, seminoma is a tumor originating from undeveloped germ cells. The spermatozoa used for ICSI in the present case were mature cells, not to be associated with malignant undeveloped germ cells. It therefore seems unlikely that children born after IVF/ICSI in men with seminoma should have an increased risk of developing malignant disease." @default.
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• W4238609937 date "2004-01-01" @default.
• W4238609937 modified "2023-09-30" @default.
• W4238609937 title "Birth of a healthy child achieved by frozen thawed spermatozoa extracted at orchidectomy due to testicular seminoma in a male with nonobstructive azoospermia" @default.
• W4238609937 doi "https://doi.org/10.1080/j.0001-6349.2004.00092b.x" @default.
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