Ten-year experience of oncotesticular sperm extraction (oncoTESE) in Australia: report of sperm retrieval rates and fertility outcomes.

Abstract

Introduction & Objectives: To assess sperm retrieval rates of onco-testicular sperm extraction (oncoTESE) in men with testicular tumours and co-existing severe spermatogenic impairment. Method(s): A multi-centre retrospective review was undertaken of oncoTESE procedures performed in Australia within the last 10 years. Patients were post-pubertal adults with a testicular tumour requiring orchidectomy, with concomitant severe oligozoospermia or non-obstructive azoospermia. Ipsilateral testicular sperm extraction was performed following radical inguinal orchidectomy. A contralateral micro-testicular sperm extraction was performed if no (or insufficient) sperm was obtained. Surgical sperm retrieval rates, live birth rates and post-operative serum testosterone were recorded. Result(s): Four surgeons compiled a total 13 patients. The mean age was 34.9 years. Seven of the 13 men had germ cell tumours (GCT), 4 of 13 had non-GCTs and 2 of 13 had benign lesions. Twelve out of 13 patients were azoospermic and 1 was severely oligozoospermic. Sperm was found in 6 of 7 GCT patients; 3 of 7 were found in the ipsilateral testis whilst the remaining 4 underwent contralateral micro-testicular sperm extraction; sperm was retrieved in 3 of 4. The respective mean pre and post orchidectomy testosterone was 12.0 vs 14.1nmol/L (GCT cohort). Cryopreserved sperm has been used in assisted reproduction in 2 of 13 patients, with a median follow up of 38.7 months. Including use of both cryopreserved and fresh sperm, 6 pregnancies were achieved, including 5 healthy live births and 1 miscarriage. Conclusion(s): In our experience, oncoTESE is feasible, with acceptable sperm retrieval and subsequent live birth rates, following assisted reproduction. OncoTESE remains under-utilised in Australia and it should be considered in the management for TC patients with severe oligozoospermia, or nonobstructive azoospermia.