PRE-CHEMOTHERAPY SPERM PROCUREMENT IN TEENAGERS: ANALYSIS OF OUTCOMES AND PREDICTORS OF SPERM RETRIEVAL
Nelson Bennett, Jr., MD1, John Mulhall, MD2.
1Lahey Clinic Medical Center, Burlington, MA, USA, 2Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
BACKGROUND:The deleterious effect of chemotherapy on the testicular germinal epithelium is well recognized. Men are routinely urged to provide a semen specimen for analysis and cryopreservation prior to the commencement of chemotherapy. However, in boys and young men with cultural or religious restrictions, the natural procurement of semen may not be possible. This analysis reviews our experience with pre-chemotherapy sperm procurement in teenagers.
METHODS: A database was constructed of all patients who had either electroejaculation (EEJ) and/or testis sperm extraction (TESE) prior to chemotherapy. Data recorded included type of malignancy, patient age, serum testosterone, gonadotropin levels, sperm concentration, motility, and number of vials cryopreserved.
RESULTS: 11 teenagers have had attempted pre-chemotherapy sperm procurement between 2004-06. Mean age was 15±2.8 years. Demographically, 55% of patients reported Roman Catholic upbringing and 37% Orthodox Jewish. 91% described themselves as Caucasian and 9% Hispanic. 8/11 (73%) had sarcomas of various types, the remainder had some form of lymphoma. Mean testicular volumes were 13.3±4 mLs, no patient had asymmetry of testicular size. Median Tanner stage was III. Mean serum testosterone level was 159±162 ng/dL, 50% having castrate levels. Mean FSH and LH levels were 1.9±1.4 IU/mL and 0.4±0.6 IU/mL. 40% had FSH levels <1. 36% reported prior ejaculation. 6/11 (55%) had EEJ performed, 5/6 producing an ejaculate and 3/5 having sperm retrieved, with a mean concentration of 1.7±1.9 M/mL. Only one patient had sperm present within the retrograde ejaculate. 8 had bilateral TESE, 2 unilateral and one a bilateral percutaneous TESA. 7/11 (64%) had sperm found on TESE, with a mean sperm concentration of 2±3 M/mL and a mean number of vials cryopreserved of 9.9±2.6. With regard to the prediction of the ability to retrieve sperm: there were no predictors of sperm retrieval on EEJ; no patient with FSH <1 IU/mL had sperm found at TESE; all patients who reported prior ejaculation had sperm found at TESE; all patients who had no sperm found were Tanner III; 2/3 boys with castrate T levels had no sperm found.
CONCLUSIONS: We have demonstrated that in the majority of boys undergoing pre-chemotherapy sperm procurement that sperm is found from TESE and that the ability to retrieve sperm is negatively correlated with subnormal FSH levels, low Tanner stage, castrate T levels, and positively associated with prior ejaculation.