Testicular sperm extraction prior to treatment in azoospermic patients with Hodgkin’s disease

M. Schrader1, M. Müller1, N. Sofikitis2, C. Goessl1, B. Straub1 and K. Miller1

1Department of Urology, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30, 12200 Berlin, Germany; 2Department of Urology, Ioannina University, Box 1186, 45110 Ioannina, Greece (E-mail: schrader@medizin.fu-berlin.de)

We read with great interest the recent paper by Rueffer et al. [1]. The authors of this multicenter study point out that even before polychemotherapy, abnormal semen quality is detected in 70% of patients and azoospermia (absence of spermatozoa in the semen) in 13%. The causes they discuss are diverse parameters responsible for severe fertility disorders in conjunction with Hodgkin’s disease (HD), including increased serum interleukin (IL)-1, IL-6, tumor necrosis factor (TNF)-{alpha} levels, tumor-associated fever and other factors. The authors also state that successful treatment of HD may lead to recovery of fertility, but only if the chemotherapy regimen does not contain gonadotoxic drugs. Problematic here is the fact that the polychemotherapeutic regimen for HD frequently includes gonadotoxic substances that cause an additional fertility disorder [2, 3]. The authors rightly point out that cryopreservation of ejaculated sperm prior to treatment is thus an important step towards protecting fertility. However, this recommendation is not valid for patients with azoospermia, since cryopreservation of ejaculate is of no help in such cases.

Based on our experience, we recommend testicular sperm extraction with cryopreservation of testicular biopsy specimens prior to treatment of patients with HD and azoospermia [4]. We successfully recovered haploid germ cells in four of 12 testicular biopsies from azoospermic men with HD. Maturation arrest was found in four of 12 cases and Sertoli-cell-only syndrome in the rest. None of the patients had secondary healing or a treatment delay because of the testicular biopsy. We think that testicular sperm extraction (TESE) should definitely be considered for azoospermic HD patients and offered as a treatment option in selected cases.

M. Schrader1, M. Müller1, N. Sofikitis2, C. Goessl1, B. Straub1 & K. Miller1

1Department of Urology, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30, 12200 Berlin, Germany; 2Department of Urology, Ioannina University, Box 1186, 45110 Ioannina, Greece (E-mail: schrader@medizin.fu-berlin.de)

References

1. Rueffer U, Breuer K, Josting A et al. Male gonadal dysfunction in patients with Hodgkin’s disease prior to treatment. Ann Oncol 2001; 12: 1307–1311.[Abstract]

2. Swerdlow AJ, Jacobs PA, Marks A et al. Fertility, reproductive outcomes, and health of offspring, of patients treated for Hodgkin’s disease: an investigation including chromosome examinations. Br J Cancer 1996; 74: 291–296.[ISI][Medline]

3. Kulkarni SS, Sastry PS, Saikia TK et al. Gonadal function following ABVD therapy for Hodgkin’s disease. Am J Clin Oncol 1997; 20: 354–357.[ISI][Medline]

4. Schrader M, Heicappell R, Müller M et al. Impact of chemotherapy on male fertility. Onkologie 2001; 24: 326–330.[ISI][Medline]





This Article
Full Text (PDF)
E-letters: Submit a response
Alert me when this article is cited
Alert me when E-letters are posted
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in ISI Web of Science
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Disclaimer
Request Permissions
Google Scholar
Articles by Schrader, M.
Articles by Miller, K.
PubMed
PubMed Citation
Articles by Schrader, M.
Articles by Miller, K.