Fertility Prospects Among Testicular Cancer Survivors: Outcomes of Surgical Sperm Retrieval in Azoospermic Patients

Introduction Since general improvements in the prognosis of cancer patients have been achieved through advances in surgery, radiotherapy, and chemotherapy, subsequent infertility in adolescents and young adults (AYAs) has become a serious problem. Sperm quality is often abnormal at the time of testicular cancer diagnosis. Anti-cancer therapy further impairs spermatogenesis and, following orchidectomy, leaves patients with a single testis, raising long-term concerns about fertility. We therefore evaluated fertility outcomes among testicular cancer survivors attending our male infertility clinic. Materials and methods From 2004 to 2023, 3,361 male infertility patients consulted our division, 117 (3.5%) of whom had a history of cancer treatment. Thirty-nine patients diagnosed with testicular cancer were evaluated for cancer treatment, semen findings, and infertility treatment. Seminoma was observed in 29 participants and non-seminomatous germ cell tumor (NSGCT) in 10 participants. Results Nineteen patients were followed up with a high orchidectomy alone. After orchidectomy, one patient received prophylactic radiotherapy to the retroperitoneal lymph node, and three were followed by chemotherapy (BEP (bleomycin, etoposide, and platinum); BLM, VP-19/CDDP). Fifteen patients underwent retroperitoneal lymph node dissection (RPLND) after BEP. One patient received high-dose chemotherapy with peripheral blood stem cell transplantation (PBSCT), followed by RPLND, and then received additional BEP. Twenty-six patients had azoospermia, and 13 patients were oligoasthenozoospermic. Sperm retrieval surgery was attempted in 18 patients with azoospermia. Thirteen patients underwent microscopic testicular sperm extraction (micro-TESE), two received onco-TESE, two received microscopic epididymal sperm aspiration (MESA), and one received retrograde vasal sperm aspiration (ReVSA) due to reduced efficacy of medications for ejaculatory dysfunction (EJD) caused by RPLND. Motile sperm recovery was obtained through micro-TESE (5/13), onco-TESE (2/2), MESA (2/2), and ReVSA (1/1). Eleven healthy deliveries were observed following intracytoplasmic sperm injection (ICSI) using surgically retrieved sperm. Conclusions Testicular cancer survivors, even those with azoospermia, can achieve fatherhood through ICSI after precise evaluation and appropriate sperm retrieval surgery.