Percutaneous Testicular Sperm Aspiration (TESA), a safe and viable fertility preservation option for pediatric oncology patient
Daniel DaJusta, MD, Janae Preece, MD, Molly Fuchs, MD, Leena Nahata, MD, Stacy Whiteside, NP, Seth Alpert, MD.
Nationwide Children's Hospital, Columbus, OH, USA.
BACKGROUND: Percutaneous Testicular Sperm Aspiration (TESA) has been use in adult males with infertility due to a variety of causes to retrieve sperm for intracytoplasmic sperm injection. Many pediatric patients diagnosed with a cancer will receive chemotherapy that could temporarily or permanently disrupt spermatogenesis and render them infertile. A small subset of patients exists, who may have already begun puberty but have no yet begin to have emissions or are too sick to proceed with sperm retrieval via masturbation. These patients could benefit from this procedure in order to obtain sperm for cryopreservation and later use. Since the creation of the Fertility program at our pediatric hospital, we have offered this technique for sperm retrieval to this select group of patients.
METHODS: Since the institution of the Fertility program at our Pediatric hospital in October 2011 to June 2016, we have provided fertility consultation to a total of 38 patients. Relevant clinical data for all patients who receive a consultation by our fertility team is kept in a prospective database. Of those, 5 patients were selected to undergo percutaneous TESA due to the inability to provide a semen specimen via masturbation. To be considered for TESA procedure patients had to be at least Tanner stage 3 by physical exam and/or laboratory hormone levels. In summary the percutaneous TESA technique involved using an 18-gauge angiocath and a stylet to penetrate the testicle and the stylet is removed. The angiocath is connected to a 15-cm length of IV extension tubing attached to a 20-cc syringe. Vacuum is applied, and the angiocath is inserted and withdrawn slowly from the periphery to the hylum until seminiferous tubules are noted to be ascending into the tubing. When the angiocath is withdrawn from the testis, there is usually a trailing strand of testicular tissue, which is cut at the skin surface and included with the specimen.
RESULTS: Mean age of the 5 patients undergoing TESA was 14 years (range: 12-16 years). Patients diagnosis include a Ewing sarcoma, a rhabdomyosarcoma, lymphoma, synovial sarcoma, recurrent lymphoma prior to bone marrow transplant therapy. All patients except one had not yet undergone any type of chemotherapy. All TESA procedures were done in conjunction with other procedures requiring general anesthesia or sedation such as placement of a central venous access and/or bone marrow biopsy for staging. Viable motile sperm was found and cryopreserved in 4 out 5 patients. The patient without sperm on the specimen had already received chemotherapy once prior to the TESE attempt.
CONCLUSIONS: Percutaneous TESA in this select subset of patient is safe and can reliably yield adequate sperm for cryopreservation. This technique should be offered for early pubertal and post pubertal patients, who are about to start therapy with drugs that can potentially affect future fertility, when they are unable to provide a specimen though normal masturbation and ejaculation. In our short experience this technique has been able to yield sperm for cryopreservation in all patients prior to the start of chemotherapy.
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