The doctors from Austin Fertility & Reproductive Medicine recently presented research at the 31st European Society of Human Reproduction and Embryology (ESHRE) meeting in Lisbon, Portugal. The research led to a new treatment algorithm for men with Congenital Adrenal Hyperplasia (CAH) and bilateral testicular adrenal rest tumors (TARTs). These patients have overproduction of testosterone from the adrenal glands resulting in diminished signaling hormones that would normally tell the testicles to produce testosterone and sperm. This is one of the factors that can lead to infertility in men with CAH.
Some men with CAH will also experience growth on non-cancerous tumors in both testicles known as TARTs which form in the tubules allowing sperm to leave the testicles and thereby cause obstruction as another source of infertility in these men. Other groups have reported sperm retrievals from the testicles of men with TARTs to use with in-vitro fertilization/intacytoplasmic sperm injection (IVF/ICSI) independently from TART removal. Other groups have reported removing the testicular tumors and then checking a semen analysis to see if the tubules can be unblocked with tumor removal. The men continued to have a sperm count of zero, as scarring from the surgery would block the outlet or the tissue had already been destroyed by the TARTs, not allowing the sperm to exit the testicle.
The doctors at AFRM presented a case series describing a new treatment algorithm which has now been successfully used in two patients. The men were treated with appropriate testicular stimulating hormones and then the tumors were removed surgically to minimize further tissue destruction and to resolve testicular pain and sperm retrieval was performed at the same surgical setting. The sperm was frozen and stored for future use with IVF/ICSI to help these men father children in the future when the timing is right for them.
Dr. Parviz Kavoussi comments, “This is the first reported case series of its kind to remove TARTs and perform sperm retrieval at the same surgical setting. This eliminates the need for subjecting these men to multiple procedures and results in excellent outcomes. It was very exciting to be able to share this information with physicians from all over the world at such a renowned meeting”.