The physicians, clinical team, and embryologists at Austin Fertility & Reproductive Medicine/Westlake IVF published a new treatment approach for azoospermic men with congenital adrenal hyperplasia (CAH) and bilateral testicular adrenal rest tumors (TARTs) in the Journal of Assisted Reproduction and Genetics. These men have overproduction of testosterone from the adrenal glands resulting in diminished signaling hormones that would normally tell the testicles to produce testosterone and sperm, which is one of the factors that can result in infertility in men with CAH.
There are men with CAH who 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 blockages 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. Others have also reported removing the testicular tumors and then checking a semen analysis to see if the tubules can be unblocked with tumor removal. The men maintained 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 team at AFRM published their report describing a new treatment approach 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.
To read the full Open Access article published in the Journal of Assisted Reproduction and Genetics,