Fertility hope for testicular cancer patients

A 33-year-old man was recently treated at The Alfred after he was diagnosed with cancer in both testicles as well as a metastasis in the abdomen. Both testicles had to be removed.

Alfred Health urologist Dr Gideon Blecher said it’s rare for a person to contract cancer in both testicles at the same time and the special circumstances prompted an urgent discussion around fertility.

“Around 30 per cent of men have impaired sperm production when they have testicular cancer and 10 per cent have no sperm in their ejaculate at all,” Gideon said.

“In this case the patient had no sperm, so the principle became trying to address the fertility issue at the same time we treated the cancer problem.”

The solution was a procedure known as Onco-testicular sperm extraction (onco-TESE).

“When men have reduced or normal sperm levels, they can have sperm frozen before their operation, but when they have no sperm, that’s when the value of an onco-TESE comes into play,” Gideon said.

“Although patients may have no sperm seen in their ejaculate sample, up to 40% may have very small numbers that can be retrieved during onco-TESE.

“In this case Monash IVF came to our theatre, we removed both testicles, put them aside and looked for areas producing sperm.

“We successfully harvested the sperm with the IVF team, who put it in incubator and transferred it back to lab and froze it.

The patient recovered from the surgery and has an excellent prognosis.

Gideon said he hoped the positive outcome would serve as a conversation starter.

“This is a fantastic example of the public and private sector collaboration, with minimal financial cost to the patient.

“It’s really important that we increase the focus on the fertility aspect of male cancer patients. For many years it’s been somewhat of a side issue.”