Purpose: Because more than 70% of children with cancer become long-term survivors, more emphasis is put on reducing late effects. Cryopreservation of semen and the intracytoplasmic sperm injection technique makes it possible to obtain pregnancy with very poor sperm quality. Two new semen retrieval methods are described that are applicable in pubertal boys with a fertility potential, although not psychologically ready to produce a semen sample, who are likely to become infertile because of anticancer therapy.
Patients and methods: Two pubertal boys (aged 14 and 15 years) had a late testicular relapse of pre-B acute lymphoblastic leukemia and Hodgkin disease, stage II, respectively. In patient 1, penile vibratory stimulation (PVS) was tried under general anesthesia without success and electroejaculation (EEJ) was performed. Before alkylating chemotherapy and testicular irradiation, PVS was performed with success in patient 2.
Results: An antegrade ejaculate of 0.7 ml with 1% motile spermatozoa and an retrograde ejaculate with 1.6 x 10(6)/ml spermatozoa (5% with fair motility) was obtained from patient 1. An antegrade ejaculate of 1.5 ml with 2.5 x 10(6)/ml spermatozoa (29% with fair motility) was obtained from patient 2.
Conclusions: PVS should be the first choice of treatment because it is noninvasive, simple, and easily applied. Because EEJ requires general anesthesia, it should be used as a second option.