PRACTICE PATTERNS AND INSTITUTIONAL VARIATION IN ONCOLOGIC TESTICULAR SPERM EXTRACTION IN THE UNITED STATES

Document Type

Conference Proceeding

Publication Date

12-1-2025

Publication Title

Fertil Steril

Keywords

adult, anejaculation, azoospermia, cancer diagnosis, cancer patient, clinical article, clinical practice guideline, conference abstract, cryptozoospermia, diagnosis, DNA fragmentation, fertility preservation, gonad, human, Likert scale, male, oligospermia, orchiectomy, partial orchiectomy, patient selection, sperm, sperm retrieval, surgery, testicular sperm extraction, therapy, thrombocytopenia, United States, urogenital tract cancer, urologist, workflow

Abstract

OBJECTIVE: Oncologic testicular sperm extraction (oncoTESE) remains a poorly defined concept that is a heterogenous and understudied fertility preservation option for cancer patients with male gonads. Given variation in practice patterns, reproductive insurance coverage, and provider availability, there is significant diversity among the accepted indications, desired evaluations, and surgical practices afforded to patients facing a cancer diagnosis. This study aimed to characterize and help further define oncoTESE practice patterns across the United States. MATERIALS AND METHODS: A 34-item, anonymized survey assessed provider demographics and oncoTESE practice patterns, including indications, contraindications, workflows, and institutional barriers surrounding OncoTESE procedures. A survey was created and electronically distributed to reproductive urologists across the United States using email addresses obtained via society membership websites. RESULTS: Thirty-two urologists (17%, 32/189) from 19 states responded to the survey. Most (90.6%, 29/32) were fellowship-trained reproductive urologists, and the majority (84%, 27/32) reported offering oncoTESE to indicated patients. The most cited indications were azoospermia (79%, 23/29), anejaculation (66%, 19/29), and severe oligozoospermia or cryptozoospermia based on ejaculate analysis (55%, 16/29). Less frequently reported indications included pre- or peripubertal status (31%, 9/29) and elevated sperm DNA fragmentation indices (21%, 6/29). The most identified relative contraindications were inability to consent (90%, 26/29), clinical instability (86%, 25/29), thrombocytopenia (59%, 17/29), and a history of remote chemotherapy (55%, 16/29). There was strong consensus that oncoTESE includes sperm retrieval during back-table orchiectomy (97%, 28/29) and ipsilateral microTESE during partial orchiectomy (86%, 25/29). However, greater variability was noted regarding contralateral microTESE at the time of orchiectomy (62%, 18/29), procedures for non-genitourinary malignancies (59%, 17/29), and delayed procedures performed years after diagnosis (41%, 12/29). Estimated patient costs for oncoTESE were most commonly reported as $2,000–$5,000 (43%, 13/30), followed by $500–$2,000 (20%, 6/30) and $5,000–$10,000 (17%, 5/30); 13% (4/30) were unsure. On a 10-point Likert scale, the most significant barriers to performing oncoTESE were logistical challenges (mean 7.00, median 8.0), followed by patient cost (mean 5.69, median 6.0) and patient illness (mean 5.42, median 5.0). CONCLUSIONS: This multi-institutional survey found strong agreement among reproductive urologists on core procedural elements, but substantial variation on oncoTESE definition, patient selection criteria, pre-procedural evaluation, and fertility preservation management. Similar institutional barriers across centers highlight opportunities to improve accessibility and standardize oncoTESE practices. IMPACT STATEMENT: These findings highlight the need to clearly define oncoTESE and develop clinical guidelines to better support the fertility preservation needs of male cancer patients. SUPPORT: NA

Volume

124

Issue

6

First Page

e274

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