Clomid after failed Onco-microsurgical testicular sperm extraction: A case for delaying contralateral surgical sperm retrieval

Background & Objectives: Onco-microsurgical testicular sperm extraction (Onco-microTESE) allows the microsurgical extraction of testicular sperm from the unaffected regions of the tumour-bearing testis at the time of radical orchidectomy. We report the case of a 36-year-old hypogonadotropic male with a testicular tumour and non-obstructive azoospermia.Method: A left radical orchidectomy was performed with simultaneous onco-microTESE. Although some sperm were found during the procedure, these were unsuitable for cryopreservation due to abnormal morphology. Given his low testosterone level (4.1 nmol/L), contralateral surgical sperm retrieval at the same sitting was not performed. Histology of the affected testicle demonstrated a classical seminoma and 'Sertoli cell only' appearance. He was subsequently started on clomiphene citrate.Results: After 9 months of clomiphene citrate, repeat semen analysis showed a total of 2.8 million sperm (1 million/mL), with 80% motility. Four vials of semen were cryopreserved, and this ejaculated sperm was used for in vitro-fertilisation (IVF) with intracytoplasmic sperm injection (ICSI). All six harvested eggs were fertilised. By day 5, there were two top grade blastocysts available, one of which was transferred and another frozen. After 9 months, the couple welcomed the birth of a healthy male infant.Conclusion: To our knowledge, this case is the first to demonstrate the benefit of clomiphene citrate in a patient with testis cancer resulting in a reversal of azoospermia and a subsequent live birth with assisted conception.Level of evidence: Not applicable