Spontaneous miscarriage after intracytoplasmic sperm injection with frozen sperm of patients with testicular germ cell tumour.

OBJECTIVE

To clarify the impact of chromosomal aberrations on the offspring of patients with testicular germ cell tumour (TGCT) by evaluating the outcomes of intracytoplasmic sperm injection (ICSI).

PATIENTS AND

METHODS

Under the ethical review of Yokohama City University, 12 patients with TGCT and 25 with non-TGCT cancer who had cryopreserved sperm for ICSI for fertility preservation between 1 April 2014 and 31 March 2023 were enrolled. For 198 oocytes from the TGCT group, 480 oocytes from the non-TGCT group, fertilisation, embryo viability, pregnancy, and spontaneous miscarriage rates were examined.

RESULTS

Females who received ICSI from patients with TGCT showed a significantly higher spontaneous miscarriage rate than those who received ICSI from patients with non-TGCT cancer (43.8% vs 9.1%, respectively, P < 0.05), with no significant between-group difference in the pregnancy rate. In the TGCT group, three cases of recurrent pregnancy loss and recurrent implantation failure were reported. The high spontaneous miscarriage rate in the TGCT group can be attributed to chromosomal abnormalities or DNA fragmentation in the sperm of patients with TGCT.

CONCLUSION

Natural conception may be an option for patients who have completed TGCT treatment and have adequate sperm. However, when semen parameters do not recover sufficiently, assisted reproductive technologies may be considered, including, where possible, the use of post-treatment sperm not affected by TGCT rather than pre-treatment sperm collected during tumour-bearing state. In selected cases, pre-implantation genetic testing for aneuploidy may also be considered.