Reply to editorial regarding Increased risk of cancer among azoospermic men

13 06 2013

To the Editor:

We thank the distinguished author for bringing attention to our work.

As Dr. Schlegel points out, a natural conclusion to draw from the manuscript is that a male factor evaluation is of critical importance for a man’s reproductive and overall health (1). Indeed, it is estimated that 20% of infertile couples do not receive a male evaluation in the U.S.(2) As is noted, the current estimates may be an underestimate of a man’s lifetime risk. The current analysis followed men for a relatively short period of time (up to 15 years) compared with a man’s complete lifespan (76.3 years) (3, 4). Thus, it is possible that his lifetime risk of cancer would continue to rise as he ages.

Dr. Schlegel does point out some limitations related to the granularity of information on each man. As is noted, infertile men are generally of higher socioeconomic status compared with the general population (5). However, access to care should be independent of semen parameters. Thus it is unlikely that the elevated cancer risk seen in azoospermic men could be entirely explained by socioeconomic factors. We look forward to seeing other groups substantiate our findings.

Michael Louis Eisenberg, M.D. , Stanford University School of Medicine, Stanford, California
Paul Betts, M.S., Cancer Epidemiology and Surveillance Branch, Texas Cancer
Registry, Texas Department of State Health Services, Austin, Texas
Danielle Herder, M.D., Baylor College of Medicine, Houston, Texas
Dolores Lamb, Ph.D., Baylor College of Medicine, Houston, Texas
Larry Lipshultz, M.D., Baylor College of Medicine, Houston, Texas


1. Schlegel PN. The relevance of increased cancer risk in infertile men. Fertil Steril 2013.

2. Eisenberg ML, Lathi RB, Baker VL, Westphal LM, Milki AA, Nangia AK. Frequency of the male infertility evaluation: data from the national survey of family growth. J Urol 2013;189:1030-4.

3. Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep 2013;61:1-167.

4. Eisenberg ML, Betts P, Herder D, Lamb DJ, Lipshultz LI. Increased risk of cancer among azoospermic men. Fertil Steril 2013.

5. Hotaling JM, Davenport MT, Eisenberg ML, VanDenEeden SK, Walsh TJ. Men who seek infertility care may not represent the general U.S. population: data from the National Survey of Family Growth. Urology 2012;79:123-7.

Published online in Fertility and Sterility doi:10.1016/j.fertnstert.2013.06.025


Unknown risk of the reintroduction of malignant cells in a Danish cohort of women autotransplanted with ovarian tissue.

31 03 2011

To the Editor:

Ovarian cryopreservation appears to hold much promise for fertility preservation of women undergoing gonadotoxic therapy. In the Netherlands, cryopreservation of ovarian tissue has been performed for a number of cancer patients. No autotransplantation of ovarian tissue has been performed thus far, due (amongst other reasons) to concerns about the risk of reintroducing the malignancy with the transplant.

The available literature on this subject is not unequivocal. For example, Shaw et al. (1) have shown in a mouse model that lymphoma can be transmitted to the recipient by both fresh and frozen ovarian tissue grafts. Kim et al. (2), on the other hand, reassuringly demonstrated that none of the mice that were xenografted with human ovarian tissue fragments derived from patients with (non)Hodgkin lymphoma developed disease. Read the rest of this entry »

An explanation for the true origin of spontaneous pregnancies after subcutaneous ovarian transplantation

28 03 2011

To the Editor:

I read with interest the article by Oktay et al. (1), in which the authors reported spontaneous pregnancies and live births after subcutaneous heterotopic ovarian transplantation to a Hodgkin lymphoma survivor who was rendered menopausal because of preconditioning chemotherapy before hematologic stem cell transplantation (HSCT), and discussed the origin of pregnancies after ovarian transplantation. They have done a good work.

I have great interest in the true origin of the spontaneous pregnancies. Although they mentioned that this patient might get pregnant without heterotopic transplantation, they did believe other explanations need more laboratory and clinical research because the third pregnancy occurred after the patient did not respond to high doses of gonadotropins and her in situ ovary was invisible by ultrasound examination. Read the rest of this entry »