There are multiple reasons why men with testicular cancer can have impaired fertility:
- 50 % of men with testicular cancer have oligospermia at diagnosis (due to some form of testicular dysgenesis and/or cryptorchidism)
- Up to 24 % may be azoospermic before orchidectomy
- Chemotherapy impairs fertility
- Dose dependent (cumulative cisplatin dose most important)
- Spermatogenesis usually recovers 1 – 4 years after chemo
- Adjuvant chemo x 1 (carbo or BEP) doesn’t appear to significantly alter function, with full recovery after 1 year
- Radiation – can take 2 – 3 years to recover spermatogenesis
- RPLND can cause retrograde ejaculation or anejaculation due to effects on the sympathetic plexus
- Pre-treatment fertility assessment is advised (semen analysis, LH/FSH/testosterone)
Chemo and radiation are both teratogenic and contraception needs to be used during and for six months after treatment.
Consider surveillance over adjuvant treatment if men worried about fertility.
There is a risk of bilateral involvement and men with bilateral orchidectomy, or who receive treatment for GCNIS in solitary testicle, will be infertile.
There are also psychological impacts of a cancer diagnosis and treatment in young men – with flow on effects to sexual health and erectile function.
Overall paternity rates for testis cancer patients on surveillance for stage 1 similar to matched population cohort, slightly worse if have chemo.
Offer cryopreservation before orchidectomy, or at a minimum before any chemotherapy.