Fertility preservation of patients with testicular cancer

Abstract

Background: Testicular cancer (TC) is one of the most common malignancies in young men of reproductive age. Although TC is a curable malignancy with a high survival rate, its treatment requires various cytotoxic modalities and negatively impacts spermatogenesis; therefore, the fertility preservation of patients with TC has been studied.

Methods: In order to give an overview of fertility preservation in patients with TC, the literature was reviewed. Original and review articles were identified and examined on the basis of PubMed database searches.

Results: Chemotherapy and radiotherapy damage spermatogenesis and retroperitoneal lymph node dissection negatively impacts ejaculatory function. Testicular sperm extraction facilitates successful sperm retrieval in patients with TC with postchemotherapy azoospermia. Although preserved sperm is used with a very low frequency (8%), the conception rates in those who have used sperm are not inferior.

Conclusion: The number of studies is limited, and because numerous treatment factors affect fertility, outstanding questions remain about preserving the fertility of patients with TC. Further studies are necessary in order to determine the best means of preventing and treating infertility in patients with TC.

Keywords: fertility; semen preservation; sperm banks; survivors; testicular cancer.

Figure 1

Flow chart showing the work‐up, primary treatment, and pathological diagnosis for testicular cancer, as recommended by the National Comprehensive Cancer Network (NCCN) guidelines. The work‐up includes the measurement of the serum tumor markers that are required for clinical staging. Discussions about sperm banking are recommended at the beginning of the primary treatment. AFP, alpha fetoprotein; hCG, human chorionic gonadotropin; H&P, history and physical examination; LDH, lactate dehydrogenase