The Semen Quality of 1158 Men With Testicular Cancer at the Time of Cryopreservation: Results of the French National CECOS Network

Abstract

Testicular cancer is the most common cancer in young men. Several studies have reported an alteration in semen quality in nonseminoma tumors, but this result has not been confirmed in all of the published data. We performed a retrospective study in a population of 1158 men with testicular cancer who banked sperm between 1999 and 2003 in 11 French Centre d'Etude et de Conservation des Oeufs et du Sperme humain laboratories. Our study evaluated prefreeze and postthaw sperm parameters according to patient medical history, tumor histological type, and disease stage. Pure seminomas were found in 48% of our population. Testicular cancer was generally diagnosed at stage I. In cases of a history of unilateral cryptorchidism, testicular cancer occurred preferentially in the maldescended testis. Semen samples were preferentially collected after orchiectomy. The sperm concentration and total sperm number were significantly lower before orchiectomy in seminomas compared with nonseminoma tumors (P , .001). After orchiectomy, these parameters decreased for nonseminoma tumors and did not vary for seminomas. Semen parameters were more severely impaired for stage III tumors, and when patients had a history of cryptorchidism or when they were less than 20 years of age. Azoospermia was more frequently observed before than after orchiectomy. In this study, we determined that sperm cryobanking should preferentially be performed before orchiectomy and that testicular sperm extraction concurrent with orchiectomy should be used in severe spermatogenesis impairment. Our study highlights that seminomas alter sperm production more significantly than nonseminoma tumors and seem to preferentially impair spermatogenesis in tumor-bearing testes.

Predictors of spermatogenesis in radical orchiectomy specimen and potential implications for patients with testicular cancer

“…Fertility preservation and paternity are significant issues in men diagnosed with testicular cancer (TC). Up to 50% of TC patients present with abnormal semen analysis at diagnosis (2,3). Furthermore, decreased fertility is well documented among survivors of TC (4,5).…”

A successful pregnancy outcome in a testicular cancer survivor: case report

“…Various mechanisms can contribute to semen impairment in testicular malignancy such as previous testicular disorders, tumor histology, stage of the disease and orchiectomy. 3 Damage of the spermatogenesis after treatment largely depends on the type of therapy and the gonadal function pretreatment. Norwegian population based study observed a 30% decrease in fertility among the cancer survivors when compared with the normal population.…”

Adult metastatic yolk sac tumor descending from an intra-abdominal testis: A case report and review of the literature

“…According to a survey conducted by Molnar et al (19), sperm concentration is reduced in men exhibiting testicular tumors compared with matched healthy men. In a French national investigation, sperm concentration and total sperm number were significantly decreased in NSGCT patients following orchiectomy, therefore sperm cryopreservation should be considered prior to orchiectomy (21). In a number of retrospective studies (22)(23)(24), sperm cryopreservation has been recommended for testicular cancer patients who intend to have a child in the future.…”