Testicular cancer and fertility

Before treatment, a little over one-half of patients with testicular cancer have fathered children, while one-fifth have a history of sterility. Radiotherapy with a gonadal dose of less than 1.5 Gy seems to do little permanent damage to fertility. Following cisplatin-based combination chemotherapy, a number of conceptions have been reported. The newer regimens affect spermatogenesis less than earlier ones due to a lower toxicity of the drugs and shorter duration of the treatment. New modifications of retroperitoneal lymphadenectomy may save ejaculatory ability in over one-half of the patients. It is uncertain whether this procedure is less detrimental to fertility than the cisplatin-based combination chemotherapy. Even though semen quality is often poor before treatment, cryopreservation of semen should be considered since in vitro fertilization may be successful even with very poor semen quality. There are no indications in the literature of permanent adverse genetic effects of the treatment.