Sarah M Lambert MD Harry Fisch MD

Male Reproductive Center, Department of Urology, Columbia University, College of Physicians and Surgeons, New York Presbyterian Hospital, 944 Park Avenue, New York, NY 10028, USA

Testicular cancer is one of the few malignancies that affect men in their reproductive years. Testicular cancer represents the most common solid organ tumor in young men between 20 and 35 years of age. The National Cancer Society predicted that 8250 new cases of testicular cancer would be diagnosed in the United States in 2006 [1]. Fortunately, testicular cancer is also one of the most curable malignancies with 370 testicular cancer-specific deaths predicted for 2006. The incidence of testicular cancer therefore correlates with a 1 in 300 lifetime risk for developing testicular cancer and a 1 in 5000 lifetime risk for dying from testicular cancer. The objective of superior testicular cancer treatment includes not only cure but also the preservation of quality of life. The preservation of fertility and sexual function represent important quality-of-life parameters in these young men. To determine how testicular cancer impacts fertility it is important to understand how infertility is assessed and how infertility and testicular cancer are interrelated.

Development of infertility and testicular cancer may arise from congenital abnormalities in testic-ular maturation, such as gonadal dysgenesis, cryptorchidism, or carcinoma in situ. Additionally, exposure to certain gonadal toxins or trauma impacts testicular integrity, including spermato-genesis and the blood-testis barrier. As a result of these factors, many men presenting with testicular cancer are found to have abnormal semen analysis parameters before initiation of treatment. With the increase in delayed childbearing and the use of assisted reproductive technologies, men

* Corresponding author.

E-mail address: [email protected] (H. Fisch).

presenting with a primary complaint of infertility can be found to have incidental testicular neoplasms [2].

The presence of a testicular neoplasm affects the local testis environment, the pituitary-gonadal hormonal milieu, and the body systemically. Aberrations in any of these factors can adversely affect spermatogenesis. The psychologic impact inherent in the diagnosis of testicular cancer can also affect sexual function and fertility as a result. These tumor-related effects on fertility are compounded by the potentially deleterious effects of treatment modalities, such as pelvic radiation, chemotherapy, and retroperitoneal lymph node dissection (RPLND).

Despite these risk factors for infertility, it is important to stress to patients the preventive methods and treatments for infertility associated with testicular cancer and treatment. In patients who have successfully treated testicular cancer and preserved fertility, the potential effects on genetic integrity must be evaluated. This article reviews the causative factors for infertility in men who have testicular cancer and the treatments available for preserving or restoring fertility.

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