CLINICAL OUTCOMES AND SPERM QUALITY AFTER CHEMOTHERAPY IN PATIENTS WITH TESTICULAR CANCER

Abstract

Testicular cancer survival rates have increased to 95%, leading to fatherhood becoming a major concern in half of male survivors. Since is not possible to predict how chemotherapy (CT) will affect spermatogenesis, sperm cryopreservation before cancer treatment is highly recommended. It is also unknown whether there is an increase in the rate of chromosomal or epigenetic abnormalities in post-CT sperm. Therefore, the use of fresh or stored sperm to undergo an IVF cycle is decided on an individual basis, based on the criteria of the attending doctor. Our aim was to evaluate the sperm quality and the IVF clinical outcomes of patients who had undergone CT to be cured of testicular cancer. This is a retrospective observational study including 119 patients diagnosed with testicular cancer who attended our clinic between 1998-2019 to cryopreserve semen before undergoing CT. A new sperm analysis was performed on the 38 patients that decided to return to our clinic after their cure. The total sperm concentration of the samples before and after CT was compared using paired t tests. Furthermore, the clinical IVF results obtained by the 27 patients who decided to undergo an IVF cycle were compared according to the origin of the sperm (frozen vs. fresh) with Fisher’s exact Tests. The patient’s mean age at the time of the cryopreservation was 31.67 ± 6.20 years. The spermiogram diagnosis at that moment was: normozoospermia (n=46, 38.65%), oligozoospermia (n=23, 19.33%), asthenozoospermia (n=13, 10.92%), oligoasthenozoospermia (n=26, 21.85%), cryptozooserpermia (n=5, 4.20%) and azoospermia (n=6, 5.04%). After cancer treatment, 38 patients (31.93%) returned to our clinic for a second semen analysis. The average time interval that elapsed was 4.26 ± 4.28 years. While 9 of the patients (23.68%) were azoospermic after CT treatment, 29 (76.32%) recovered spermatogenesis. Mean total sperm concentration before and after CT in those patients was 78.11 vs. 59.35 million, respectively (p>0.05). Twenty-seven patients underwent an IVF cycle. Following the doctor's instructions, 20 used frozen pre-CT samples, while 7 used fresh post-CT samples. Comparable ongoing pregnancy rates (66.66% vs. 56.75%; p>0.05), implantation rates (52.63% vs. 43.39%; p>0.05), miscarriage rates (0% vs. 14.28%; p>0.05) and live birth rates (100% vs. 90.47%; p>0.05) were found respectively. Acording to our data, the risk of azoospermia in patients diagnosed with testicular cancer undergoing CT is 24%. The patients who recover spermatogenesis after CT have a total sperm count similar to that before cancer treatment. Testicular cancer survivors obtain as good IVF clinical results as those obtained by the infertile population attending our clinic, whether they use a fresh sample or a sample that was frozen before the CT.