Fertility after high-dose chemotherapy for testicular cancer

Abstract

Objectives To describe long-term gonadal function after high-dose chemotherapy (HDC). HDC for testicular cancer was recently developed. The evaluation of testicular function after chemotherapy for testicular cancer is an important part of overall care, especially in young patients. Methods Between 1994 and 2001, 27 patients underwent HDC (1250 mg/m 2 carboplatin, 1500 mg/m 2 etoposide, and 7.5 g/m 2 ifosfamide) at Kobe University Hospital. Information on gonadal function during follow-up was available for 10 of these patients. The mean patient age ± SD at treatment was 32.2 ± 8.4 years. The relationships among age at treatment, semen analysis, serum hormone levels (follicle-stimulating hormone, luteinizing hormone, testosterone, prolactin, and estradiol), cumulative dose of cisplatin and carboplatin, and length of follow-up were determined. Results Spermatogenesis recovered after cessation of HDC in 5 of 10 patients. Semen analysis in these patients showed the mean sperm concentration and motility at 42.4 ± 10.4 million/mL and 67.2% ± 17.0%, respectively. The patients were divided into azoospermic and nonazoospermic groups. The age of the nonazoospermic and azoospermic patients was 28.2 ± 8.7 and 36.2 ± 6.5 years, respectively. Follicle-stimulating hormone levels in the nonazoospermic group (11.7 ± 3.4 mIU/mL) were significantly lower than in the azoospermic group (32.8 ± 14.4 mIU/mL; P = 0.0472). No other statistically significant difference was observed in the other hormone levels or the cumulative dose of cisplatin and carboplatin between the azoospermic and nonazoospermic groups. Conclusions Spermatogenesis recovers after HDC in some patients. Patients should be informed that they may or may not be fertile after HDC.