Routine sperm banking for testicular cancer patients should be performed both before and after orchidectomy

Abstract

Background: Despite some groups recommending that sperm banking for testicular cancer patients prior to orchidectomy results in improved overall semen quality, it remains common practice for this to occur post operatively, prior to any chemotherapy. Having seen anecdotal evidence of patients being rendered azoospermic and thus sterile by unilateral orchidectomy, we investigated further. Methods: Forty men listed for orchidectomy banked a single sample before surgery and were then given the opportunity to bank further samples post operatively. Results: Post orchidectomy, overall sperm concentration ( p = 0.01) and motility ( p < 0.05) were lower compared to before surgery and two men had azoospermia. However, the overall picture was misleading as in 13 individuals their sperm output was increased ( n = 13) after surgery. Both cases of post operative azoospermia were amongst the patients with seminoma although at least 50% of patients with teratoma had severe oligozoospermia post surgery. Conclusions: Despite the relatively high frequency of normal sperm counts amongst seminoma patients, there was no significant difference in total sperm output or sperm quality between these men and those with teratoma or mixed cell tumours. As overall sperm quality was lower after surgery and some patients had totally compromised fertility, our centre has changed its policy to encouraging sperm banking prior to surgery. However, we maintain that generalisation of this population is unwise and patients should also attend after surgery to optimise the quality of their samples in the sperm bank.