Infertility remains a major complication of testicular malignancy. Although the risk of testes cancer is small, the disease affects men in their peak reproductive years and fertility issues will be important to the majority of patients. As mortality from testes cancer falls, more attention is being focused on reducing morbidity, including infertility.
There is no reliable way to predict which patients will retain or recover fertility potential after treatment, and the adverse effect on fertility should be considered in all patients. Recovery of spermatogenesis may continue for up to 5 year following treatment, but a failure to improve after 2–3 years implies a poor prognosis.
Treatment will depend largely on the semen quality at the time of evaluation. Azoospermia and a markedly elevated FSH level indicate spermatogenic failure. Oligospermic patients will likely require some form of assited reproductive technique, although chances of pregnancy will continue to be less than 25% following either artificial insemination or IVF. Normospermic patients should have sperm-function testing and antisperm antibody assays performed. A thorough evaluation of the woman should also be carried out.
More research needs to be done on cytoprotection of the seminiferous epithelium from the effects of chemotherapy and radiotherapy before it can be recommended in the clinical setting.