Fertility after chemotherapy for testicular germ cell cancers.
OBJECTIVE
To analyze the probability of recovery of spermatogenesis after orchidectomy and cisplatin-based chemotherapy (CT) for testicular germ cell cancer.


METHODS
One hundred seventy-eight patients treated between 1979 and 1991 were selected by the requirement of sperm count both pre-CT and post-CT. Counts were classified as normospermic (NS) if more than 10 x 10(6)/mL, oligospermic (OS) if 1 to 9 x 10(6)/mL, and azoospermic (AS) if less than 1 x 10(6)/mL. The median follow-up time after CT before sperm analysis was 30 months.


RESULTS
Analysis of 170 patients whose spermatogenesis was reassessed at least 1 year after CT showed that of 89 patients whose pre-CT counts were NS, the post-CT count was NS in 64%, OS in 16%, and AS in 20%. There was clear evidence for continued recovery beyond 1 year; the probability of spermatogenesis increased to 48% by 2 years and 80% by 5 years. There was a significantly higher probability of recovery to OS and NS count levels in the 54 patients treated with carboplatin-rather than cisplatin-based therapy. There was an independent and similar effect of normal pre-CT count. There was a reduced probability to recover to OS in the 26 patients treated with more than four cycles of CT. A prognostic model identified three groups with 25%, 45%, and 82% probabilities of recovering spermatogenesis by 2 years after CT.


CONCLUSIONS
Analysis of pre-CT sperm count together with details of planned treatment can be used to predict recovery of spermatogenesis following germ cell CT.
Lampe
H
H
Urological Oncology Unit, Royal Marsden National Health Service Trust, Surrey, United Kingdom.
Horwich
A
A
Norman
A
A
Nicholls
J
J
Dearnaley
D P
DP
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000494:pharmacology*; D016190:Carboplatin / Q000494:pharmacology; D002945:Cisplatin / Q000494:pharmacology; D005298:Fertility / Q000187:drug effects*; D018237:Germinoma / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013076:Sperm Count / Q000187:drug effects*; D013736:Testicular Neoplasms / Q000188:drug therapy*
D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin