Gonadal function and fertility in patients with bilateral testicular germ cell malignancy.
OBJECTIVE
To evaluate gonadal function and fertility in patients with bilateral testicular cancer (TC).


METHODS
In 1999, 63 patients with bilateral invasive TC or carcinoma in situ (CIS) in the contralateral testis completed a mailed questionnaire evaluating their fatherhood (Cases). Their gonadal function had also been assessed after the first orchiectomy for TC before further treatment. The results were compared with those from 174 patients with unilateral TC (Controls).


RESULTS
In Cases the post-orchiectomy serum levels of FSH and LH were above those of the Controls (p<0.001). Serum testosterone was similar, whereas sperm concentrations were lower in Cases (p<0.001). In Cases with metachronous invasive TC the level of serum FSH was associated with the interval between the two diagnoses. After the first orchiectomy, 10 of 25 Cases (40%) initiated a pregnancy, in 4 Cases by assisted fertilization. In the Control group 74% of the patients who attempted fatherhood succeeded (p=0.002).


CONCLUSIONS
After unilateral orchiectomy for TC elevated serum FSH and/or oligospermia represent a high-risk factor of metachronous bilateral TC or synchronous CIS. At least one-third of these patients attempting fatherhood are successful after the first orchiectomy. Assisted fertilization is often necessary and the overall paternity rate is below that of patients with unilateral TC.
Jacobsen
Kari Dolven
KD
Department of Medical Oncology, The Norwegian Radium Hospital, Montebello, 0310, Oslo, Norway. s.d. fossa@klinmed.uio.no
Fosså
Sophie D
SD
Bjøro
Trine P
TP
Aass
Nina
N
Heilo
Arne
A
Stenwig
Anna E
AE
D000293:Adolescent; D000328:Adult; D002278:Carcinoma in Situ / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D003131:Combined Modality Therapy; D005298:Fertility / Q000502:physiology*; D005640:Follicle Stimulating Hormone / Q000097:blood; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007248:Infertility, Male / Q000209:etiology*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D009919:Orchiectomy / Q000009:adverse effects*; D013076:Sperm Count; D013736:Testicular Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D013737:Testis / Q000503:physiopathology*; D013739:Testosterone / Q000097:blood
D012739:Gonadal Steroid Hormones; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone