title: The Biochemical and Pathological Correlates of Successful Semen Cryopreservation From Patients With Testicular Cancer: A Single Tertiary Center Experience.
abstract: OBJECTIVE
  To determine the predictors for success with regard to semen cryopreservation and good semen quality of patients with testicular cancer.
  
  
  METHODS
  A total of 50 men (aged 16-36 years) with testicular cancer, referred for semen cryopreservation prior to gonadotoxic treatment, were included. Age, alpha fetal protein (α-FP), beta human chorionic gonadotropin, lactate dehydrogenase, clinical staging, tumor volume, and pathological reports were evaluated as correlates of successful semen cryopreservation and good semen quality.
  
  
  RESULTS
  The overall success rate was 52%. α-FP (4113.1 ng/mL vs 81.2 ng/mL) and tumor volume (77.7 mL vs 25.5 mL) were significantly higher in the failure group as compared to the success group. The seminoma to nonseminomatous germ cell tumor ratio was lower in the failure group as compared to the success group (9/17 vs 3/21). There was nearly a significant difference (P = .066). The optimal cutoff value for α-FP > 1000 ng/mL showed the highest Youden index (0.689) and resulted in a sensitivity of 0.625 and specificity of 1.0 for predicting poor outcome. In terms of multivariate analysis, the α-FP (P = .013), tumor volume (P = .047), and α-FP > 1000 ng/mL (P  =  .010) were significantly associated with poor semen quality and failure to preserve semen. Sperm quality was found to be higher in the seminoma versus the nonseminomatous germ cell tumor patients in: sperm concentration (21.5 million/mL vs 11.8 million/mL, P  <  .027). Furthermore, tumor volume is correlated to α-FP (P  =  .018) and is weakly correlated to lactate dehydrogenase (P = .067) CONCLUSION: Elevated α-FP and tumor volume are independently poor factors for semen quality and semen cryopreservation. In clinical use, α-FP is a noninvasive tool to predict the success of semen cryopreservation and patients with α-FP > 1000 ng/mL should be informed of the higher risk of poor semen quality and semen cryopreservation concerns.
authors.affiliation: Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, National Taiwan University, Taipei, Taiwan; Department of Urology, Ten-Chan Hospital, Taoyuan, Taiwan.
authors.forename: Yuan-Hung
authors.initials: YH
authors.lastname: Pong
authors.affiliation: Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Ming-Hong
authors.initials: MH
authors.lastname: Kao
authors.affiliation: Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Chuan
authors.initials: YC
authors.lastname: Lu
authors.affiliation: Department of Urology, Ten-Chan Hospital, Taoyuan, Taiwan.
authors.forename: Ivy Chung-Yung
authors.initials: IC
authors.lastname: Lee
authors.affiliation: Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Ju-Ton
authors.initials: JT
authors.lastname: Hsieh
authors.affiliation: Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, National Taiwan University, Taipei, Taiwan; Department of Urology, Ten-Chan Hospital, Taoyuan, Taiwan.
authors.forename: Vincent F S
authors.initials: VF
authors.lastname: Tsai
authors.affiliation: Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, National Taiwan University, Taipei, Taiwan; Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: changhong@ntu.edu.tw.
authors.forename: Hong-Chiang
authors.initials: HC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D015925:Cryopreservation; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000378:metabolism; D012189:Retrospective Studies; D012661:Semen; D055101:Semen Analysis; D018239:Seminoma / Q000378:metabolism; D013736:Testicular Neoplasms / Q000378:metabolism; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000096:biosynthesis
chemical_list: D000509:alpha-Fetoproteins