Journal of Clinical Oncology, Vol 1, 179-183, Copyright © 1983 by American Society of Clinical Oncology
Fertility after chemotherapy for testicular cancer
RE Drasga, LH Einhorn, SD Williams, DN Patel and EE Stevens
Sixty-nine patients with disseminated testicular cancer and no prior
retroperitoneal lymphadenectomy treated with cisplatin, vinblastine, and
bleomycin with or without doxorubicin were evaluated for semen analysis,
serum gonadotropins, and testosterone. Since 1979, 41 men have been
prospectively studied. Before treatment 77% were oligospermic, 17% were
azoospermic, and only 6.6% could meet requirements for sperm banking. After
2 mo of therapy, 96% were azoospermic. A group of 28 patients treated
between 1975 and 1979 were retrospectively evaluated. Normal sperm counts
were found in 46% of those studied. Only 17% were azoospermic. Thirty-two
percent have impregnated their wives, resulting in 5 healthy babies, 1
spontaneous abortion, and 3 ongoing pregnancies. These results show that
(1) significant impairment of spermatogenesis exists before therapy,
precluding the possibility of sperm banking in most patients, (2)
combination chemotherapy in testicular cancer has substantial effects on
gonadal function, rendering almost all patients azoospermic, and (3) a high
degree of recovery of spermatogenesis occurs sometime after 2-3 yr from the
initiation of treatment.
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