Evaluation and Preservation of Fertility in Patients with Testicular Cancer

Young men presenting with testicular cancer enjoy a very high prospect of cure and look forward to an average of 40 additional years of life. As such, emphasis has focused on care algorithms that are not only curative, but also minimize the consequences of the disease and associated treatments on subsequent quality of life. Concerns regarding therapy-related second malignancies and cardiovascular disease have led to management strategies emphasizing the reduction or elimination of chemotherapy and radiation therapy and increase utilization of surveillance for early-stage patients. Germ cell tumors present typically in the late 20s or early 30s, occurring in a timeframe when many young men begin to consider their families seriously. Indeed, more than 80% of young patients report significant concerns regarding diminished fertility. The biology and anatomy of most germ cell tumors lead to significant potential for disrupted fertility from both disease-related factors-hypogonadism and diminished native spermatogenesis-and manifold treatment-related complications such as ejaculatory dysfunction, chemotherapy, and radiation effects on spermatogenesis and testosterone production. Despite these unique challenges of managing fertility in patients with germ cell tumors, such efforts are rewarded with a high rate of fertility preservation for most patients with no evidence that subsequent progeny are affected by the parent's disease or treatments. Herein, we review the biological and clinical issues associated with reduced fertility potential in patients with germ cell tumors, methods for evaluating and preserving fertility in such patients, and anticipated overall success rates.