Fertility following chemotherapy for testicular germ cell cancer

Many patients with testicular germ cell cancer show impaired spermatogenesis before undergoing cytotoxic chemotherapy. The known pretreatment infertility and the reversibility of the fertility problems observed in some of them after successful anti-cancer treatment has so far prevented an assessment of the true impact of chemotherapy on long-term fertility. The introduction of a wait-and-see strategy (surveillance) for testicular cancer patients and recent prospective trials comparing patients with and without cytotoxic chemotherapy have now provided the means for estimating the extent by which chemotherapy itself affects long-term fertility: whether or not spermatogenesis is irreversibly impaired by chemotherapy is determined by the cumulative dose of cisplatin. At cumulative doses > 400 mg/m(2), irreversible impairment of gonadal function should be expected to occur. At cumulative cisplatin doses < 400 mg/m(2) (equivalent to 4 courses of state-of-the-art treatment), chemotherapy is unlikely to cause irreversible damage to fertility.