Fertility and reproductive technology use in testicular cancer survivors in Japan: A multi‐institutional, cross‐sectional study

Abstract

To evaluate fertility and use of reproductive technology of testicular cancer survivors in a multi-institutional, cross-sectional study. Methods: This study recruited testicular cancer survivors who were followed after treatment for testicular cancer at eight high-volume institutions between 2018 and 2019. The participants completed the questionnaires on marital status, fertility and use of reproductive technology. Results: A total of 567 testicular cancer survivors, with a median age of 43 years, responded to the questionnaire. Chemotherapy was given to 398 survivors, including three cycles of cisplatin-based chemotherapy in 106 patients and four cycles in 147 patients. Among 153 survivors who attempted sperm cryopreservation, 133 (87%) could preserve sperm. Of the 28 survivors whose cryopreserved sperm was used, 17 (61%) fathered children. Of the 72 survivors who fathered children without the use of cryopreserved sperm, 59 (82%) fathered naturally. Whereas 33 (20%) of 169 survivors treated without chemotherapy fathered children without using cryopreserved sperm, 39 (10%) of 398 treated with chemotherapy fathered children (P < 0.05). Furthermore, the paternity rate was 12% and 5% in testicular cancer survivors with three and four cycles of cisplatin-based chemotherapy, respectively (P < 0.05). However, of 121 survivors who wanted to have children, 14 (12%) received counseling about infertility treatment. Conclusions: Testicular cancer survivors preserving their sperm have a higher paternity rate after chemotherapy, especially after four cycles, than those not using cryopreserved sperm. Physicians who give chemotherapy for testicular cancer need to take particular care not only with respect to recurrence of testicular cancer, but also to post-treatment fertility.

Association of financial toxicity with quality of life in testicular cancer survivors

“…3 TC survivors frequently experience psychological burdens, physical and sexual dysfunction, infertility, loss of income, and fear of recurrence. 4,5 Financial toxicity (FT) is an economic side effect of cancer treatment, which arises from the subjective financial distress (FD) and objective financial burden (FB) of patients who undergo cancer treatments. 6 Cancer patients are anxious and uncomfortable with their condition and are mentally burdened by increased spending and reduced wealth stemming from cancer treatment.…”

“…However, standard chemotherapies for TC such as bleomycin, etoposide, and cisplatin may cause long‐term adverse events 3 . TC survivors frequently experience psychological burdens, physical and sexual dysfunction, infertility, loss of income, and fear of recurrence 4,5 …”

An evaluation of the population characteristics, semen quality, and utilization status of autologous sperm cryopreservation and fertility preservation in for 662 patients: a 6-year monocentric retrospective study

“…Furthermore, 57.8% of male patients failed to discuss fertility preservation with the doctors prior to tumor treatment [ 9 ]. However, 87% of testicular tumor survivors were willing to preserve their spermatozoa by freezing [ 13 ]. Although the COVID-19 pandemic had a significant impact on the medical environment, the numbers of patients undergoing autologous sperm cryopreservation in our bank was still close to the numbers recorded for 2017–2019, moreover, 74.3% and 57.5% of annual cases was cancer patients in 2020 and 2021.…”

Cisplatin for cancer therapy and overcoming chemoresistance

“…A study on post-cisplatin-treated fertility in testicular germ cell cancer survivors demonstrated a higher sperm preservation rate and higher paternity rate compared to those not using cryopreserved sperms, treated with 4 cycles of cisplatin therapy [112]. The researchers suggested the clinicians should consider not only the prevention of recurrence, but also the post-treatment fertility status, particularly in younger male patients [112]. Contrarily, a rat study of chemically induced TC reported a decrease in fertility following cisplatin treatment, which was recovered by the anticancer drug, quercetin [113].…”