Regeneration of Spermatogenesis after Testicular Cancer Chemotherapy

Abstract

Purpose: Azoospermia is a common side effect of chemotherapy. Although most patients restore spermatogenesis over time, the exact time course has not been well described. We analyzed the recovery of spermatogenesis in testicular cancer patients following chemotherapy. Patients and Methods: 49 patients, consisting of 45 treated with a bleomycin, etoposide and cisplatin (BEP) regimen and 4 with high-dose chemotherapy, were followed up with occasional semen analyses. The primary endpoint of this study was the confirmation of motile spermatozoa in the patients' semen. Results: Among 45 patients treated with BEP, 44 recovered spermatogenesis. The recovery of spermatogenesis was delayed depending on the increase in BEP cycles. In groups of patients who received 1-2, 3 and 4 cycles, the recovery rates of spermatogenesis within 2 year were 83.3, 80.0 and 66.7%, respectively. In the group with 5-6 cycles of BEP, re-spermatogenesis was significantly delayed and no patients re-established spermatogenesis within 2 years. The patients' age and semen parameters before chemotherapy were not useful as predictive factors for the recovery of spermatogenesis. Conclusion: The recovery of spermatogenesis was rather fast and was often observed as early as several months after BEP treatment when the number of cycles was <4.

Fertility managment in testicular cancer: the need to establish a standardized and evidence‐based patient‐centric pathway

“…Bujan et al found that men receiving two or fewer BEP cycles had their motility count return to pre‐treatment values after 12 months. Another study confirmed that spermatogenesis recovered within 2 years in the vast majority of patients, except those who received five or more cycles . Azoospermia was seen in 37% of patients 3 months after chemotherapy, which subsequently dropped to 3% after 24 months .…”

“…History of cryptorchidism [11,45] Age <29 years [45] High FSH pre orchiectomy [63] Pre-treatment fatherhood [45] Dry ejaculation [45] Age >35 years [70] Cumulative dose >850 mg cisplatin-based therapy [49] Increasing number of cisplatin-based therapy [50] Combined TC therapies [44,45] Low sperm count at diagnosis [63] TC, testicular cancer.…”

“…Year [50] >850 mg cisplatin cumulative dose has low paternity rates at 42% [49] and failure to recover spermatogenesis [49] Avoid conception 6 months posttreatment [90] microTESE if no recovery after 2 years Radiotherapy Direct toxic effect of radiation damage on testicular germ and Leydig cells 24% azoospermic after 6 months Recovery of azoospermia after 24 months [43] microTESE if no recovery after 2 years BEP, bleomycin and etoposide; microTESE, microdissection testicular sperm extraction; onco-microTESE, microdissection testicular sperm extraction at the time of orchidectomy; PESA, percutaneous epididymal sperm aspiration; RPLND, retroperitoneal lymph node dissection; SSR, surgical sperm retrieval; TESA, testicular sperm aspiration.…”

Review and follow-up of patients using a regional sperm cryopreservation service: ensuring that resources are targeted to those patients most in need

“…Suzuki et al . () demonstrated remarkable rates of testicular recovery in a group of 49 testicular cancer patients with 44 out of the 45 treated with BEP regaining fertility, the speed of that recovery being related to the total number of BEP treatment cycles received. Even with such rapid and high rates of recovery, sperm banks should still use a cautious and vigilant approach with regard to disposal of patient material because some patients may relapse and require further chemotherapy.…”

Cisplatin-Based Chemotherapy for Testicular Germ Cell Tumors: Complication Rates of Peripheral versus Central Venous Administration

“…Hazardous complications like febrile neutropenia can make further hospitalization necessary. Chemotherapy-associated acute side effects as well as long-term toxicities such as oligospermia, infertility, neurotoxicity and secondary malignancies have been well described [6,7,8,9,10]. …”