For men of reproductive age, one of the key problems arising after treatment of TGCTs is the ability to realize reproductive function. More than half of the patients in this group are young, socially active and completely cured, wanting to have children, in addition, 75% of these patients were childless at the diagnostic stage. 

Purpose: To determine the significance of assessing the reproductive potential in patients with TGCTs after treatment.

A retrospective analysis of medical records after treatment of patients with TGCTs was performed at the Germ Cell Tumor Treatment Center of the N.N. Petrov National Medical Research Center of Oncology. The study included 114 patients with unilateral testicular tumor process. 15 patients were excluded from the study due to refusal to undergo a spermogram (n7), as well as due to the presence of initial retrograde ejaculation. Then 99 patients participated in the study. All patients were divided into 4 groups: 1) observation, n12; 2) patients who received polychemotherapy (bleomycin, etoposide, and cisplatin (BEP), n87; 3) BEP + retroperitoneal lymphadenectomy (BEP + RPLND), n87; and 4) radiation therapy, n0. All patients underwent spermogram assessment before treatment and after each stage of treatment. Paternity was defined as the date of birth of the first child after treatment of TGCTs with or without assisted reproductive technologies (IVF).

In the analysis of spermogram before treatment (n99), only 29.29% (n29) had normospermia. The frequency of azoospermia was 17.17% (n17), oligozoospermia 14.14% (n14), teratozoospermia 14.14% (n14), teratozoospermia + oligozoospermia 25.25% (n25). All patients underwent orchofuniculectomy (OFE). Results of spermogram after OFE: norm 15.15% (n15), azoospermia 21.21% (n21), asthenozoospermia 29.29% (n29), teratozoospermia 7.07% (n7), teratozoospermia+oligozoospermia 27.27% (n27). Dynamic observation was offered to 7 patients from the study, the remaining patients (n92) underwent polychemotherapy (BEP). During the control spermogram: azoospermia 82.6% (n76), asthenozoospermia 5.43% (n5), teratozoospermia 2.17% (n2), teratozoospermia+oligozoospermia 9.78% (n9). All patients underwent surgical intervention in the amount of retroperitoneal lymphadenectomy. After surgical treatment, 4 patients dropped out of the study due to refusal to perform a spermogram. Results of the control spermogram (n88): azoospermia 18.18% (n16), asthenozoospermia 3.41% (n3), teratozoospermia 2.27% (n2), teratozoospermia + oligozoospermia 6.82% (n6), retrograde ejaculation developed in 69.32% (n61). None of the patients in the study received radiotherapy (n0). The probability of paternity statistically significantly decreased after chemotherapy (95% confidence interval [CI]=1.91-2.83) and RPLND + BEP (95% CI=5.61-6.7), in the observation group (95% CI=0.87-1.09). The need for assisted reproductive technologies to achieve paternity was increased after all treatment methods. Sperm cryopreservation was performed by 77.78% of patients (n77). Of the 99 patients who participated in the study, 13.13% (n13) realized reproductive function, in 73.74% (n73) the function was not realized, 13.13% (n13) did not try to realize the function. Of those who realized it, 76.92% (n10) succeeded independently without the use of assisted reproductive technologies, childbirth with the help of in vitro fertilization (IVF) was realized in 15.38% of patients (n2), with the help of intracytoplasmic sperm injection (ICSI) in 7.7% of patients (n1).

Surgical, therapeutic methods such as orchiectomy, chemotherapy and radiation therapy, retroperitoneal lymphadenectomy are very effective in the treatment of testicular germ cell tumors, but their gonadotoxic side effects have a significant impact on fertility.

When planning treatment for TGCTs, it is important for all patients to undergo fertility assessment with subsequent sperm cryopreservation, since the risks of infertility after treatment are extremely high.