Fertility after chemotherapy for testicular germ cell cancer

Objective: To investigate the impact of cytostatic chemotherapy on long-term fertility in patients with testicular germ cell cancer. Background: Many patients with testicular germ cell cancer show impaired spermatogenesis before undergoing cytotoxic chemotherapy. The known infertility before treatment and the reversibility of the fertility problems observed in some of them after successful anticancer treatment so far have prevented an assessment of the true impact of chemotherapy on longterm fertility. The introduction of a wait-and-see strategy (surveillance) for patients with testicular cancer and recent prospective trials comparing patients with and without cytotoxic chemotherapy now have provided the means for estimating the extent to which chemotherapy itself affects long-term fertility. Result(s): Whether spermatogenesis is impaired irreversibly 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. Conclusion(s): At cumulative cisplatin doses <400 mg (equivalent to 4 courses of state-of-the-art treatment), chemotherapy is unlikely to cause irreversible damage to fertility. (C) 1997 by American Society for Reproductive Medicine.