Semen analysis of subfertility caused by testicular carcinoma
Background: Infertility is a common problem in testicular cancer. Affected men often decide to undergo sperm banking before chemo/radiotherapy. The cumulative effects of therapy can considerably reduce fertility.
Objective: Testicular cancers impair fertilizing ability, even before diagnosis. This study tries to verify individual traits and semen quality in patients with testicular cancer.
Materials and Methods: This observational study analyzed 190 semen of patients with testicular cancer (16 to 47 yr old) referred to the sub-fertility laboratory at the St. Mary hospital for semen banking prior to treatment carcinoma. Several aspects of their semen analyses were examined. The cases were divided into four different categories: seminoma, teratoma, mixed germ cell tumors and others.
Results: The results showed that 23 cases were azoospermic, and 13 of the patients who were not azoospermic, their sperm of “normal” morphology were too few to count. Among patients that could produce spermatozoa, 59.4% had a sperm concentration of < 20 × 106/ml. The mean of “motility excellent” and “sluggish” taken together in all the cases was 47.2%. More than 92% of the patients had an abnormal morphology. The morphology of sperm is the most sensitive semen parameter that is affected by testicular carcinoma.
Conclusion: Abnormal spermatogenesis is seen in most patients with testicular cancer before treatment with radiation, chemotherapy, or surgery. The causes of poor semen quality in cancer patients are not well-understood, but the patients with impaired spermatogenesis should have precise examination to find out the correct diagnosis of problem and preserve the fertility before any treatment.
Key words: Infertility, Testicular cancer, Semen analyses, Spermatogenesis.
 Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1999. CA Cancer J Clin 1999; 49: 8–31.
 Woodward PJ, Sohaey R, O’Donoghue MJ, Green DE. From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics 2002; 22: 189–216.
 Bergström R, Adami HO, Möhner M, Zatonski W, Storm H, Ekbom A, et al. Increase in testicular cancer incidence in six European countries: a birth cohort phenomenon. J Natl Cancer Inst 1996; 88: 727–733.
 Trabert B, Chen J, Devesa SS, Bray F, McGlynn KA. International patterns and trends in testicular cancer incidence, overall and by histologic subtype, 1973- 2007. Andrology 2015; 3: 4–12.
 Ruf CG, Isbarn H, Wagner W, Fisch M, Matthies C, Dieckmann KP, et al. Changes in epidemiologic features of testicular germ cell cancer: age at diagnosis and relative frequency of seminoma are constantly and significantly increasing. Urol Oncol 2014; 32: 33. e1–6.
 Buljubašić R, Buljubašić M, Bojanac AK, Ulamec M, Vlahović M, Ježek D, et al. Epigenetics and testicular germ cell tumors. Gene 2018; 661: 22–33.
 Dias TR, Agarwal A, Pushparaj PN, Ahmad G, Sharma R. Reduced semen quality in patients with testicular cancer seminoma is associated with alterations in the expression of sperm proteins. Asian J Androl 2020; 22: 88–93.
 Morrish DW, Venner PM, Siy O, Barron G, Bhardwaj D, Outhet D. Mechanisms of endocrine dysfunction in patients with testicular cancer. J Natl Cancer Inst 1990; 82: 412–418.
 Ping P, Gu BH, Li P, Huang YR, Li Z. Fertility outcome of patients with testicular tumor: before and after treatment. Asian J Androl 2014; 16: 107–111.
 Fraietta R, Spaine DM, Bertolla RP, Ortiz V, Cedenho AP. Individual and seminal characteristics of patients with testicular germ cell tumors. Fertil Steril 2010; 94: 2107–2112.
 Huddart RA, Norman A, Moynihan C, Horwich A, Parker C, Nicholls E, et al. Fertility, gonadal and sexual function in survivors of testicular cancer. Br J Cancer 2005; 93: 200–207.
 Meistrich ML. Effects of chemotherapy and radiotherapy on spermatogenesis in humans. Fertil Steril 2013; 100: 1180–1186.
 Di Santo M, Tarozzi N, Nadalini M, Borini A. Human sperm cryopreservation: update on techniques, effect on DNA integrity, and implications for ART. Adv Urol 2012; 2012: 854837.
 Lass A, Akagbosu F, Abusheikha N, Hassouneh M, Blayney M, Avery S, et al. A programme of semen cryopreservation for patients with malignant disease in a tertiary infertility centre: lessons from 8 years’ experience. Hum Reprod 1998; 13: 3256–3261.
 Gandini L, Lombardo F, Salacone P, Paoli D, Anselmo AP, Culasso F, et al. Testicular cancer and Hodgkin’s disease: evaluation of semen quality. Hum Reprod 2003; 18: 796–801.
 Botchan A, Hauser R, Yogev L, Gamzu R, Paz G, Lessing JB, et al. Testicular cancer and spermatogenesis. Hum Reprod 1997; 12: 755–758.
 Gnessi L, Scarselli F, Minasi MG, Mariani S, Lubrano C, Basciani S, et al. Testicular histopathology, semen analysis and FSH, predictive value of sperm retrieval: supportive counseling in case of reoperation after testicular sperm extraction (TESE). BMC Urol 2018; 18: 63–70.
 Panidis D, Rousso D, Stergiopoulos K, Papathanasiou K, Delkos D, Papaletsos M. The effect of testicular seminoma in semen quality. Eur J Obstet Gynecol Reprod Biol 1999; 83: 219–222.
 Bussen S, Sutterlin M, Steck T, Dietl J. Semen parameters in patients with unilateral testicular cancer compared to patients with other malignancies. Arch Gynecol Obstet 2004; 269: 196–198.
 Panner Selvam MK, Agarwal A, Pushparaj PN. Altered molecular pathways in the proteome of cryopreserved sperm in testicular cancer patients before treatment. Int J Mol Sci 2019; 20: 677–691.
 Petersen PM, Skakkebaek NE, Vistisen K, Rorth M, Giwercman A. Semen quality and reproductive hormones before orchiectomy in men with testicular cancer. J Clin Oncol 1999; 17: 941–947.