Semen quality and reproductive hormones before and after orchiectomy in men with testicular cancer

Purpose: We clarify the impact of removal of the tumor bearing testis on se men quality and reproductive hormones in men with testicular cancer. Materials and Methods: Semen quality and levels of reproductive hormones we re investigated in 48 men before and after orchiectomy for testicular cance r. Semen analysis was done in 35 of these men and hormone analyses were don e in 47. The hormone data of patients with (14) or without (33) elevated va lues of human chorionic gonadotropin (HCG) were analyzed separately. Results: Median sperm concentration and total sperm count decreased from 17 x 10(6)/ml. (range 0 to 117) and 39 x 10(6) (0 to 433), respectively, befo re to 7 x 10(6)/ml. (0 to 69) and 30 x 10(6) (0 to 200), respectively, afte r orchiectomy. After orchiectomy sperm concentration was decreased in 30 of 35 men (p = 0.001) and azoospermia developed in 3 (9%). In men without det ectable HCG median follicle-stimulating hormone levels increased (p <0.001) from 5.7 IU/l. (range 0.01 to 30) before to 10.0 IU/l. (4.6 to 48) after o rchiectomy in 33 of 33 patients. Median inhibin B significantly decreased ( p = 0.003) from 108 pg./l. (range 60 to 193) before to 95 pg./l. (less than 20 to 141) after orchiectomy. Median luteinizing hormone increased signifi cantly from 3.1 IU/l. (range 1.1 to 9.9) before to 5.2 IU/l. (2.1 to 27) af ter treatment (p <0.001). Testosterone and sex hormone-binding globulin did not change significantly after orchiectomy. Patients with detectable serum HCG before orchiectomy had a considerable increase in follicle-stimulating hormone after orchiectomy, and a concomitant decrease in testosterone and estradiol. Conclusions: Semen quality was poor at diagnosis and deteriorated further a fter orchiectomy compared with pretreatment values. Our findings indicate t hat in some patients the most appropriate time for cryopreservation of seme n is before orchiectomy. Androgen production was maintained by increased lu teinizing hormone stimulation after orchiectomy.