FERTILITY AFTER CHEMOTHERAPY FOR TESTICULAR GERM-CELL CANCER

Objective: To investigate the impact of cytostatic chemotherapy on lon g-term fertility in patients with testicular germ cell cancer. Backgro und: Many patients with testicular germ cell cancer show impaired sper matogenesis before undergoing cytotoxic chemotherapy. The known infert ility 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 lo ngterm fertility. The introduction of a wait-and-see strategy (surveil lance) for patients with testicular cancer and recent prospective tria ls comparing patients with and without cytotoxic chemotherapy now have provided the means for estimating the extent to which chemotherapy it self affects long-term fertility. Result(s): Whether spermatogenesis i s impaired irreversibly by chemotherapy is determined by the cumulativ e dose of cisplatin. At cumulative doses >400 mg/m(2), irreversible im pairment of gonadal function should be expected. Conclusion(s): At cum ulative cisplatin doses <400 mg (equivalent to 4 courses of state-of-t he-art treatment), chemotherapy is unlikely to cause irreversible dama ge to fertility. (C) 1997 by American Society for Reproductive Medicin e.