Spermatogenesis after unilateral orchiectomy for testicular cancer in patients following surveillance policy

Purpose: Only limited information is available on the natural course of spe rmatogenesis in patients with testicular cancer who underwent unilateral or chiectomy and surveillance. We analyze long-term exocrine function of the r emaining testicle in patients following surveillance policy. Materials and Methods: Sperm counts and serum follicle-stimulating hormone (FSH) levels were available in 60 nonrelapsing cases approximately 3 weeks (baseline), 1 year and 2 years or greater after orchiectomy. Contralateral testicular cancer subsequently developed in 2 men. Results: At baseline 36 patients were normospermic (10 or greater x 10(6)/m l.), 7 were azoospermic and 17 were oligospermic. After 1 year 45 patients were normospermic. Mean sperm concentrations increased significantly from 2 6 to 39 x 10(6)/ml. during year 1 after orchiectomy. Elevated serum FSH at baseline was associated with incomplete recovery of spermatogenesis, althou gh sperm counts improved in 3 of 7 patients. Furthermore, in the 2 initiall y oligospermic patients with subsequent contralateral testicle cancer trans ient normospermia was observed after 1 year. After orchiectomy fatherhood w as recorded in 28 men and was assisted by fertilization using fresh semen i n 2. Conclusions: In nonrelapsing testicular cancer cases on surveillance, initi ally reduced spermatogenesis recovers during year 1 after orchiectomy espec ially if baseline serum FSH is normal. Transient recovery also occurs in pa tients in whom contralateral testicular cancer subsequently develops. In hi gh risk patients and in initially oligospermic patients with plans for futu re fatherhood, the period of improved spermatogenesis may be used for multi ple semen cryopreservations enabling subsequent assisted fertilization.