Impact of chemotherapy on male fertility

Testicular tumors and malignant lymphomas are, with increasing incidence, t he most frequent malignant diseases in men between the age of 15 and 34. Wi th the introduction of cisplatin-based polychemotherapy, cure rates rose to over 90% in patients with germ cell tumors and were comparably favorable a t around 80% in those with malignant lymphomas. In view of these high cure rates, increasing clinical importance is attached to chemotherapy-induced f ertility disorders. One problem involved in assessing the influence of chem otherapy on fertility is the fact that the malignant disease itself strongl y alters spermatogenesis. This complicates an evaluation of the effect of c ytostatic therapy on fertility disorders. There are significant cytostatic- and dose-specific differences. Longterm infertility due to cytostatic ther apy may be expected in more than 50% of the patients at a cumulative dose o f cisplatin > 0.6 g/m(2), cyclophosphamide > 6 g/m(2), and procarbazine gre ater than or equal to4 g/m(2). However, it takes up to 3 years or more for spermatogenesis to recover after the termination of chemotherapy. An indivi dual assessment of the post-therapeutic fertility status is extremely limit ed, since variance of the pretherapeutic fertility status causes interindiv idual differences, and the numerical data mentioned above only permit a vag ue estimation. Before patients undergo cytostatic therapy, cryo preservatio n of germ cells should thus be suggested or, in some cases, testicular extr action of spermatozoa.