Testicular function following chemotherapy

Testicular dysfunction is a common long-term sequela of cytotoxic chemother apy used in the treatment of many malignancies. The degree to which testicu lar function is affected is dose- and agent-dependent. The impact on germin al epithelial function of standard multi-agent regimens used in the treatme nt of lymphomas has been widely studied. Procarbazine-containing regimens r esult in azoospermia in the vast majority of patients, but much lesser degr ees of long-term gonadotoxicity are apparent with the newer forms of chemot herapy. High-dose chemotherapy used as preparation before bone marrow trans plant is also associated with irreversible germinal epithelial failure in t he majority of men. Treatment of testicular cancer with cisplatin and carbo platin regimens leads to temporary azoo- and oligozoospermia in most men, w ith a recovery to normospermia in 80% by 5 years. There is also evidence of mild Leydig cell impairment in a proportion of men treated with cytotoxic agents, although the clinical significance of this is not clear. Several me thods of preserving testicular function during potentially sterilizing trea tment have been considered. At present, sperm banking remains the only prov en method, although hormonal manipulation to enhance recovery of spermatoge nesis and cryopreservation of testicular germ cells are possibilities for t he future.