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Most genitourinary tract cancers have a negative impact on male fertility. Although testicular cancers have the worst impact, other tumors such as prostate, bladder, and penis are diagnosed early and treated in relatively younger patients in which couple fertility can be an important concern. The purpose of this review is to highlight both the pathogenetic mechanisms of damage to male fertility in the context of the main urological cancers and the methods of preserving male fertility in an oncological setting, in light of the most recent scientific evidence. A systematic review of available literature was carried out on the main scientific search engines, such as PubMed, Clinicaltrials.Gov, and Google scholar. Three hundred twenty-five relevant articles on this subject were identified, 98 of which were selected being the most relevant to the purpose of this review. There is a strong evidence in literature that all of the genitourinary oncological therapies have a deep negative impact on male fertility: orchiectomy, partial orchiectomy, retroperitoneal lymphadenectomy (RPLND), radical cystectomy, prostatectomy, penectomy, as well as radiotherapy, chemotherapy, and hormonal androgen suppression. Preservation of fertility is possible and includes cryopreservation, hormonal manipulation with GnRH analogs before chemotherapy, androgen replacement. Germ cell auto transplantation is an intriguing strategy with future perspectives. Careful evaluation of male fertility must be a key point before treating genitourinary tumors, taking into account patients' age and couples' perspectives. Informed consent should provide adequate information to the patient about the current state of his fertility and about the balance between risks and benefits in oncological terms. Standard approaches to genitourinary tumors should include a multidisciplinary team with urologists, oncologists, radiotherapists, psycho-sexologists, andrologists, gynecologists, and reproductive endocrinologists., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Objectives : The relationship between male infertility (MI) and testicular cancer (TC) is bilateral. On one hand, it is well-established that patients diagnosed with TC have a high risk of pre- and post-treatment infertility. On the other hand, the risk of developing TC in male infertile patients is not clearly defined. The objective of this review is to analyze the histopathological, etiological, and epidemiological associations between MI and the risk of developing testicular cancer. This review aims to provide further insights and offer a guide for assessing the risk factors for TC in infertile men. Materials and Methods : A comprehensive literature search was conducted to identify relevant studies discussing the relationship between MI and the risk of developing TC. Results : The incidence rates of germ cell neoplasia in situ (GCNIS) appear to be high in infertile men, particularly in those with low sperm counts. Most epidemiological studies have found a statistically significant risk of developing TC among infertile men compared to the general or fertile male populations. The concept of Testicular Dysgenesis Syndrome provides an explanatory model for the common etiology of MI, TC, cryptorchidism, and hypospadias. Clinical findings such as a history of cryptorchidism could increase the risk of developing TC in infertile men. Scrotal ultrasound evaluation for testis lesions and microlithiasis is important in infertile men. Sperm analysis parameters can be useful in assessing the risk of TC among infertile men. In the future, sperm and serum microRNAs (miRNAs) may be utilized for the non-invasive early diagnosis of TC and GCNIS in infertile men. Conclusions : MI is indeed a risk factor for developing testicular cancer, as demonstrated by various studies. All infertile men should undergo a risk assessment using clinical examination, ultrasound, and semen parameters to evaluate their risk of TC.

Background: Elevated intrascrotal temperature has been suggested as a risk factor for testicular cancer, which is the most common neoplasm among young men. Varicocoele was linked to increased intrascrotal temperature, but whether it is associated with testicular cancer is unclear., Objective: To explore the possible association between varicocoele at adolescence and the incidence of testicular cancer at adulthood., Design, Setting, and Participants: This nationwide, population-based, historical cohort study includes 1,521,661 Israeli male adolescents (mean age 17.5 ± 0.4 years), who were screened for varicocoele during the years 1967-2012, as part of their medical assessment prior to compulsory military service. The mean follow-up was 18 ± 4.2 years., Outcome Measurements and Statistical Analysis: The diagnosis of testicular cancer was ascertained from linkage of records to the the Israeli National Cancer Registry. Survival analysis was applied., Results: In total, 53,210 adolescents were diagnosed with varicocoele stages 2 and 3 prior to military service. Of 1988 (0.13% of the total cohort) men who were diagnosed with testicular cancer during follow-up, 54 (0.1%) had varicocoele prior to military service, while 1934 (99.9%) did not; p = 0.213. The age at cancer diagnosis and the distribution of seminomas versus non-seminomas did not differ significantly between those with and without varicocoele in adolescence. In a multivariable analysis controlling for sociodemographic factors, varicocoele was not associated with testicular cancer; odds ratio = 0.816 (CI: 0.615-1.083)., Conclusions: Varicocoele in adolescents was not found to be associated with testicular cancer in young adults., Patient Summary: In light of the theoretical association between varicocoele and testicular cancer, we conducted this large population study. We found no association between varicocoele in young adulthood and testicular cancer later in life., (© 2022 American Society of Andrology and European Academy of Andrology.)

Male infertility is one of the most common diseases in andrology. Studies show that male infertility is significantly correlated with the incidence and mortality of tumors, especially malignant tumors in the genitourinary system, such as testis cancer and prostate cancer. The relationship of male infertility with genitourinary system tumors involves various aspects, mainly including changes in chromosome mutations, epigenetic marks, hormonal imbalance, and congenital deformity. Besides, some chronic diseases are shown to be significantly associated with male infertility, and semen quality or fertility status may be biomarkers of the overall health of males. In-depth studies of the correlation between male infertility and these factors are very important for an insight into the pathogenesis and prevention of the related diseases.

The presence of cancer in the testis, as well as the therapies used to treat testis cancer, can impair fertility potential for affected men. Fertility preservation is an important aspect of survivorship care and should be offered to all patients before initiating treatment. The only established means of fertility preservation in men is cryopreservation of sperm. Methods for fertility preservation in prepubertal boys are still experimental. Physicians treating men with testicular cancer should be familiar with the available options. This article outlines testicular cancer and its treatment's effects on fertility, fertility preservation options, and barriers to accessing this specialized care., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: The aim of the present paper was to determine the impact of testicular cancer (TC) and its treatments on fertility and to review the current management options for the infertile patient with TC, both before diagnosis and after treatment, with the aim of providing practical recommendations to update contemporary guidelines and standardize clinical practice., Patients and Methods: Searches were conducted for relevant articles on Pubmed and Google Scholar between 2000 and 2017, with additional articles sourced from reference lists of included publications., Results: At time of diagnosis, 6-24% of patients with TC were reported to be azoospermic and 50% oligozoospermic. Without conducting semen analysis at diagnosis, these patients cannot be identified and may be at further risk of subfertility. Gonadotoxic therapies cause an overall decrease in male fertility by 30% and there is currently no method to predict which patients will become azoospermic after treatment. Patients with larger, more invasive tumours, however, are at greater risk of infertility from local tumour effects, and are also more likely to undergo several different type of therapy, which has further detrimental effects on conception rates. Most treatment-induced infertility recovers 2 years post-treatment, but paternity can be delayed during a couple's peak reproductive years. Semen cryopreservation remains the procedure of choice in preserving fertility, but the service is underused, with only 24% of patients banking sperm. Microdissection testicular sperm extraction (microTESE) at the time of orchidectomy (onco-microTESE) is a successful infertility treatment option for those found to be azoospermic or severely oligozoospermic at diagnosis, while microTESE may still retrieve sperm in azoospermic patients after chemotherapy., Conclusion: The underutilisation of semen analysis and sperm cryopreservation results in the failure to identify the azoospermic or severely oligozoospermic patient at diagnosis who may benefit from fertility-preserving procedures, for example, onco-microTESE at the time of orchidectomy. Fertility preservation and counselling needs to be broached earlier in the TC treatment pathway and made a greater priority. Given the advances in treatment, more patients with TC are surviving and looking to return to a normal life. Preserving their future fertility plays an important role in achieving this., (© 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.)

Background and Objectives: To evaluate the pathological features and recurrence of incidental testis tumours treated by partial orchiectomy in a population of infertile men., Methods: We retrospectively pooled, from four andrology referral centres, 32 patients diagnosed with testis mass during regular infertility workup. Patients included had an impaired sperm analysis and testis sparing surgery was performed to prevent secondary azoospermia or androgen therapy., Results: Mean age was 36 (IQR, 32 to 37). The mean largest tumoral diameter was 8.5 mm (IQR, 5 to 10). A total of 25% (8 of 32) of patients had a malignant tumour (seminoma, 7 of 32, 22%; teratoma, 1 of 32, 3%) and 75% (24 of 32) had a benign lesion (Leydig cell tumour, 23 of 32, 72%; scar tissue, 1 of 32, 3%). Malignant tumours were then managed by total orchiectomy (six of eight) or by radiotherapy (two of eight). With a mean follow up of 26 months (IQR, 8 to 32), one patient (3%) had an homolateral recurrence, which was a Leydig cell tumour. Not a single patient developed metastasis., Conclusion: Seventy-five per cent of the tumours discovered during infertility management were of a benign pathology. A conservative approach could be proposed initially to avoid unnecessary orchiectomies. Orchiectomy and radiotherapy could be discussed as salvage therapies for malignant lesions., (© 2018 Wiley Periodicals, Inc.)

Purpose: We report the safety of surveillance of small testicular masses incidentally discovered during evaluation of male infertility., Materials and Methods: We retrospectively reviewed a prospectively collected database to identify patients with male infertility found to have incidental small testicular masses (hypoechoic lesions less than 10 mm) on scrotal ultrasound. The men were offered close surveillance with interval imaging and office followup. Patient and imaging characteristics were collected to compare the surveillance and surgical groups with additional comparisons between benign and malignant pathologies to elucidate predictors of underlying malignancy., Results: Of 4,088 men in whom scrotal ultrasound was completed for male infertility evaluation 120 (2.9%) were found to have a subcentimeter testicular mass. Average followup was 1.30 years (range 0.1 to 16.9). A total of 18 men (15%) proceeded to extirpative surgery while 102 remained on surveillance at last followup. In those with at least 1 month of followup the mean lesion growth rate was -0.01 mm per year. Reasons for surgery included testicular exploration for infertility, mass growth, positive tumor markers, history of testis cancer, concerning imaging characteristics and patient choice. Six of the 18 men who underwent surgery were found to have malignancy, which was seminoma in all. All malignant lesions were greater than 5 mm on initial imaging and demonstrated vascularity, although size and vascularity were not significantly different from those of benign lesions on final pathology findings. No patients demonstrated advanced or recurrent disease., Conclusions: Small testicular masses are not uncommon, especially in the infertile male population. Most of these masses do not show significant growth during long-term evaluation and can be safely surveilled with close followup., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Leiomyoma of the bilateral testicular tunica albuginea is extremely rare. To our knowledge, there are only 3 definitely reported cases. This is the first report of bilateral testicular tunica albuginea leiomyomas as a potential cause of male infertility. Herein, we report a case of a 47-year-old man who presented with painless bilateral testicular masses for more than 30 years, besides he also suffered from unexplained infertility. The complete resection of the tumors was performed. The final pathological diagnosis was leiomyomas of the bilateral tunica albuginea. Postoperatively, the patient underwent testicular biopsy. Histopathology confirmed moderate atrophy of bilateral testes, and the number of spermatogenic cells in the seminiferous tubules were significantly decreased. In this case, bilateral testicular dysplasia is the root reason for the patient's infertility. Thus, despite the benign nature of bilateral testicular tunica albuginea leiomyomas, they may cause bilateral testicular hypoplasia and infertility in men. In the case of men with fertility requirements, early local mass excision is often necessary.

Testicular germ cell tumours (TGCT) represent 1%-1.5% of all male neoplasms, and they have the highest prevalence among men between 15 and 35 years old. Synchronous bilateral disease is a rare presentation, and the ratio of metachronous to synchronous bilateral disease is about 4 : 1. Several studies have suggested a correlation between male infertility and testicular cancer, with a 20-fold increase in the incidence of testicular cancer in infertile patients compared with the general population. At the time of diagnosis, 50%-75% of patients with unilateral TGCT present with subfertility; almost 13% of the patients are azoospermic before treatment, and up to two-thirds of patients become azoospermic following adjuvant cancer therapies. Therefore, fertility preservation should be considered in all oncological treatments. The only available option to preserve the reproductive potential in azoospermic patients with testicular cancer is to perform an onco-testicular sperm extraction (onco-TESE) before cancer treatment. In this paper, we describe a rare case of a patient with synchronous bilateral testicular cancer and azoospermia who was submitted to onco-TESE, sperm cryopreservation, and which was followed by the delivery of a healthy baby after intracytoplasmic sperm injection (ICSI), emphasising the importance of fertility preservation in oncology patients., (© 2014 Blackwell Verlag GmbH.)

Introduction: The incidence of testicular nodules discovered during infertility evaluation is increasing. These nodules are suspicious of malignancy. There is no paraclinical examination which allows histological orientation to these nodules. The recommendations propose priority treatment by total orchidectomy., Patients and Methods: Through a retrospective cohort study of infertile patients, our goal is to study the enhancement of testicular nodules after injection of ultrasound contrast. The secondary objective is to determine whether CEUS may argue in favor of conservative treatment. From june 2010 to march 2013, 24 patients had underwent ultrasound contrast study of abnormal testicular parenchyma detected prior to infertility evaluation carried ultrasound. The characteristics of ultrasound enhancement were correlated with the pathological findings of surgical patients and proposed treatments (surgery or surveillance)., Results: Fifteen patients were followed up, 9 were operated (7 partial orchidectomies, 2 total orchidectomies). Histological analysis found four Leydig cell tumors, 2 Sertoli cell tumors and 3 seminomas. No adverse changes were noted during the follow-up. This study showed a typical semiology of early, intense and homogeneous enhancement with a phenomenon of wash in 100% of Leydig cell tumors. All Leydig cell tumors have been treated by partial orchidectomy. Seminomas have intense enhancement in 100% of cases. There was a phenomenon of wash in 2 out of 3 cases. When a wash in was described, it was always described as heterogeneous. All seminomas were finally treated by total orchidectomy. The sensitivity and positive predictive value of ultrasound intense enhancement for the diagnosis of testicular cancer was 89% (Se) and 80% (PPV)., Conclusion: There is a semiology of ultrasound enhancement of testicular nodules with features that can guide in favor of a malignant tumor, seminoma or Leydig cell tumor. If a prospective study was undertaken, these arrangements could guide us to treatments promoting preservation of the testicular parenchyma., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Almost all testicular germ cell tumours are proved to originate from carcinoma in situ cells. Infertility is one of the factors that increase the risk of carcinoma in situ. The reported prevalence for carcinoma in situ from different parts of the world is 0-3.7% in infertile men. This retrospective study was performed to determine the prevalence of carcinoma in situ in Iranian infertile men. We reviewed the testicular biopsies of 1153 infertile men at the pathology department of Avicenna Infertility Center. One hundred and fifty-one cases were suspicious of having carcinoma in situ. Immunohistochemical marker for placental alkaline phosphatase was employed to confirm the diagnosis of carcinoma in situ. Positive results were detected in 7 (0.6%) of 1153 cases (95% CI 0.24%-1.24%), 6 (0.94%) of which (95% CI 0.34%-2.04%) were under the age of 35 years (636 patients were in this age group). This study is the first study in Iran determining the prevalence of carcinoma in situ among the infertile Iranian men; the result is in the range of reports from other countries., (© 2013 Blackwell Verlag GmbH.)

Objective: To report a case of an infertile man with nonobstructive azoospermia who underwent simultaneous radical orchiectomy for testicular cancer and testicular sperm extraction (TESE) for preservation of fertility., Design: Case report and literature review., Setting: University teaching hospital., Patient(s): A couple being treated for infertility., Intervention(s): Radical orchiectomy with simultaneous TESE., Main Outcome Measure(s): Sperm retrieval, histologic evaluation of archived testicular pathology slides., Result(s): We retrieved 20 spermatozoa from the multiple random TESE samples obtained at radical orchiectomy. Histologic evaluation of the archived testicular pathology slides revealed that the testis contained several foci of active spermatogenesis, suggesting that a significantly greater number of spermatozoa would likely have been retrieved had a microdissection TESE been performed instead of the multiple TESEs., Conclusion(s): We propose that microdissection TESE should be considered the preferred sperm retrieval technique at the time of radical orchiectomy in men with coexistent nonobstructive azoospermia and testicular cancer., (Copyright © 2014. Published by Elsevier Inc.)

Aims: In this study we report our results with storage of cryopreserved semen intended for preservation and subsequent infertility treatment in men with testicular cancer during the last 18 years., Methods: Cryopreserved semen of 523 men with testicular cancer was collected between October 1995 and the end of December 2012. Semen of 34 men (6.5%) was used for fertilization of their partners. They underwent 57 treatment cycles with cryopreserved, fresh, and/or donor sperm., Results: A total of 557 men have decided to freeze their semen before cancer treatment. Azoospermia was diagnosed in 34 men (6.1%), and semen was cryopreserved in 532 patients. Seminoma was diagnosed in 283 men (54.1%) and nonseminomatous germ cell tumors in 240 men (45.9%). 34 patients who returned for infertility treatment underwent 46 treatment cycles with cryopreserved sperm. Totally 16 pregnancies were achieved, that is, 34.8% pregnancy rate., Conclusion: The testicular cancer survivors have a good chance of fathering a child by using sperm cryopreserved prior to the oncology treatment, even when it contains only limited number of spermatozoa.

Background: Epidemiological studies treat testicular germ cancer as a single disease, the behavior of the two histological types of cancer; seminoma and nonseminoma have differences in reproductive hormone secretion and impair fertility differently., Objective: To demonstrate that the serum concentration of pituitary hormones involved in fertility and spermatogenesis in the affected male is different in the two histological types., Methods: Were determined by radioimmunoassay or inmunoradiometric assay, luteinizing hormone, follicle stimulating hormone, total testosterone, prolactin, estradiol, human chorionic gonadotropin and alpha fetoprotein in 37 patients with germ cell cancer (15 seminoma and 22 nonseminoma) and 35 controls. We analyzed the semen of patients, and were questioned about paternity before the cancer diagnosis., Results: Age was higher in patients with seminoma cancer, showed decreased luteinizing hormone, follicle stimulating hormone, and testosterone and increased estradiol and prolactin in nonseminoma compared with seminoma. In patients with nonseminoma they had 9 children, 5 were oligozoospermic, 3 azoospermic and 6 normal concentration, 8 did not provide sample, seminoma group they had eight children, only one azoospermic, nine normal concentration, and 5 did not provide sample ., Conclusions: The hormonal behavior is different in men with nonseminoma compared with seminoma, so that the negative impact on the reproductive axis and fertility is higher in cases of non-seminoma.

Introduction: Testicular parenchyma abnormalities and testis cancers are more frequent in infertile men, hence the guidelines recommending a systematic scrotal ultrasound., Methods: A retrospective review of all patients treated with total or partial orchidectomy, from January, 2000 to July, 2010, for a testicular lesion discovered during an infertility evaluation work-up. Physical, examination data, type of surgery and pathological results were reported., Results: Forty-five patients were treated. The majority of tumors (80%) were non palpable, and incidentally discovered with scrotal ultrasonography. Eight cases were partial orchidectomies, and 37 cases were radical orchidectomies. A frozen section examination was performed in 13 cases, and led to two radical orchidectomies. Standard histological examination revealed 33 (73.3%) benign lesions (11 Leydig cell hyperplasias, 17 Leydig cell tumors, five Sertoli cell tumors) and 10 (22.2%) malignant lesions (nine seminomas and one teratoma). Ten patients had a Klinefelter syndrome, for whom all the lesions were benign., Conclusion: The majority of non-palpable testicular lesions, discovered by ultrasonography in a population of infertile men were benign tumors. Conservative management in this context appears to be an option, to preserve the endocrine function and the fertility of these patients, while being ontologically safe., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: Evidence from previous studies has suggested there may be physical and mental changes in health among testicular cancer survivors. No studies have been conducted in the United States, however., Methods: Study participants were initially enrolled in the US Servicemen's Testicular Tumor Environmental and Endocrine Determinants (STEED) study between 2002 and 2005. A total of 246 TGCT (testicular germ cell tumor) cases and 236 non-testicular cancer controls participated in the current study, and completed a self-administered questionnaire. Mean time since diagnosis for cases was 14 years, and no less than five for all cases. Component scores determined from responses to questions about physical and mental health on SF36 were tabulated to yield two summary measures, physical component scores (PCS), and mental component scores (MCS). Component and summary scores were normalized to a score of 50 with a standard deviation of 10 by a linear T-score transformation., Results: Overall, cases may not suffer greatly in different quality of life than controls. When all cases and controls are compared, TGCT cases had lower PCS (mean: 51.9 95% CI: 50.6-53.2, P value: 0.037) than controls (mean: 53.6 95% CI: 52.7-54.6). MCS were not significantly different (P value: 0.091). In multivariate analyses, several physical health components were worse for TGCT cases such as role-physical (OR 1.19, 95% CI: 1.01-1.39) and general health (OR 1.26, 95% CI: 1.07-1.49) compared to controls. However, TGCT cases treated with chemotherapy had lower PCS (cases: 50.2, 95% CI: 47.6-52.8; controls: 53.6, 95% CI: 52.7-54.6, P value: 0.0032) and MCS (cases: 49.3, 95% CI: 46.5-52.1; controls: 52.0, 95% CI: 50.9-53.2, P value: 0.039). TGCT cases who received treatments other than chemotherapy did not differ from controls in either PCS or MCS., Discussion: Physical and general health limitations may affect testicular cancer survivors. Men treated with chemotherapy, however, may be most likely to suffer adverse health outcomes due to a combination of body-wide effects on physical and mental factors which affect various aspects of physical health, mental health, and overall quality of life. And in particular, physical functioning, role-physical, and general health are strongly affected.

A 42-year-old man referred to our hospital with the chief complaint of a solid mass of right scrotal contents. As ultrasonography revealed a right testicular tumor, right high orchiectomy was performed and the pathlogical diagnosis was testicular seminoma. At the age of 35-year-old, he was admitted to another hospital for male infertility due to azoospermia. Because left testicular tumor was found, left high orchiectomy was performed, with right testicular biopsy and testicular sperm extraction of the right testis at the same time. Pathological diagnosis revealed left testicular seminoma and no malignancy of the right testicular biopsy specimen. After the second operation, he has been receiving androgen replacement therapy, with no evidence of tumor recurrence.

Introduction: Testicular germ cell tumors (TGCT) disproportionately affect men between the ages of 15 and 49 years, when reproduction is typical. Although TGCT treatment directly affects gonadal tissues, it remains unclear whether there are long-term effects on fertility., Methods: To examine post-TGCT treatment fertility, study participants in a previously conducted case-control study were contacted. The men were initially enrolled in the US Servicemen's Testicular Tumor Environmental and Endocrine Determinants (STEED) study between 2002 and 2005. A total of 246 TGCT cases and 236 controls participated in the current study and completed a self-administered questionnaire in 2008-2009., Results: TGCT cases were significantly more likely than controls to experience fertility distress (OR 5.23; 95% CI 1.99-13.76) and difficulty in fathering children (OR 6.41; 2.72-15.13). Cases were also more likely to be tested for infertility (OR 3.65; 95% CI 1.55-8.59). Cases, however, did not differ from controls in actually fathering children (OR 1.37; 95% CI 0.88-2.15). These findings were predominantly observed among nonseminoma cases and cases treated with surgery only or surgery-plus-chemotherapy., Discussion: While expressing greater fertility distress, higher likelihood of fertility testing, and difficulty fathering children, these data suggest that TGCT survivors are no less likely to father children than are other men. It is possible that treatment for TGCT does not permanently affect fertility or, alternatively, that TGCT survivors attempt to father children with greater persistence or at younger ages than do other men.

Introduction: Testicular cancer affects men mostly in their reproductive age with a cure rate over 90% and fertility is one of the main concerns of survivors. To further elucidate the question of fertility after treatment for testicular cancer, we performed a survey in patients treated in our institution., Patients and Methods: We sent a questionnaire to patients treated for testicular cancer at our institute from 1976 to 2002 (n = 490) of whom 297 (60.6%) responded. We considered the patients to have conserved fertility if they had children after treatment without assisted reproductive technologies., Results: Before treatment 119/297 (40.1%) of patients and after treatment 150/297 (50.5%) of patients tried to have children (p = 0.019). Of 119 patients who tried to have children before treatment for testicular cancer 98 (82.4%) succeeded and 74/150 (49.3%) were successful after treatment (p < 0.001). After treatment patients had 1-3 (median 1) children. The median time to birth of first child from diagnosis was 12 years. The post-treatment fatherhood in patients treated with surgery only (orchidectomy +/- retroperitoneal lymphnode dissection-RPLND) was 59%, in those with additional radiotherapy 68%, and chemotherapy 50% (p = 0.233). Fertility rate in patients where a non nerve sparing RPLND was performed was only 37%, 62% in patients with nerve sapring RPLND, and 77% in patients where RPLND was not performed (p < 0.0001)., Conclusion: Fertility rate after treatment for testicular cancer is reduced. From our data, the most important treatment modality that influences fertility is non nerve sparing RPLND that should be avoided whenever possible in order improve the quality of life our patients.

A Leydig cell tumor is a rare disease entity occurring in the testis. Occasionally it is considered to be related to male infertility. We report a case study of a Leydig cell tumor in a single testis presenting as male infertility. A 38-year-old male was referred to our hospital because of a tumor in his right testis. He had undergone left orchiectomy at one year old because of a testicular tumor. During an examination related to the infertility, ultrasound revealed a 1 cm tumor. Tumor markers were all within normal ranges.Hormonal examination showed that luteinizing hormone (LH) 30.3 mIU/ml (1.5-12.4) and follicle stimulating hormone (FSH) 11.9 mIU/ml (1.7-8.6) were higher than normal limits, but total testosterone(total T) and estradiol (E2) were within normal ranges. Tumor enucleation was first performed, and then testicular sperm extraction (TESE) was carried out from a macroscopically normal site of the testis.Histopathological diagnosis was a benign Leydig cell tumor surrounded by Leydig cell hyperplasia. For 12 months after the operation there has been no recurrence. Although high LH and FSH persisted, total T and E2 were within normal ranges.

The concept of an increasingly common Testicular Dysgenesis Syndrome (TDS) has been widely adopted with little epidemiological appraisal. In this paper we critically review the epidemiologic evidence of the existence of a non-genetic TDS. We systematically assess and discuss the evidence of all six possible associations between the four defining conditions of TDS: impaired spermatogenesis, undescended testis, hypospadia and testicular cancer. We also evaluate whether there are common risk factors for these four conditions. We conclude that epidemiologic studies provide little support for existence of a widespread TDS because there are no consistent non-causal associations between its different manifestations. There is furthermore little evidence of shared causes between the alleged components of the syndrome.

Due to cisplatin-based chemotherapy, the survival rate of testicular cancer patients approaches 90%. Chemo- or radiotherapy may cause long-term complications, e.g. cardiovascular disease, secondary cancers and reduced fertility. Sperm cryopreservation is recommended depending on the extent of therapy and should be performed before orchiectomy. Furthermore, patients should be informed about long-term complications and their possible reduction by optimizing the risk factor profile.

Objective: To evaluate the presence of antisperm antibodies in testicular cancer patients 1 month after orchiectomy and before radiotherapy or chemotherapy., Design: Clinical study., Setting: Department of andrology and seminology at a university hospital., Patient(s): One hundred ninety patients with testicular cancer., Intervention(s): Determination of semen parameters and autoimmune reaction evaluated on the sperm surface and in blood serum., Main Outcome Measure(s): Autoimmune reaction on the sperm surface by the direct immunobead test (IBT), and in blood serum by the indirect IBT and the gelatin agglutination test (GAT), was evaluated 1 month after orchiectomy and before beginning chemotherapy or radiotherapy., Result(s): Of the 190 patients, 11 (5.8%) were positive for antisperm antibody by GAT. On indirect IBT, 3 of the 11 GAT-positive patients were positive to IgG class only, with values of 22%, 24%, and 40%. Of the 11 GAT-positive patients, 4 showed no antibody bound to the sperm surface, and 3 were positive to IgG class only (28%, 21%, and 38%), with binding exclusively on the tail. Direct IBT could not be performed in the remaining 4 patients., Conclusion(s): Our data support the hypothesis that testicular cancer might not be a possible cause of antisperm autoimmunization and infertility.

A similarity was found between the percentage of thawed, DNA-damaged spermatozoa in cancer patients and that in candidates to become sperm bank donors who had low sperm cryofreezability. Both groups were significantly different from the sperm bank donor group. It is suggested that the higher rate of DNA fragmentation in sperm from cancer patients compared with sperm bank donors is apparently a result of selecting donors by the level of sperm cryofreezability (i.e., high), rather than a direct effect of an existing malignancy.

A total of 749 men attending an infertility clinic with their partners between 1 January 2004 and 31 May 2006 underwent a testicular ultrasound examination and a semen analysis around the time of their first visit. On testicular ultrasound examination, the presence of a testicular tumour was suspected in nine men. Of these, seven underwent an orchidectomy. A malignant tumour (seminomata) was present in five of these seven men, representing a malignancy incidence of 0.7% (5/749). In these five men, the semen was abnormal in three and normally fertile in the remaining two. In the two other men who underwent an orchidectomy, a benign Leydig cell tumour and an area of Sertoli cell-only were discovered, respectively. A watch was kept on the apparent tumour sites in the remaining two men, revealing no change in ultrasonic appearance over a period of 2-12 months. These data demonstrate that testicular tumours can present in an infertility clinic among men with normal as well as an abnormal semen analysis. A plea is made for the greater use of diagnostic ultrasound among infertile men.

The aim of this study is to evaluate the feasibility of testicular sperm extraction (TESE) in a cancerous testicle during orchiectomy for testicular neoplasm. This is a retrospective study and includes case histories of four azoospermic patients with incidental testicular cancer. None of the patients had fathered children prior to surgery and all patients were strongly motivated by the desire to have offspring. Patients underwent surgical exploration via inguinotomy and spermatic cord clamping. After nodule excision, micro-TESE was performed from the same albugineal incision, under microscopic guidance. Frozen section examination was not performed in the case of large nodules (>3 cm in diameter). Two patients showed classic seminoma and underwent orchiectomy. In two patients, a Leydig cell tumour was found (one patient underwent orchiectomy for large nodule size). Micro-TESE was performed in four patients. Spermatozoa were found in three patients and the retrieved sperm was cryopreserved. One ICSI cycle was performed, but pregnancy failed. In azoospermic patients with testicular nodules, TESE in the cancerous testis is feasible and may avoid further surgery, without any oncological risk.

1745 patients at the Department of Urology of Tenon Hospital (Paris, France) from 1990 to 2006 and at the department of urology of Tbilisi State Medical University (Georgia) during last several months have been examined and counseled on male infertility. Leydig cell tumor was found in 4 patients, among them 3 by palpation and testicle echography, fourth patient (at the age of 33) with bilateral varicocele (III stage at the left, II stage at the right) was more interesting for us. Leydig cell tumor was found out at the scrotum exploration. Oligoteratozoospermia (OATS) has been distinguished from his spermogram. Microsurgical bilateral correction of varicocele and scrotum exploration, and double-sided double biopsy of testicle have been carried out. During examination of the left testis the hardly palpable node has been found out in the lower pole. We became compelled to make enlarged incision of tunica alba of the testicle lower pole. After that it was found out the solid, well encapsulated and yellow-brown node (8 mm in diameter). The node enucleation away from tumor by 0.5 cm has been carried out. Exact histological investigation confirmed the presence of Leydig cell tumor. In 6 years after surgical operation the tumor node 1.8 mm in diameter has been found out in right (contra lateral) testis. The patient was urgently operated, ex-tempo investigation confirmed the presence of Leydig cell tumor in right testicle--high orchidectomy at the right has been carried out. Now, patient has not any symptoms of disease during 3.5 years of observation. Given case shows that the enucleation of Leydig cell tumor proves to be equivalent alternative of orchidectomy, which is suggested by many authors. Taking into account the presence of encapsulation and tumor benignity it is important to have opportunity of the testicle preservation due to infertility problems. However, this tactics must be carried out under strong observation due to the opportunity of relapse even in several days after surgical operation.

Objective: To identify the frequency that sperm banking was used by men being treated for testicular cancer at our institution, and to characterize the differences between men choosing to bank sperm or not, and outcomes in terms of after-treatment pregnancies., Patients and Methods: A questionnaire addressing sperm banking and fertility was administered to men treated for testicular cancer at our institution between 1994 and 2004; the results were evaluated statistically., Results: Overall, 31 of 129 (24%) respondents had banked sperm. Of these, two had used their banked sperm to father a child, and 12 had had children naturally. Men who banked sperm were a mean of 10.3 years younger (P < 0.001) and less likely to have children at the time of diagnosis (P < 0.025) than men choosing not to bank sperm. The cost of banking sperm was reported to include a mean fee of US dollars 358 (median 300, range 0-1000), and a mean annual maintenance fee of US dollars 243.86 (median 300, range 0-1200)., Conclusions: Only a minority of men in this study chose to bank sperm (24%). Among those who did, the use of banked sperm was low (<10%), and many men could have children without using banked sperm. Given the relatively high costs of sperm banking and the low rate of sample use, patients should be counselled on the costs and benefits of sperm banking before treatment for testicular cancer.

Objectives: To evaluate the frequency of testicular tumours in infertile men and to specify their clinical, ultrasound and histological characteristics., Material and Methods: Retrospective study of all partial or total orchidectomies performed between January 1995 and April 2004. During this period, 3,000 new patients consulted for assessment of infertility. The clinical, laboratory and ultrasound assessment was identical for each patient., Results: Twenty-six testicular tumours were operated in 25 patients, i.e. 0.83% of the infertile men who consulted our department. Six tumours were clinically palpable (23%) and 20 (77%) were discovered on ultrasonography. The size of nodules ranged between 4 and 49 mm. Twenty-three radical orchidectomies and only 3 partial orchidectomies were performed, as 96% of testes presenting a nodule were hypotrophic. Histological examination demonstrated 15 Leydig cell tumours (58%), 8 seminomas (30%), mature teratoma,1 Sertoli cell tumour, and 1 burnt-out tumour. Nine (36%) patients had a history of cryptorchidism. Tumour markers were normal in 24 of the 25 patients (96%). All nodules were hypoechoic. All tumours were classified as pT1 N0 M0 and no recurrence has been observed to date., Conclusion: The incidence of testicular tumours in infertile men is much higher than in the general population. This incidence ranges between 0.35% and 0.83% according to various studies. A urological and andrological assessment should therefore be performed in all men presenting with infertility.

Objective: Patients with testicular cancer have decreased fertility prior to the diagnosis of cancer, although it is not clear whether the subfertility is the result of an emerging tumor, or whether subfertility and testicular cancer share causes. To test if they share causes, we assessed fertility among brothers of patients with testicular cancer., Methods: We compared 5,613 siblings (2,878 brothers) of patients with germ-cell testicular cancer, diagnosed in Sweden from 1960 to 2002, with 6,151 population controls (3,202 men). Using the Swedish Multi-Generation Register, we obtained information on the number of children born (until December 2003) from cases (n = 9,480) and controls (n = 10,739). Fertility was measured using two indicators, (a) offspring twinning rates, as dizygotic twinning is reduced by male subfertility, and (b) number of children. We used unconditional logistic regression, and analyzed brothers and sisters separately. Analyses on the number of children were restricted to subjects (39%) born prior to 1954, for whom information on reproductive life until age 50 was available., Results: Brothers, but not sisters, of patients with testicular cancer were less likely to have unlike-sex twins than controls (for unlike-sex twins, the odds ratio for the father being a sibling of testicular cancer patient was 0.53; 95% confidence interval, 0.26-1.09). The likelihood of being a brother of a patient with testicular cancer decreased monotonically with increasing number of children (P = 0.05), whereas no association was observed for the sisters., Conclusion: The decreased fertility found among brothers of patients with testicular cancer argues in favor of shared causes between cancer-associated subfertility and testicular cancer. Genetic links and shared environment could explain the association.

Spermatogenesis takes place within the testicular seminiferous tubules which consist of the peritubular lamina propria and the seminiferous epithelium. The latter is composed of germ cells and somatic Sertoli cells. Sertoli cells trigger germ cell development by mediating follicle-stimulating hormone and androgen hormonal stimuli.Spermatogenesis comprises proliferation of spermatogonia, meiosis of spermatocytes, and differentiation of spermatids into spermatozoa (spermiogenesis). There are six distinct and specific germ cell associations (I-VI). These "stages of spermatogenesis" occur sequentially along the length of a tubule. Different defects in spermatogenesis occur in adjacent seminiferous tubules (mixed atrophy) and are associated with deficits in differentiation of Sertoli cells. Biopsy specimens should be fixed in Bouin's solution. Diagnosis of preinvasive carcinoma in situ is based on the immunohistochemical demonstration of placental-like alkaline phosphatase (PLAP), which is expressed exclusively in carcinoma in situ cells. Histological evaluation should be performed using a score count system, and the use of histological techniques for protein and mRNA expression. Testicular biopsy should only be performed in accordance with strict indication criteria, and histological evaluation should be carried out in specialist centres, i.e. as recommended by the European Academy of Andrology (EAA).

Modern treatments cure most testicular cancer patients, so an important goal is to minimise toxicity. Fertility and sexual functioning are key issues for patients. We have evaluated these outcomes in a cross-sectional study of long-term survivors of testicular cancer. In total, 680 patients treated between 1982 and 1992 completed the EORTC Qly-C-30(qc30) questionnaire, the associated testicular cancer specific module and a general health and fertility questionnaire. Patients have been subdivided according to treatment received: orchidectomy either alone (surveillance, S n = 169), with chemotherapy (C, n = 272), radiotherapy (R, n = 158), or both chemotherapy and radiotherapy (C/RT n = 81). In the surveillance group, 6% of patients had an elevated LH, 41% an elevated FSH and 11% a low (< 10 nmol l(-1)) testosterone. Hormonal function deteriorated with additional treatment, but the effect in general was small. Low testosterone was more common in the C/RT group (37% P = 0.006), FSH abnormalities were more common after chemotherapy (C 49%, C/RT 71% both P < 0.005) and LH abnormalities after radiotherapy (11% P < 0.01) and chemotherapy (10%, P < 0.001). Baseline hormone data were available for 367 patients. After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3-9.25) iu l(-1) compared to 3 (IQR 1-5) iu l(-1) for S; P < 0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (-2 (IQR -8.0 to -1.5) vs 1.0. (IQR -4.0-4.0) P < 0.001). Patients with low testosterone (but not elevated FSH) had lower quality of life scores related to sexual functioning on the testicular cancer specific module and lower physical, social and role functioning on the EORTC Qly C-30. Patients with a low testosterone also had higher body mass index and blood pressure. Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children. In total, 207 (30%) patients reported attempting conception of whom 159 (77%) were successful and a further 10 patients were successful after infertility treatment with an overall success rate of 82%. There was a lower overall success rate after chemotherapy (C 71%; CRT 67% compared to S 85% (P = 0.028)). Elevated FSH levels were associated with reduced fertility (normal FSH 91% vs elevated 68% P < 0.001). In summary, gonadal dysfunction is common in patients with a history of testicular cancer even when managed by orchidectomy alone. Treatment with chemotherapy in particular can result in additional impairment. Gonadal dysfunction reduces quality of life and has an adverse effect on patient health. Most patients retain their fertility, but the risk of infertility is likely to be increased by chemotherapy. Screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors.

The incidence of testicular cancer is rising. Despite a high cure rate, efforts should be made to obtain diagnosis at the pre-invasive intratubular carcinoma in situ (CIS) stage, as the disease is potentially lethal and treatment has severe side-effects, especially regarding reproductive function. CIS diagnosis is presently only possible by a surgical biopsy of the testis. Immunocytological staining for transcription factor activator protein (AP-2gamma), previously identified as a marker for neoplastic germ cells, was performed in centrifuged samples of ejaculates obtained from 104 andrological patients, including patients with testicular cancer and subfertility. Cells positive for AP-2gamma were found only in semen samples from patients diagnosed a priori with testicular neoplasms and, surprisingly, in a 23 year old control subject with oligozoospermia and no symptoms of a germ cell tumour. Testicular biopsies performed during the follow-up of this patient revealed widespread CIS in one testicle, thus proving a potential diagnostic value of the new marker. For the first time, a patient without clinical symptoms of testicular neoplasia was diagnosed at the pre-invasive CIS stage using a new, simple method based on immunocytological staining of a semen sample for AP-2gamma, a novel marker for CIS. The value of this method for diagnostic use in the clinic requires further careful validation in a large series of patients and controls, but the preliminary results are promising.

Objectives: To investigate the frequency of azoospermia factor (AZF) deletions in Dutch patients with testicular germ cell tumors (TGCTs). Reduced fertility is associated with TGCTs and reduced fertility and TGCTs might share genetic risk factors according to the testicular dysgenesis hypothesis. Up to 8% of infertility and reduced fertility in the general male population can be explained by the presence of constitutional deletions of part of the long arm of the Y chromosome (Yq11), referred to as the AZF region., Methods: In 112 patients with TGCT, screening for constitutional deletions in the AZF region was performed by multiplex polymerase chain reaction analysis in DNA extracted from peripheral blood lymphocytes. A set of 24 primer pairs, of which 20 primer pairs are homologous to previously identified and mapped sequenced tag sites within the AZF region were used., Results: No deletions in the Yq11 region were detected in any of the 112 patients., Conclusions: Large Y chromosome microdeletions in the AZF region are not a major contributor to the development of TGCT and TGCT-associated reduced fertility.

In the past, cancer survivors tended to be most concerned about disease recurrence and treatment side effects. As survival rates have increased, however, patients are now also concerned about quality-of-life issues such as preserving fertility potential. It is well known that cancer treatment adversely affects male fertility via direct effects on the testis and/or through the endocrine glands. Evidence also suggests that the disease process itself may affect a man's fertility by influencing spermatogenesis. However, the causes of poor semen quality in cancer patients are not well understood. Multiple factors are likely involved, including preexisting defects in germ cells, systemic effects of cancer, and endocrine and immunological disturbances. This paper will summarize available evidence on different factors involved in impaired spermatogenesis in patients with various cancers with emphasis on testicular cancer and Hodgkin lymphoma. Cryopreservation of spermatozoa is a simple and practical approach available to all patients with cancer who wish to preserve their fertilizing potential before cancer therapy.

Infertility affects up to 15% of the sexually active population, and in 50% of cases, a male factor is involved, either as a primary problem or in combination with a problem in the female partner. Because many commonly encountered drugs and medications can have a detrimental effect on male fertility, the medical evaluation should include a discussion regarding the use of recreational and illicit drugs, medications, and other substances that may impair fertility. With the knowledge of which drugs and medications may be detrimental to fertility, it may be possible to modify medication regimens or convince a patient to modify habits to decrease adverse effects on fertility and improve the chances of achieving a successful pregnancy. Concern is growing that male sexual development and reproduction have changed for the worse over the past 30 to 50 years. Although some reports find no changes, others suggest that sperm counts appear to be decreasing and that the incidence of developmental abnormalities such as hypospadias and cryptorchidism appears to be increasing, as is the incidence of testicular cancer. These concerns center around the possibility that our environment is contaminated with chemicals--both natural and synthetic--that can interact with the endocrine system.

Objectives: Oncological therapies, either surgery, radiotherapy or chemotherapy, may cause irreversible subfertiliy/infertility. Both chemotherapy and radiotherapy have cytotoxic effects on gametogenesis and there are not preventive alternatives currently available. The objective of this article is to review current criteria for semen cryopreservation and its usefulness as a method for preservation of fertility in patients with cancer., Methods/results: We reviewed a large group of recent original articles and systematic reviews on the issue with a common feature: evaluation of fertility status after oncological therapy., Conclusions: Every male patient in fertile age who could wish future fatherhood should be offered the option to storage cryopreserved semen samples before starting oncological therapies, with the exception of patients with azoospermia at the time of diagnosis.

Sex cord tumor with annular tubules (SCTAT) is a rare tumor seen in the ovary usually associated with Peutz-Jeghers syndrome. Testicular SCTAT are more infrequent and only four such cases have been reported in the literature. A 28-year-male presented with infertiliy. He had a history of orchiopexy 10 years back for right-sided inguinal testes. A right testicular biopsy done to investigate the cause of infertility revealed testicular atrophy with a focus suspicious of SCTAT. The right-sided orchiectomy revealed two firm nodules of 0.5 and 0.2 cms of SCTAT and sertoli cell nodule (SCN) respectively on microscopy. He did not have any features of Peutz-Jeghers or any other dysgenetic syndrome. He is asymptomatic after follow up of 26 months. This is the fifth case of testicular SCTAT and the first with SCN.

Purpose: We retrospectively assessed the number and histology of testicular lesions diagnosed clinically and by ultrasonography in a population of infertile men., Materials and Methods: From October 2000 to January 2003, 560 infertile men underwent physical examination, hormonal assessment (follicle-stimulating hormone, luteinizing hormone, testosterone) and scrotal ultrasonography. Eight men were diagnosed with focal testicular ultrasonographic lesions. In 4 cases there was a palpable lesion and in the other 4 cases the lesion was not palpable, diagnosed by ultrasonography (1 was cryptorchid). Only cases of lesions with clear-cut ultrasonographic edges and no history of recent genital infections were considered for explorative surgery through the groin. Microcalcifications were reported if present. The testicle was only preserved when frozen section examination revealed a benign lesion and the margins were negative., Results: Gynecomastia was not present in any patient. No microcalcifications were observed. Follicle-stimulating hormone was high in all patients (range 19.8 to 66.0 mUI/ml, mean 34.4). Luteinizing hormone levels were variable (range 1.32 to 28 mUI/ml, mean 12.3). Testosterone was normal in all cases (range 2.82 to 6.25 ng/ml, mean 4.2). Ultrasonographic features of the lesions were hypoechoic area (6 patients) and mixed hyper-hypoechoic area (2 patients). Histological outcomes of Leydig cell tumor (in 3 patients), focal Leydig cell hyperplasia (1 patient), fibrosis (1 patient), diffuse Leydig cell hyperplasia (1 patient), classic seminoma (1 patient) and embryonal carcinoma (in 1 patient) were observed., Conclusions: Of 560 infertile patients 8 (1.4%) showed focal testicular lesions, 2 (0.4%) were diagnosed with germ cell tumors and 3 (0.5%) with interstitial cell neoplasms. The malignant tumors were both palpable and in 2 of 3 cases Leydig cell tumors were diagnosed only with ultrasonography.

Background: Patients with testicular cancer have an excellent survival rate, and fertility is one of the main concerns of survivors. The authors investigated fertility status after treatment for testis cancer in long-term survivors., Methods: Four hundred fifty-one consecutive patients with testicular cancer (1979-1999) from health facilities in the French Midi-Pyrenees region were enrolled. Testis tumors were classified according to the Royal Marsden Hospital Classification. Fertility status was assessed by means of a mailed, standardized questionnaire focused on reproductive events that occurred before and after treatment. Of 451 patients with germ-cell tumors, information concerning fertility was obtained in 446 patients (98.9%). The follow-up was at least 3 years., Results: Before they were diagnosed with testicular cancer, 91.2% of patients who had tried to get their partners pregnant had succeeded, compared with 67.1% of patients after treatment. Radiotherapy had a much more deleterious effect on fertility compared with chemotherapy alone. Furthermore, cumulative conception rates (log-rank test) for patients who received radiotherapy were significantly lower compared with the rates for patients who received chemotherapy., Conclusions: The outcome of this study, which included the largest series reported to date, showed that fertility in patients with testicular cancer decreased by 30% after treatments and that radiotherapy seemed to have the most deleterious effect on fertility., (Copyright 2004 American Cancer Society.)

Objectives: To describe long-term gonadal function after high-dose chemotherapy (HDC). HDC for testicular cancer was recently developed. The evaluation of testicular function after chemotherapy for testicular cancer is an important part of overall care, especially in young patients., Methods: Between 1994 and 2001, 27 patients underwent HDC (1250 mg/m2 carboplatin, 1500 mg/m2 etoposide, and 7.5 g/m2 ifosfamide) at Kobe University Hospital. Information on gonadal function during follow-up was available for 10 of these patients. The mean patient age +/- SD at treatment was 32.2 +/- 8.4 years. The relationships among age at treatment, semen analysis, serum hormone levels (follicle-stimulating hormone, luteinizing hormone, testosterone, prolactin, and estradiol), cumulative dose of cisplatin and carboplatin, and length of follow-up were determined., Results: Spermatogenesis recovered after cessation of HDC in 5 of 10 patients. Semen analysis in these patients showed the mean sperm concentration and motility at 42.4 +/- 10.4 million/mL and 67.2% +/- 17.0%, respectively. The patients were divided into azoospermic and nonazoospermic groups. The age of the nonazoospermic and azoospermic patients was 28.2 +/- 8.7 and 36.2 +/- 6.5 years, respectively. Follicle-stimulating hormone levels in the nonazoospermic group (11.7 +/- 3.4 mIU/mL) were significantly lower than in the azoospermic group (32.8 +/- 14.4 mIU/mL; P = 0.0472). No other statistically significant difference was observed in the other hormone levels or the cumulative dose of cisplatin and carboplatin between the azoospermic and nonazoospermic groups., Conclusions: Spermatogenesis recovers after HDC in some patients. Patients should be informed that they may or may not be fertile after HDC.

A history of urogenital inflammation occurs in 5-12% of men attending infertility clinics. Usually, infection has a detrimental effect on sperm quality by reducing concentration and motility, and possibly affecting the number of morphological normal spermatozoa. In addition, infection may be the source of auto-antibodies against spermatozoa, found in about 8% of the infertile male population. In contrast to the situation in women, there is no clear evidence that male accessory gland infections can result in epididymal blockage or vassal obstruction, with the exception of genital tuberculosis. Although Chlamydia trachomatis is a well-documented source of chronic prostatitis, the infection does not seem to cause obstruction of the reproductive tract, as it does in women. If male urogenital infection causes obstruction it is most likely located at the level of the ejaculatory ducts. Chronic prostatitis has been proved to cause scarring of the prostatic and ejaculatory ducts, resulting in low seminal volume with low fructose and alpha-glucosidase. Many of these men present with severe oligozoospermia or azoospermia, normal size testis and normal gonadotrophins. We performed an excisional testicular biopsy in all men presenting with <1 million spermatozoa per millilitre and found that 39 of 78 (50%) had a normal spermatogenesis. A history of male accessory genital infection was found in 12% of the men and 10% had abnormalities found on transrectal ultrasound of the prostate (like oedema, dilatation of the seminal vesicles and ejaculatory ducts) intraprostatic calcifications and dilatation of the periprostatic venous plexus. Ejaculatory duct obstruction is a common cause of male infertility and infections are present in at least 22-50% of these men. Transurethral resection of the ejaculatory ducts may result in a significant improvement of the sperm quality and in spontaneous pregnancies in up to 25% of the couples. In case of failure sperm aspiration from the epididymis and intracytoplasmic sperm injection is the treatment of choice.