Sexual function and fertility preservation in testicular cancer survivors

Testicular cancer is a common cancer among reproductive age men, with the necessary treatment options having varying impacts on fertility and sexual function. Treatment begins with orchiectomy and is often followed by a combination of chemotherapy, radiation, and/or retroperitoneal lymph node dissection, which have different effects on spermatogenesis, gonadotropin levels, and ejaculation. Alkylating agents such as cisplatin are commonly used for testicular cancer and are amongst the most spermatotoxic chemotherapeutic agents. Radiation poses gonadotoxic effects despite gonadal shielding due to a scatter effect. Suprahilar and bilateral retroperitoneal lymph node dissections can cause ejaculatory dysfunction. Options to preserve fertility vary by pubertal status. While the standard recommendation for post pubertal patients is cryopreservation, prepubertal patients rely on experimental protocols for cryopreservation of germ cells with stem cell capabilities, with the hope that these cells will one day be stimulated to produce sperm. These topics are reviewed to give insight into current literature around fertility in testicular cancer survivorship and determine best possible practices in fertility preservation among patients.