Return of Fertility After Treatment for Nonseminomatous Testicular Cancer: Changing Concepts

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Abstract
The return of ejaculation was studied in 31 patients who had undergone retroperitoneal lymphadenectomy for stage I or II nonseminomatous germ cell testicular cancer. Ejaculation returned spontaneously in 13 patients and was restored by sympathomimetic drugs in 5 of 8 patients treated. Both patients known to have tried to father a child succeeded. The effects of chemotherapy (vinblastine and bleomycin with or without cisplatin) were studied in 34 patients, 24 of whom also had undergone retroperitoneal lymphadenectomy. Although chemotherapy profoundly depressed spermatogenesis during treatment, 75% of the patients tested 18 mo. or more after completion of treatment had some return of function, as evidenced by normal FSH levels and/or the presence of live sperm in the ejaculate. It apparently is possible to perform a therapeutically sound retroperitoneal lymphadenectomy for low stage nonseminomatous testicular cancer that permits return of ejaculation in many patients; spermatogenesis recovers in a significant number of patients treated for this cancer with moderan chemotherapy. Thus, traditional beliefs that operative and drug treatment of nonseminomatous testicular cancer invariably causes infertility must be revised.