What are the chances of infertility and should sperm be banked?

Patients with testicular cancer have an excellent chance of surviving and may very well be interested in future fertility. This future fertility may be complicated by both pretreatment and treatment-related subfertility. The risk of ejaculatory dysfunction from retroperitoneal lymph node dissection (RPLND) for low-stage disease has been nearly erased by nerve-sparing techniques. In those patients with an ejaculation, electroejaculation and artificial insemination is effective. With cisplatinum-based chemotherapy, nearly all patients will become azoospermic with the majority recovering spermatogenesis within four years. Most patients undergoing prophylactic radiation therapy for seminoma will return to baseline semen quality within 2 years. In men with persistent poor semen quality, assisted reproductive technologies may allow having children, even with very low numbers of viable sperm. Assisted reproductive technologies have also greatly improved the chance of pregnancy with cryopreserved sperm. Therefore, prospects for procreation are quite good for men facing treatment for germ cell tumors. In those patients who do not recover spontaneous fertility, semen cryopreservation gives additional hope for having children. Patients should be given the option of semen cryopreservation if any viable sperm are present, even if the specimen is extremely poor.