By Dr. Oliver Pack (Medical Doctor – Reg. No. 030308944).
Testicular cancer is the most common solid tumor in young men between 15 and 35 years of age. Therefore, its diagnosis often coincides with a stage of life in which they have not yet fulfilled their desire to become fathers. For this reason, one of the first considerations is the possibility of sperm cryopreservation for future use in assisted reproduction treatments to achieve pregnancy.
It is a type of tumor that originates in testicular cells, which are responsible for sperm and testosterone production. In most cases, it is detected early, allowing effective treatment with high cure rates (over 95% in early stages).
However, both the disease and its treatment can affect testicular function, potentially compromising fertility.

There is no single cause that explains the development of this type of cancer, but some factors that increase the risk have been identified, such as:
In many cases, cancer appears without clear risk factors, so early diagnosis is very important in order to plan the most appropriate treatment.
Diagnosis usually begins after the detection of a lump or an increase in size in one of the testicles. From that moment on, tests such as testicular ultrasound and blood analysis of tumor markers are performed.
Initial treatment usually consists of the removal of the affected testicle (orchiectomy) in order to confirm the diagnosis and determine the type of tumor. Depending on the stage, it may be necessary to add chemotherapy or radiotherapy.
The impact on fertility in men who suffer from this type of tumor will depend on several factors, including the type of treatment and the patient’s previous condition.
Surgery may reduce sperm production when the remaining testicle does not function properly. However, it is chemotherapy and, to a lesser extent, radiotherapy that may have a more significant effect. These treatments may cause a decrease or temporary absence of sperm (azoospermia), as well as damage to sperm DNA, which can affect fertilization capacity and increase the risk of failures in embryonic development.
In some cases, these effects are reversible over time, as testicular function may progressively recover, but in others they may be permanent. Therefore, it is essential to plan fertility before starting oncological treatment.

Before starting treatment, specialists usually recommend sperm preservation through semen freezing. This is a simple procedure that consists of obtaining one or more semen samples, which are cryopreserved for future use in assisted reproduction techniques. Normally, these types of treatments have high success rates, since the samples have not been affected by oncological treatment, although their quality will depend on the patient’s previous condition.
In situations in which it is not possible to obtain a semen sample naturally, other options such as testicular biopsy to retrieve sperm directly from the testicle may be considered.
Nowadays, overcoming testicular cancer does not imply giving up fatherhood. Many men are able to have children after treatment, either naturally or through assisted reproduction techniques.
In cases where semen quality recovers, pregnancy can be achieved spontaneously. However, when this does not occur, it is necessary to resort to techniques such as in vitro fertilization with intracytoplasmic sperm injection (ICSI), which allows a single sperm to be injected directly into the egg. In this way, the partner’s egg can be fertilized and subsequently transferred to the uterus for pregnancy to occur.
For all these reasons, it is essential that all patients diagnosed with testicular cancer are informed early about fertility preservation options before starting treatment.
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European Association of Urology (EAU).
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https://uroweb.org/guidelines/testicular-cancer
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American Society of Clinical Oncology (ASCO).
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Actualización de la guía ASCO sobre preservación de la fertilidad en personas con cáncer, incluyendo recomendaciones para la evaluación y manejo de la fertilidad antes del tratamiento oncológico:
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Ikuo Hamano, Shinya Hatakeyama, Ryo Nakamura.
Fertility preservation of patients with testicular cancer.
Reproductive Medicine and Biology.
2017;
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Revisión sobre la preservación de la fertilidad en pacientes con cáncer testicular y las principales estrategias disponibles antes del tratamiento oncológico:
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Fertility considerations in men with testicular cancer.
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2020;
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Artículo científico sobre las consideraciones relacionadas con la fertilidad masculina en pacientes con cáncer testicular, incluyendo opciones de preservación de la fertilidad:
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Paternity After Treatment for Testicular Germ Cell Cancer.
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Estudio científico que analiza la paternidad después del tratamiento del cáncer de células germinales testicular y los factores asociados a la fertilidad posterior:
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