Three out of every four men who attempt to father a child after treatment for testicular cancer are able to do so, according to a new study.
The research, published in the Journal of the National Cancer Institute, shows that the ability to conceive and the time it takes to conception are strongly related to the type and intensity of treatment.
Dr. Marianne Brydoy, a researcher in the department of oncology and medical physics at Haukeland University in Bergen, Norway, said that patients who undergo low-dose chemotherapy have a much better chance of conceiving than those who have high-dose treatments. Men who have radiation therapy also had a slightly lower rate of conception, but they tended to be older, so it is unclear whether the failure to conceive was related to treatment or to naturally declining fertility.
"The desire to have children in the future should be taken into consideration when treatment is discussed," Dr. Bergen said.
She also stressed that, while the majority of men are able to conceive children naturally after the removal of a cancerous testicle and follow-up drug or radiation treatments, all testicular cancer patients should routinely be offered the opportunity to freeze their sperm before treatment begins.
"Because infertility cannot be predicted on an individual basis, it is important to continue the policy of offering sperm preservation prior to treatment," Dr. Bergen said.
The study involved 1,433 Norwegian men diagnosed with testicular cancer between 1980 and 1994.
Researchers found that 66 per cent of men who wanted a baby were able to conceive naturally with their partner within 15 years.
About one in five men turned to fertility clinics to boost their sperm volume, or to implant sperm frozen prior to treatment, and half of these men were able to conceive with their partner.
In total, 76 per cent of men who tried fathered children after treatment.
Testicular cancer is rare, though it is the most common form of cancer among young men. It is usually diagnosed between the ages of 19 and 39, the peak reproductive years.
In Canada, an estimated 850 men will be diagnosed with testicular cancer in 2005, and 30 will die, according to the Canadian Cancer Society.
While it is one of the most treatable forms of cancer, the therapy for testicular cancer can be devastating, emotionally and psychologically.
The standard treatment is orchiectomy, the castration of one testicle, to remove the cancerous tumour. That is followed by chemotherapy and sometimes radiation to ensure the cancer does not spread.
Scott Saxman of the cancer evaluation program at the U.S. National Cancer Institute said the most common question among men who are diagnosed with testicular cancer is: "Will I still be able to have children?"
He said the new study offers solid data that will allow physicians to counsel their patients. But Dr. Saxman noted that, if anything, the data likely underestimates the ability of men to conceive after surviving testicular cancer. That is because, over the years, the dose of chemotherapy drugs and radiation used has steadily decreased.
Men are advised not to attempt to have children in the year after treatment due to fears that chemo drugs and radiation may damage sperm and cause birth defects in the baby.
Treatment, however, can damage the reproductive system. About one in 10 men reported "dry ejaculation" and they experienced the most difficulty in fathering a child.
Men who had children prior to a diagnosis of testicular cancer, however, were best able to impregnate their partner again afterward. This is not surprising, given that men with low fertility are at higher risk of developing testicular cancer in the first place.
The underlying cause of testicular cancer is unknown. The principal risk is to boys born with undescended testes. There is also some evidence that boys who suffer viral illnesses during infancy, who enter puberty early or born of older mothers are at higher risk.
Most cases of testicular cancer are detected by men themselves. Young men, in particular, are urged to regularly check their testicles for lumps or other notable changes.
The testicles are a pair of male sex glands that produce and store sperm and they are the main source of the male sex hormone testosterone.
André Picard