The overall rate of fatherhood after treatment for testicular cancer is high, but the ability to conceive and the time to conception are influenced by the type and intensity of treatment, according to a new study in the November 2 issue of the Journal of the National Cancer Institute.

Testicular cancer, the most common cancer among men ages 20 to 40, has a high cure rate: 95% of patients are cured through treatment. Because many of these patients are diagnosed at an age when they are starting a family, the ability to father children after treatment is often a concern. However, there are little reliable data on post-treatment fertility available to guide these men.

To assess post-treatment fertility among testicular cancer survivors, Marianne Bryd?y, MD, of Haukeland University Hospital in Bergen, Norway, and colleagues studied 1,814 men who had been treated for testicular cancer in Norway between 1980 and 1994 who had been invited to participate in a follow-up survey between 1998 and 2002.

Of the 1,433 men who were assessable, post-treatment conception was attempted by 554, and 71% were successful within 15 years of treatment (without the use of cryopreserved semen) and 76% were successful within 20 years. Success varied by type of treatment, ranging from just 48% among men treated with higher doses of chemotherapy to 92% among men followed by surveillance alone (after removal of the testicle affected by cancer). The median time from diagnosis to birth of the first child was 6.6 years, but this also varied with treatment type. About 22% of couples who attempted post-treatment conception reported that they needed some form of assistance with reproduction.

"With recent advances in assisted fertility techniques, more testicular cancer survivors may be helped to father children. However, because infertility cannot be predicted on an individual basis, it is important to continue the policy of offering sperm preservation prior to treatment," the authors write.

In an editorial, Scott Saxman, MD, of the National Cancer Institute, notes that the results of this study will help physicians to provide answers to testicular cancer patients who are concerned about their ability to father children, although some of the data may no longer be relevant because of improvements in treatments now available.

"Clearly the impact of therapy on fertility, as well as other long-term complications, for men with testicular cancer needs to be better categorized and understood," he writes. "However, this will be a moving target as treatment approaches continue to change and improve. Seriously addressing these public health issues for patients in the United States will require a national collaborative effort that identifies and collects, on an ongoing basis, longitudinal information on the health status of these men."