In recent decades, there has been an increase in the incidence of testicular cancer affecting males mainly of 20-35 years of age and industrial city residents. The toxicity of the antineoplastic therapies to male genital cells is now unchallenged and can cause chromosomal abnormalities to the spermatozoa such as aneuploidies, structural chromosomal abnormalities or mutations.

A multicenter study carried out in eight fertility centers in different regions in France (8 CECOS-Centers d'Etude et de Conservation des Oeufs et du Sperme) collected data on semen quality prior to chemotherapy / radiation therapy and after 3, 6, 12 and 24 months after it was over. Patients underwent radiotherapy or BEP chemotherapy (Bleomycin-Etoposide-Cisplatin) of 2-4 cycles. The samples were analyzed according to the World Health Organization's (WHO) guidelines, while the chromosomes were analyzed with FISH on chromosomes X, Y and 18. Aneuploidies in the tribal chromosomes constitute one of the most frequently occurring chromosomal abnormalities at birth.

Effect on sample parameters

26 patients (48%) with true seminoma underwent radiotherapy and 28 (52%) with non-seminom underwent BEP chemotherapy. Before starting the treatment, semen parameters did not differ between true and non-seminoma patients. After two cycles of chemotherapy (BEP) or radiotherapy, there was a significant decrease in sperm concentration, total sperm count and sperm motility, the lowest parameters being 3 and 6 months post-treatment. Parameters as a whole came back to normal pre-treatment levels 12 months after the end of the radiotherapy and 24 months after the end of chemotherapy, except for the percentage of good sperm motility which remained low. By comparing the effect of radiotherapy to that of the chemotherapy on sperm quality, the overall number and the sperm's motility are being afftected more with chemotherapy. However, 24 months after the end of the treatment, 100% of the patients who underwent 1-2 cycles of chemotherapy, 76% of them with over 2 cycles and 88% of those undergoing radiotherapy, sperm's production came back to > 39x106 per ejaculation.

The effect on the DNA of spermatozoa.

The percentage of hyperploidies (XY), diploidies, aneuploidies in the semen and the total chromosomal abnormalities increased especially after 6 to 12 months of chemotherapy and came back to normal levels 24 months after the end of the treatment. The same percentages were found to be increased after 3 to 6 months of radiotherapy and came back to pre-treatment levels 12 months later. The percentage of the aneuploidies 24 months after the chemotherapy was higher compared to that after the radiotherapy.

In summary, the radiotherapy's effect on the quality of sperm samples as well as on the sperm's chromosome is milder than that of the chemotherapy in patients with testicular tumor and shorter recovery times in normal pretreatment levels are needed.

It is crucial to see the long-term effects of antineoplastic therapies on the integrity of the germ cells and for couples wishing to have a baby to get proper guidance and counseling. Normal conception should be postponed for > 12 months after radiotherapy or > 24 months after > 2 cycles of chemotherapy. The gonadotoxic effects of these therapies should be analyzed to the couple before their onset and the cryopreservation of the sperm should always be proposed in order to maintain fertility.

By Paschalidou Chrysa

Clinical Embryologist at Embryogenesis