Chemotherapy-induced infertility in patients with testicular cancer.

A 29-year-old Caucasian married man, Mr. A, is the father of a 1-year-old daughter and is a successful tax attorney who maintains a healthy lifestyle. While performing a testicular self-examination, Mr. A noticed a small, fixed mass in his left scrotum. After medical workup, biopsy, and consultation, a left orchiectomy and retroperitoneal dissection were recommended. Pathology revealed a nonseminoma germ cell testicular tumor, pT4, N4, M-positive; with tumor invading the scrotum; vascular and lymphatic invasion; and a solitary lung lesion noted on computed tomography scan. No additional metastatic lesions were found on bone scan or magnetic resonance imaging. Biopsy confirmed the metastatic lesion in the lung. Postoperatively, Mr. A was scheduled to receive four cycles of bleomycin, etoposide, and cisplatin (BEP), a standard treatment for testicular germ cell cancer. Mr. A and his wife had been planning to have a second child. In initial consultation with the oncologist, Mr. A brought up the topic. He and his wife wanted to know whether his cancer or any of his treatment would have an effect on their ability to conceive. The oncologist gently explained that a decrease in fertility occurs with testicular cancer, which is compounded by orchiectomy and chemotherapy. The oncologist informed Mr. A that, during chemotherapy, sperm counts usually are low and often undetectable, with only 20%–50% of patients treated with chemotherapy resuming normal sperm counts two to three years after completion of treatment (Kreuser, Harsch, Hetzel, & Schreml, 1986; Nijman, Schraffordt Koops, Kremer, & Sleifer, 1987). Mr. A and his wife were alarmed to learn that it was impossible to predict whether or when he would resume normal sperm counts or whether he would remain azoospermic (i.e., the absence of sperm in the semen). Fertility options were discussed with Mr. A and his wife. Brittany R. Bradford, RN, BSN