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Post-treatment paternity in testicular cancer survivors.

4527 Background: Previous studies on fertility following treatment of testicular cancer (TC) mainly address s-FSH values and sperm parameters. The aim of this study was to analyse post-treatment fatherhood according to treatment.


METHODS
An unselected population of 1814 patients treated for unilateral TC in Norway in 1980-1994 was invited to participate in the survey with a questionnaire enquiring data on the attempt and achievement of pre- and post-treatment children, as well as the use of medical assistance and cryopreserved semen.


RESULTS
1433 patients were evaluable (compliance 79 %, mean observation time 11.3y). Of these, 826 (58 %) had own children at diagnosis. A total of 556 patients attempted post-treatment paternity. They were grouped according to treatment: Surveillance (N= 53), retroperitoneal surgery (RPLND, N=81), radiotherapy (RT, N=202) and two chemotherapy ± RPLND/RT groups according to cisplatin dose (≤ or > 850 mg; N=183 and 37). Of these, 361 (65 %) fathered 1-7 children by semen produced after treatment. Factors influencing the ability to father children (multivariate cox regression analysis) were treatment group (table), ejaculation function (table), pre-treatment fatherhood (p<0,001) and period of treatment (1989-1994 more favourable, p=0,001). The overall median actuarial time from diagnosis to 1. born child was 6,7 y (table). The actuarial paternity rate at 15 years in patients treated with 3-4 courses of cisplatin based chemotherapy ± RPLND was 82 % if they retained antegrade ejaculation and 14 % with "dry ejaculation". Despite acknowledged pre-treatment fertility problems in 60 patients, 30% fathered post-treatment. An additional 12 (2%) of the 556 patients achieved paternity by the use of cryopreserved semen.


CONCLUSIONS
Paternity rate and time to fatherhood reflects the intensity of primary treatment. "Dry" ejaculation considerably reduces paternity, despite several treatment options. [Figure: see text] No significant financial relationships to disclose.