Cryopreservation of Spermatozoa Prior and Post‐Orchiectomy in Patients With Testicular Germ Cell Cancer—Does the Timing Matter?

ABSTRACT Background Testicular germ cell cancer (TGCC) is the most frequent malignancy in young men of reproductive age. According to guidelines, semen cryopreservation should be performed prior to orchiectomy. Lack of time and local facilities as well as mental pressure are challenges in terms of fertility preservation before surgery. Objective This study aims at comparing semen parameters before and after orchiectomy in TGCC patients. Materials and Methods We prospectively recruited 25 patients with TGCC who performed semen cryopreservation at our Centre. Study participation included a pre‐surgery cryopreservation (T0) and post‐surgery visits within 8 weeks (T1) before any further gonadotoxic therapies. Testicular ultrasound, hormone values, and total sperm count (TSC), sperm concentration, sperm motility and vitality were included for analysis. The primary endpoint was the change in TSC (ΔTSC) from T0 to T1. p < 0.05 was considered statistically significant. Results Histopathology of the 25 patients revealed 16 seminomas and nine non‐seminomas. Median age was 30 years (interquartile range IQR: 28–35; mean age ± standard deviation SD 30.96 ± 5.86). TSC was higher at T1 compared with T0 in seven patients, while 18 patients showed a lower TSC at T1. Median TSC for all patients was 52.8 Mill/ejac. (IQR: 26.8–88.8) before—and 26.5 Mill/ejac. (IQR: 4.4–82.6) after orchiectomy showing an overall decrease. Wilcoxon signed rank test however did not result in a statistically significant decrease in TSC ( p = 0.083). There was a decline in sperm concentration ( p = 0.004) and in motility (a+b) ( p = 0.004). Discussion Because we found an overall decrease in sperm quality post‐surgery, we suggest that semen cryopreservation in TGCC patients should always be performed before orchiectomy. However, in some patients higher TSC was observed after orchiectomy. Thus, an individualized additional potential for cryopreservation in selected patients post‐surgery can be discussed. We consider our findings a starting point for a prospective multicenter study to validate the obligation for pre‐surgical cryopreservation and to identify subgroups who might benefit from additional post‐surgery cryopreservation.