Fertility Preservation in Testicular Cancers: Current Options and Future Trends

Summary Testicular germ cell tumors are a common solid malignancy in young men, with rising incidence over recent years. Life-saving therapies for testicular cancer – including radical orchiectomy, retroperitoneal lymph node dissection, radiotherapy, and chemotherapy – often result in compromised fertility, a significant concern for this patient population. Fertility preservation is a critical component of testicular cancer care, as patients express a desire for biological parenthood posttreatment. Unfortunately, gonadotoxic therapies can impair spermatogenesis, leading to infertility and profound psychological distress, including depression and anxiety. Proactive fertility preservation measures, particularly sperm cryopreservation before treatment, provide an opportunity to safeguard reproductive potential. Despite clear recommendations from organizations such as the National Comprehensive Cancer Network, the American Society of Clinical Oncology, and the American Society of Reproductive Medicine, fertility counseling remains inconsistently practiced. Misconceptions about sperm banking costs, posttreatment recovery potential, and assisted reproductive techniques (ART) success rates further hinder implementation. In addition, practical barriers, such as limited awareness and ethical considerations – particularly for minors or regarding posthumous reproduction – complicate the integration of fertility preservation into cancer care. As survival rates among patients with testicular cancer continue to rise, the demand for fertility preservation grows. This evolving need has led to the emergence of oncofertility, a discipline dedicated to balancing cancer treatments with reproductive goals. Fertility preservation not only enables biological parenthood but also alleviates some of the psychological burden associated with cancer-related infertility. This article examines the current options and future trends in fertility preservation for men with testicular cancer, addressing clinical practices, patient education, and strategies to overcome existing barriers.