SPERM quality is already significantly impaired in many men with testicular cancer before treatment begins, a new study shows.
Researchers evaluated fertility outcomes in men with testicular cancer, following patients from pretreatment semen assessment and sperm cryopreservation through to subsequent use of banked sperm and reproductive outcomes, highlighting the importance of early discussions around fertility.
The retrospective cohort of participants included 126 men with confirmed testicular malignancies who underwent orchiectomy between 2017 and 2023. Of these, 91 underwent semen analysis and elected to cryopreserve sperm before surgery. Researchers also compared semen parameters with 100 healthy sperm donor candidates.
At diagnosis, patients with testicular cancer had significantly lower quality semen across every parameter bar one. This included lower sperm concentration, total motility, normal morphology, and total motile sperm count (TMC) compared to healthy controls. Ejaculate volume, however, was the only measurement similar between groups.
Differences were also observed according to tumour type. Sex-cord stromal tumours were associated with the poorest semen quality, while patients with both seminoma and non-seminoma tumours had broadly comparable parameters.
Among patients with Stage II disease, however, those with non-seminoma had significantly higher sperm concentration, progressive motility, and TMC than those with seminoma.
The study found that freezing and thawing samples caused further reduction in quality and amplified the differences between cancer patients and healthy controls.
Post-thaw total motility declined by 62% in patients with testicular cancer compared with 30% among controls. Total motile counts also fell by approximately 95% in cancer patients, compared with 84% in healthy donor candidates.
According to the researchers, these reductions can leave post-thaw sperm counts below thresholds typically required for intrauterine insemination or conventional IVF, potentially increasing reliance on intracytoplasmic sperm injection (ICSI), a more complex and often more expensive process.
Despite the potential effect of cancer and its treatment on fertility, use of cryopreserved sperm was uncommon amongst the cohort. During a median follow-up of 5.3 years, only 8% of the men had used their banked samples for assisted reproductive technology (ART). Of 1,001 vials in total cryopreserved across the cohort, just nine were used for assisted reproduction.
Among 76 men who banked sperm but did not subsequently use it, 20 achieved spontaneous pregnancies, with 15 resulting in live births. Seven couples used cryopreserved sperm for ART, resulting in 12 pregnancies and eight live births, representing a live-birth rate of 67% per pregnancy.
The researchers caution that the relatively small cohort and median follow-up of 5.3 years may underestimate eventual sperm use, particularly as some patients may pursue fatherhood later.
Nevertheless, the findings suggest that impaired sperm production frequently precedes cancer treatment itself. Although relatively few patients ultimately require their stored samples, sperm cryopreservation still may provide an important safeguard for future fertility.
The authors conclude that early, individualised fertility counselling remains important for men diagnosed with testicular cancer before they begin treatment, including realistic discussions about sperm quality, the likelihood of using stored samples, and the potential need for ART in the future.
Reference
Lifshitz K et al. Semen quality at diagnosis, cryopreservation utilization, and reproductive outcomes in testicular cancer: a longitudinal cohort study. Int Urol Nephrol. 2026. https://doi.org/10.1007/s11255-026-05326-7
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