Plodnost po zdravljenju raka mod (Slovene)

After treatment of testicular cancer, 30 % of these young men become infertile. Only 5 to 10 % of them use sperm cryopreserved before cytotoxic treatment. Beside oncological treatment, other factors, i.e. primary testicular disease or histologic type of tumour are supposed to affect spermatogenesis. Impairment of sperm DNA integrity and mutagenic effect on chromosomes might be the causes of infertility. The aims of the study are to research i) how patients manage the infertility problem, ii) what are the clinical and histologic prognostic factors of spermatogenesis impairment, and iii) what are the extent and duration of sperm DNA and chromosome damage. In this 3-year prospective study, 50 men after orchidectomy will be enrolled yearly, and controlled at orchidectomy, at sperm cryopreservation, at 3, 6, 12 and 24 months after orchidectomy with histologic scoring of spermatogenesis, clinical examination and psychologic testing, hormonal evaluation, sperm DNA fragmentation and testing for aneuploidy of chromosomes X, Y, 13, 18 and 21 using FISH method. Psychologic testing will clarify the mechanisms of fight against infertility. Histologic scoring of spermatogenesis will be performed at the same time as the histologic evaluation of the cancer lesion and compared with the effects related to treatment; it may be used as a predictive factor of fertility potential. The amplitude and duration of sperm DNA fragmentation and chromosomal aneuploidy will permit us to counsel patients adequately in terms of fertility and offspring risks.

The preliminary analysis indicates the important changes in sex hormone levels, especially in FSH in patients treated for testicular cancer. The final analysis will be focussed on the effect of testosterone deficiency and oscillation of FSH on sperm quality and on patients' psychologic characteristics.

This research has already provided new knowledge in pathogenesis of changes, triggered by testicular cancer, affecting general physical, mental, sex and reproductive status of young men. Thus, the final analysis will help therapists to be better equipped for helping the patients in improving their general well-being.